Income Sure

You spend years planning your career, working hard and building your skills. You dedicate long hours to earn recognition over time and sacrifice a lot along the way. At LSG we believe your livelihood, after you have cemented your career, deserves the same attention. Insure your most important asset, Your Income

 
Application Form
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Policy Summary

Income Sure

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    Personal Details

  • Policy Holder Protection Data (Compulsory)
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    Telephone details

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    Weekly Cashflow Protector (Weekly Benefit)

  • Weekly Cashflow Protector (Weekly Benefit) 30 day waiting period (excess) (14 days Virgin Active Instructors) for sickness 7 day for accident. Up to maximum 104 weeks excluding waiting period
  • Weekly Cashflow Protector (Weekly Benefit) 30 day waiting period (excess) (14 days Virgin Active Instructors) for sickness 7 day for accident. Up to maximum 104 weeks excluding waiting period
  • 30 day waiting period (excess) (14 days Virgin Active Instructors) 7 day waiting period for accident (excess) Up to maximum 24 months excluding waiting period
  • 30 day waiting period (excess) (14 days Virgin Active Instructors) 7 day waiting period for accident (excess) Up to maximum 24 months excluding waiting period
  • 30 day waiting period (excess) (14 days Virgin Active Instructors) 7 day waiting period for accident (excess) Up to maximum 24 months excluding waiting period This is for self-employed persons to cover business overheads and excluding the Insured Person's earnings which must be insured under the Weekly Cashflow Protector benefit
  • (All Cancers except skin cancer) Fixed benefit on diagnosis
  • Fixed benefit on birth of a child after 12 consecutive months on the policy
  • Price: R50.00
  • Price: R15.00
  • This is the total of the benefits chosen above as well as the Compulsory benefit of R50.00 and the Policy fee of R15.00
    R0.00
  • I hereby authorise LSG Insurance Services (Pty) Ltd or its authorised administrator to debit my account with the agreed monthly premium payment at:
  • NOTE: Debits cannot be raised through FNB Savings, Master Card Holders, or account numbers exceeding 13 digits
  • R0.00
    • I/we declare that after proper enquiry the statements and particulars given above are true and that I/we have not miss-stated or suppressed any material fact.
    • I/we agree that this Proposal Form, together with any other material information supplied by me/us shall form the basis of any contract of insurance affected thereon.
    • I/we undertake to inform underwriters of any material alteration to these facts occurring before the completion of the contract.
    • I/We understand that submitting this electronic declaration form will from the basis of this contract.
    •  I/We understand that the Binding Fee included in the premium relates to services provided and hereby consent to such fee.
    • Insurance is not bound until accepted by insurers
    • Only property in South Africa
    • I/We understand that in order to provide you with insurance, we must process your personal information. We will share your personal information with other insurers, industry bodies, credit agencies and service providers. This includes information about your insurance, claims and premium payments. We do this to provide insurance services, prevent fraud, assess claims and conduct surveys. We will treat your personal information with caution and have put reasonable security measures in place to protect it. By electronically submitting this form, you agree to the processing and sharing of your personal information.
    Copy of policy wording available on request.