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  • The below application form is directly linked to, and is hosted on the insurers secure website. Auto & General Insurance Company Limited are the official Insurance underwriters of this product and require such application forms to be completed on their secure website for compliance purposes. Both Total Risk Administrators (PTY) LTD (FSP No.40815) and Auto & General Insurance Company Limited (FSP No. 16354) are Authorised Financial Services providers and hold valid licenses with the appropriate regulatory authorities.

Total Risk Administrators Pty (Ltd) is an authorised Financial Service Provider.
Reg No 1999/024507/07
FSP No 40815

Copyright © 2018
Total Risk Administrators Pty (Ltd).
Website by Tenzing Agency

Terms and Conditions Apply.
Errors and Omissions Excepted.

Our products are underwritten by:

A&G Logo

Auto & General Insurance Company Limited
Reg No 1973/016880/06
FSP No 16354

Our products are underwritten by:

A&G Logo

Guardrisk Insurance Co. Ltd
Reg No 1992/001639/06
FSP No 75
Guardrisk Life Ltd
Reg No 1999/013922/06
FSP No 76

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SECTION 1: PERSONAL DETAILS

SECTION 2: CLAIM DETAILS

SECTION 3: REQUIRED DOCUMENTATION

It is very important that the medical aid statement reflecting the claims submitted, the hospital account and the doctor's statements are provided with this claim! If these documents are not attached it will be considered an invalid claim.

The following documentation is required BEFORE a claim can be processed. Please use the tick boxes to ensure that you have included the required documentation:


I confirm that the first 2 pages of the Hospital Account or Pre-Authorisation Letter is attached.


I confirm that the Medical Aid Statement is attached.


I confirm that the Doctor / Service Provider Statement* is attached.





SECTION 4: POLICYHOLDER'S BANKING DETAILS - FOR CLAIMS REFUND PROCESS

As per the terms and conditions of this policy all the required information must be submitted to TRA within 3 months of the date of medical aid processing the claim after which the claim will be considered "stale". Refunds are generally made directly into the policyholder's bank account.

I declare that the aforegoing details are, to the best of my knowledge true, correct and complete: