Schedule Rozkład. Your Insurance Certificate Twój Certyfikat Ubezpieczenia How to make a Claim Jak Złożyć Roszczenie

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1 Financial Expert Independent Ltd High Street Crewe CW2 7BN tel: +44 (0) fax: +44 (0) Underwritten by DUAL Corporate Risks on behalf of certain underwriters at Lloyd s. FAMILY ACCIDENT INSURANCE CERTIFICATE RODZINNE UBEZPIECZENIE NW - CERTYFIKAT Gwarantowane przez DUAL Corporate Risks w imieniu niektórych gwarantów Lloyd s. Schedule Rozkład Your Insurance Certificate Twój Certyfikat Ubezpieczenia How to make a Claim Jak Złożyć Roszczenie General Certificate Definitions Ogólne Definicje Certyfikatu General Certificate Conditions Ogólne Warunki Certyfikatu General Certificate Exclusions Ogólne Wyłączenia Certyfikatu Your cover Twoja Ochrona Optional extensions Dodatkowe Rozszeżenia Important Information Ważne Informcje Complaints Procedure Procedura Składania Skarg Financial Services Compensation Scheme Financial Services Compensation Scheme Page Number Numer strony Page 1 of 48

2 Significant features and benefits of the cover you have requested: Istotne cechy oraz korzyści wnioskowanego ubezpieczenia: Certificate-holder Benefits Korzyści dla Posiadacza Certyfikatu Accidental Permanent Injury Trwałe Uszkodzenie Ciała w Wyniku Wypadku Paralysis of Limbs total and irreversible Porażenie kończyn całkowite i nieodwracalne Blindness - permanent and irreversible in both eyes Ślepota - trwała i nieodwracalna w obu oczach Loss of Hands or Feet - permanent physical severance Utrata dłoni lub stóp trwała utrata kończyny Deafness - permanent and irreversible in both ears Głuchota - trwała i nieodwracalna w obu uszach Loss of Use of elbow, hip, shoulder, knee, ankle, wrist Utrata możliwości korzystania z łokcia, biodra, barku, kolana, stawu skokowego, nadgarstka Loss of one Hand or Foot - permanent physical severance Utrata jednej ręki lub nogi - trwała utrata kończyny Loss of Thumb Utrata kciuka Deafness - permanent and irreversible in one ear Głuchota - trwała i nieodwracalna w jednym uchu Loss of Major Organ (kidney, spleen, lung, pancreas, urinary bladder or stomach) Utrata głównego narządu (nerka, śledziona, płuco, trzustka, pęcherz moczowy i żołądek) Blindness - permanent and irreversible in one eye Ślepota - trwała i nieodwracalna w jednym oku Loss of Tongue Utrata języka Loss of Speech - permanent and irreversible Utrata mowy - trwała i nieodwracalna Third-degree Burns - covering 20% of the body's surface area Oparzenie trzeciego stopnia - obejmujące 20% powierzchni ciała Loss of Forefinger Utrata palca wskazującego Loss of other Finger or a Toe Utrata innego palca u ręki lub nogi Total Permanent Disablement (bodily injury only) Trwała Niepełnosprawność w Wyniku Wypadku (tylko uszkodzenie ciała) GBP 100,000 GBP 80,000 GBP 80,000 GBP 40,000 GBP 40,000 GBP 40,000 GBP 20,000 GBP 20,000 GBP 20,000 GBP 20,000 GBP 20,000 GBP 20,000 GBP 20,000 GBP 10,000 GBP 5,000 GBP 100,000 Bone Fracture Złamanie Kości Major (leg, ankle, arm, back, neck, hip, pelvis, cranium, mandible, shoulder, or wrist) Główna część ciała (noga, kostka, ramię, plecy, szyja, biodro, miednica, czaszka, żuchwa, ramiona lub nadgarstek) Minor (any other) excluding the nose Każda inna bez nosa GBP 2,000 GBP 400 Accidental Death GBP 100,000 Page 4 of 48

3 Śmierć w Wyniku Wypadku Hospitalisation (per 24 hour period) as a result of accident or sickness (sickness subject to 12-month waiting period) Hospitalizacja (przez okres 24 godzin) w wyniku wypadku lub choroby (choroba podlega 12-miesięcznemu okresowi karencji) GBP 100 Within 1 year W ciągu 1 roku After 1 year Po 1 roku Funeral benefit Świadczenie Pogrzebowe Premiums refunded Zwrot składek GBP 2,000 Child benefits Świadczenie Gwarantujące Ochronę Dziecka Accidental Permanent Injury Trwałe Uszkodzenie Ciała w Wyniku Wypadku Paralysis of Limbs total and irreversible Porażenie kończyn całkowite i nieodwracalne Blindness - permanent and irreversible in both eyes Ślepota - trwała i nieodwracalna w obu oczach Loss of Hands or Feet - permanent physical severance Utrata dłoni lub stóp trwała utrata kończyny Deafness - permanent and irreversible in both ears Głuchota - trwała i nieodwracalna w obu uszach Loss of Use of elbow, hip, shoulder, knee, ankle, wrist Utrata możliwości korzystania z łokcia, biodra, barku, kolana, stawu skokowego, nadgarstka Loss of one Hand or Foot - permanent physical severance Utrata jednej ręki lub nogi - trwała utrata kończyny Loss of Thumb Utrata kciuka Deafness - permanent and irreversible in one ear Głuchota - trwała i nieodwracalna w jednym uchu Loss of Major Organ (kidney, spleen, lung, pancreas, urinary bladder or stomach) Utrata głównego narządu (nerka, śledziona, płuco, trzustka, pęcherz moczowy i żołądek) Blindness - permanent and irreversible in one eye Ślepota - trwała i nieodwracalna w jednym oku Loss of Tongue Utrata języka Loss of Speech - permanent and irreversible Utrata mowy - trwała i nieodwracalna Third-degree Burns - covering 20% of the body's surface area Oparzenie trzeciego stopnia - obejmujące 20% powierzchni ciała Loss of Forefinger Utrata palca wskazującego Loss of other Finger or a Toe N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Page 5 of 48

4 Utrata innego palca u ręki lub nogi Total Permanent Disablement (bodily injury only) Trwała Niepełnosprawność w Wyniku Wypadku (tylko uszkodzenie ciała) N/A Bone Fracture Złamanie Kości Major (leg, ankle, arm, back, neck, hip, pelvis, cranium, mandible, shoulder, or wrist) Główna część ciała (noga, kostka, ramię, plecy, szyja, biodro, miednica, czaszka, żuchwa, ramię lub nadgarstek) Minor (any other) excluding the nose Każda inna bez nosa Accidental Death Śmierć w Wyniku Wypadku N/A N/A N/A Hospitalisation (per 24 hour period) as a result of accident or sickness (sickness subject to 12-month waiting period) Hospitalizacja (przez okres 24 godzin) w wyniku wypadku lub choroby (choroba podlega 12-miesięcznemu okresowi karencji) N/A Cancer Benefit Świadczenie na wypadek nowotworu N/A Funeral benefit Excluded for Child Cover Świadczenie Pogrzebowe nie obejmuje ochrony dziecka Page 6 of 48

5 Certificate of Insurance Certificate Introduction This Certificate provides information on the optional coverage that You have selected. This Certificate is not intended to give You all of the relevant information needed. Please refer to the Schedule for details on Your selected optional Benefits, listed in this Certificate. This Certificate is evidence that You are covered under the Contract number as stated in the Schedule which is the Contract that governs this insurance product and which We have agreed with the Insurers. All terms contained in this Certificate that are applicable to You are stated below. In order that this Agreement may be issued, the Insurers have entered into a Binding Authority Agreement. This Agreement empowers an authorised person of Dual Corporate Risks Limited (DUAL) to sign and issue this Certificate on behalf of Insurers. Please keep this document safe, it contains the information needed to understand what You are covered for and what to do in the event of a claim, or if a complaint arises about any aspect of the cover and service this Certificate is intended to give. The cover provided by this insurance contract is detailed in this Certificate and Schedule and in any attached memoranda or endorsements for the Period of Insurance. The level of cover for each Benefit stated in this Certificate depends on the cover You have purchased and these Benefits are outlined in the Schedule. Please read the whole document carefully. It is important that: 1. You check that the coverage applied for is included; 2. You comply with the duties under the insurance as a whole. Our aim is to ensure that all aspects of the Certificate are dealt with promptly, efficiently and fairly at all times. We are committed to providing You with the highest standard of service. If You have any questions or concerns about this contract of insurance in the first instance, contact Your insurance broker. Law Applicable In the absence of any agreement in writing to the contrary, this Certificate will be governed by and construed in accordance with the Laws in England and Wales. Any dispute relating to this Certificate will be subject to the jurisdiction of the courts of England and Wales. Page 7 of 48

6 1 How to Claim on this insurance To make a claim on this insurance please telephone or fax as soon as possible or Alternatively write to; Davies Group PO BOX 2801 Telecom House, Hanley, Stoke on Trent ST4 9DN For the purpose of assessing and verifying the claim and before We agree a claim, We may require the Insured Person to undergo a medical examination, which would be at Our expense. We may also need statements or medical reports from the Insured Person's treating medical attendant or consultant. Any medical evidence and information that We require to assess and verify a claim will be paid for by Us. We may also require the Insured Person to attend any available rehabilitation courses deemed appropriate by Us. Any attendance by You on a rehabilitation course that We require will be paid for by Us. Your claim may be reviewed by Our Chief Medical Officer. If evidence satisfactory to Us is not provided, We may decline the claim. If We ask You or the Insured Person to attend a medical examination or rehabilitation course and You or the Insured Person refuse or do not attend, or if We do not receive the necessary consent to access Your or the Insured Person's medical records or reports, We may refuse the claim. No amount of Benefit shall become payable until You have provided proof to Our satisfaction of: the eligibility of the Insured Person, including date of birth; the occurrence of the Insured Event, with the relevant medical evidence. If We agree to a payment of Benefit, We are not admitting liability under this Certificate in respect of any pending or future claims. Each claim is dealt with on its own merits. If You are unclear about whether You can claim, or how to claim, please contact Us using the contact details above. Page 8 of 48

7 2 General Certificate Definitions Interpretation 1. The headings in this Certificate are inserted for convenience only and shall not affect its construction. 2. The use of singular or plurals is used for illustration only. Where the following terms are used in this Certificate they have the following meaning: Accident Authorised Representative Benefit(s) Blindness Bodily Injury Cancer Certificate Certificate-holder Congenital illness means a sudden, unexpected, unusual, specific, external event which occurs at an identifiable time and place during the Period of Insurance. means a business entity or person who has entered into a formal Contract with Us or the Insurer allowing such business entity or person to legally represent Us. means the Benefit payable in the event of an Insured Person suffering a specified Accidental Permanent injury, Accidental Total Permanent Disablement, a Major Bone Fracture or a Minor Bone Fracture, Accidental Death, Hospitalisation and/or Funeral Benefit. Where optional child cover has been selected, Benefit also means the Benefit payable in the event of an Eligible Child being diagnosed with Cancer. means permanent and irreversible loss of sight to the extent that, even when tested with the use of visual aids, vision is measured at 3/60 or worse using a Snellen eye chart. means identifiable physical injury which is caused by an Accident, and solely and independently of any other cause (except Illness directly resulting from, or medical or surgical treatment rendered necessary by such injury) results in an Insured Person s death or disablement within 12 months from the date of the Accident. means any malignant tumour positively diagnosed with histological confirmation and characterised by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukaemia, sarcoma and lymphoma except cutaneaous lymphoma (lymphoma confined to the skin). For the above definition the following are not covered: All cancers which are histologically classified as any of the following: pre-malignant; non-invasive; cancer in situ; having either borderline malignancy; or having low malignant potential. All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2NOMO. Chronic lymphocytic leukaemia unless histologically classified as having progressed to at least Binet Stage A. Any skin Cancer (including cutaneous lymphoma) other than malignant melanoma that has been histologically classified as having caused invasion beyond the epidermis (outer layer of skin). means this wording, the Schedule and any memoranda or endorsements amending and attaching to this wording and/or Schedule. means the person, business entity or organisation shown in the Schedule that is insured under and is the legal holder of this Certificate. means a disease or problem existing at and usually before birth, referring to conditions that are present at birth, regardless of their causation. Page 9 of 48

8 Deafness Declined Occupation Disappearance Eligible Children/ Child Estate Executor Hospital Insured Event Insured Person(s) Insurers Irreversible Legal Guardian Loss of Forefinger Loss of Thumb Loss of Hand or Foot Loss of Hands or Feet Loss of other Finger or a Toe Loss of Major Organ Loss of Speech Loss of Tongue Loss of Use Major Bone Fracture Minor Bone Fracture Occupation means permanent and irreversible loss of all hearing to the extent that the loss is greater than 95 decibels across all frequencies using a pure tone audiogram. those Occupations for which We do not provide cover and which are excluded from this insurance. These Occupations are namely agricultural worker; farm labourer or fruit picker; member of the armed forces; asbestos worker; coal miner; motorcycle courier; professional diver; demolition worker; any user of explosives; unskilled labourer or any unskilled worker on a construction site; oil or gas driller, worker and rigger; quarry worker; pneumatic driller; professional sportsperson; tunneller. means the disappearance of an Insured Person for a period of at least 12 continuous months where sufficient evidence is provided to Us that leads Us to conclude that the Insured Person has sustained Bodily Injury and that such Bodily Injury has caused the Insured Person s death. means the Certificate-holder's children (including legally adopted children and stepchildren) aged from 6 months to 18 years old (or 23 years old if in full-time education) who are unmarried. Step-children are defined as children of the Certificate-holder's spouse or partner by a previous union. Eligible Children do not need to live with the Certificate-holder. means property, which is vested in or is held by the executor or personal representative after death. means a person appointed by a will to administer the deceased's estate after death. The executor is empowered to deal with the estate as directed by the will from the time of death. means a medical or surgical establishment registered as such in the country where it is located and where the Insured Person is, or will be, under the care of a Qualified Physician. means an event for which any Benefit is payable. means any person, category or group of persons shown as being insured by this Certificate, as shown in the Schedule. means the insurers stated on the Schedule. means cannot be materially improved upon by medical treatment and/or surgical procedures that are reasonably available at the time of claim. means a person appointed by a will or by a court who has legal responsibility for providing for the care and management of a child and of the child's property. means permanent physical severance of an entire forefinger. means permanent physical severance of an entire thumb. means permanent physical severance of a hand or foot above the wrist or ankle joint. means permanent physical severance of any combination of 2 or more hands or feet at or above the wrist or ankle joints. means permanent physical severance of any finger entirely other than a forefinger or permanent physical severance of any toe entirely. means the total and permanent removal of a kidney, spleen, lung, pancreas, urinary bladder or stomach. means total, permanent and irreversible loss of the ability to speak. means the complete severance of a proportion or whole of the tongue, which is sufficient to affect the ability to speak. means total and irrecoverable permanent loss of function. means a break caused by an Accident, which can be evidenced by x-ray or other suitable clinical diagnosis, of a bone within the leg, ankle, arm, back, neck, hip, pelvis, cranium, mandible, shoulder, or wrist. means a break caused by an Accident, which can be evidenced by x-ray or other suitable clinical diagnosis, of any other bone not covered under Major Broken Bone. The nose and teeth are specifically excluded. means the Occupation stated by You in Your application form. Page 10 of 48

9 Occupational Exposure Optional Surgery Paralysis of Limbs Permanent Personal Representative Qualified Physician Severance Schedule Sickness Start date Suicide Third-degree Burn means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials (OPIM) that may result from the performance of Your occupational duties in the UK as a clinical health care worker, meaning You carrying out observation and treatment of patients. This does not include exposure as a consequence of non-compliance with the UK Health Department's "Guidance for Clinical Health Care Workers: Protection against infection with bloodborne viruses" issued in 1998 by the Expert Advisory Group on AIDS and the Advisory Group on Hepatitis or any updates to these guidelines or other relevant guidance issued by the UK Health Department. means an operation You or the Eligible Child's parent(s) or legal guardian choose to have done, which may not be essential to continuation or quality of life. The voluntary donation of one or more of Your organs to Your parent(s), sibling(s) (including legally adopted siblings and step-siblings) or children (including legally adopted children and step-children), is specifically excluded from this definition. means total and irreversible loss of muscle function or sensation to the whole of any two limbs. means expected to last throughout the Insured Person's life, irrespective of when the cover ends. means a person appointed by a court to administer an estate where the deceased did not make a will before their death. means an independent doctor and/or surgeon and/or specialist and/or consultant, professionally qualified in the branch of medicine to which the referral under this Certificate applies. means the complete separation and dismemberment of the part from the body. means the document incorporated into this Certificate identifying You and the operative sections of this Certificate together with details including, but not limited to, the Period of Insurance, Operative Times, Premium, maximum amounts payable, Deferment Periods, Benefit Periods and Excesses. means any illness or infirmity and is not Bodily Injury. means the date on which cover incepts as detailed on the Schedule. Means death of the Insured Person by their own hand whether sane or insane at the time. means burns that involve damage or destruction of the skin to its full depth through to the underlying tissue and covering at least 20% of the body's surface area. Page 11 of 48

10 Total Permanent Disablement UK Resident War We/Us/Our You/Your/Yourself means loss of the physical ability, to do at least 3 of the 6 tasks listed below ever again following an Accident. The relevant specialists must reasonably expect that the disability will last throughout life with no prospect of improvement, irrespective of when the cover ends or You expect to retire. You need the help or supervision of another person and are unable to perform the task on Your own, even with the use of special equipment routinely available to help and having taken any appropriate prescribed medication. The tasks are: Washing the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means. Getting dressed and undressed the ability to put on, take off, secure and unfasten all garments and, if needed, any braces, artificial limbs or other surgical appliances. Feeding Yourself the ability to feed Yourself when food has been prepared and made available. Maintain personal hygiene the ability to maintain a satisfactory level of personal hygiene by using the toilet or otherwise managing bowel and bladder function. Getting between rooms the ability to get from room to room on a level floor. Getting in and out of bed the ability to get out of bed into an upright chair or wheelchair and back again. Disabilities for which the relevant specialists cannot give a clear prognosis are not covered. For very young children who would not normally be expected to be able to perform these activities even if fully healthy, Total Permanent Disablement means that, in the opinion of a specialist consultant pediatrician, and subject to the agreement of Our Chief Medical Officer, the Eligible Child sustained Bodily Injury which caused the Eligible Child to be, or likely to be, totally unable to ever perform any 3 of the above activities without the help of another person or the use of special devices and equipment. means any person whose habitual residence, meaning the place where the person's centre of vital interests (economic, domestic & social) is located, is in the UK. A person who is a UK resident will cease to be a UK resident if they leave the UK with the intention of not returning to reside in the UK within 6 months, or if they are away from the UK for a continuous period of 6 months. means invasion, civil war, revolution and any activity arising out of or attempt to participate in the use of military force between nations. means DUAL Corporate Risks Limited, on behalf of Insurers. means the Certificate-holder as stated on the Schedule. Page 12 of 48

11 3 General Conditions Applicable to ALL parts of this Certificate 3.1 Claim Conditions i. Claims Notification You must notify the Authorised Representative immediately or as soon as reasonably possible if You have a claim, potential claim or Insured Event covered by this Certificate. Details can be found in the Schedule. ii. Compliance with Certificate Terms and Conditions We shall not be liable to pay any claims under this insurance unless You and/or the Insured Person(s) comply with all terms and conditions set out in this Certificate. 3.2 Information You and/or the Insured Person shall, at their own expense, provide Us or the Authorised Representative, with: i. All the assistance that We or the Authorised Representative require; ii. All materials (paper, electronic or otherwise) that We or the Authorised Representative require including but not limited to all records, receipts, correspondence, statements, reports, police reports and post mortem reports, immediately or as soon as reasonably practicable but no later than 31 days from the date of request of such materials by Us or the Authorised Representative; iii. Access to the applicable Insured Person s medical records and/or any confidential records that are relevant to a claim under this Certificate. 3.3Medical Examination and Post Mortem You or the Insured Person shall allow a Qualified Physician or other adviser acting on Our behalf, or an independent Qualified Physician or other independent adviser, to examine (including a post-mortem) and/ or interview an Insured Person in any respects that are relevant to a claim under this Certificate. 3.4 Mitigation of Loss and Other Obligations You or the Insured Person shall: i. Take such action as may be required to mitigate or minimise any loss or potential loss under this Certificate; ii. iii. iv. Make no admission of liability, or offer or promise any payment without the Authorised Representative s prior written consent; Provide a statutory sworn declaration in any respect to a claim under this Certificate, if required by Us or the Authorised Representative; In the event of a valid claim for death due to Disappearance and before the claim is paid, provide Us with a written and signed agreement to refund, in full, any amounts paid under this Certificate for such Disappearance if the Insured Person is subsequently found to be alive; v. Allow Us at Our sole discretion and at any time to: a. Take whatever action is necessary to minimise, mitigate or prevent a loss under this Certificate; b. Exercise the subrogation rights granted to Us under this Certificate Page 13 of 48

12 vi. In the event of a written acceptance by You or the Insured Person that, We have paid the claim in full under this Certificate, then We will not make any further payments for the same claim; vii. Immediately reimburse to Us any payment made under this Certificate in good faith in respect of a claim where it is subsequently established that We were not liable to pay the claim. 3.5 Subrogation We shall be subrogated to all Your or the Insured Person s rights of recovery against any person, organisation or authority before or after any applicable payment under this Certificate. You shall execute and deliver to Us or the Authorised Representative all materials, electronic or otherwise, including but not limited to documentation, papers, correspondence or evidence of any kind. You or the Insured Person shall do nothing to prejudice such subrogation rights. 3.6 Currency Conversion If Your claim is in a currency other than pounds sterling (GBP) the applicable rate of exchange is the selling rate listed by the Financial Times in England ( at the date of loss. 3.7 Interest on Claims Payable We will not pay any interest on any monies payable under this Certificate. 3.8 Assignment This Certificate will not be assigned unless agreed by Us. However, You can assign this Certificate to a named Insured Person or their heirs. Payment to the named Insured Person or their heirs will discharge Us in respect of the Benefit or indemnity concerned. 3.9 Trust You hold Your rights under this Certificate on trust for the benefit of the Insured Person and, where applicable, for Yourself Trading Sanction(s) Restrictions We shall not be liable to provide the insurance under this Certificate or to pay claims where to do so would breach applicable sanctions, prohibitions or restrictions under United Nations resolutions or the trade or economic sanctions, laws or regulations of, but not limited to, the European Union, United Kingdom and the United States of America Gender and Use of Singular and Plural In this Certificate, where consistent with the context, the masculine gender shall include the feminine; the singular shall include the plural and the plural the singular Payment of premium Premiums are payable monthly throughout the term of the insurance. You are allowed 30 days in which to pay the first premium ('the grace period') which runs from the Start date of Your insurance or, Your monthly premium payment date if You have chosen a specific monthly premium payment date. If the premium has not been paid by the end of this time, cover automatically ends without value at the date on which the unpaid premium was due. If You make a claim within the grace period, any unpaid premium will be deducted from the Benefit that is payable by Us. We shall not be affected by any trust, charge, lien, assignment or any other dealing related to this Certificate Page 14 of 48

13 3.13 Rights of Third Parties No person other than You or Us may enforce any terms of this Certificate and the provisions of the Contract (Rights of Third Parties) Act, 1999 do not apply Notification of Material Changes You must notify Us immediately or as soon as reasonably practicable of any change in circumstances that affects or may affect the risks covered under this Certificate, including the acquisition or creation of a new subsidiary, group or holding company (whether by merger or otherwise) Cancellation/ Cooling Off Period i. Cooling Off You are entitled to cancel this Certificate by writing to Your insurance broker or Us within 30 days of either (with the exception of any insurance in force for less than 28 days): a. The date You received this Certificate or b. The start of the Period of Insurance whichever is the later. If You cancel within this period You will be entitled to a full refund of any premiums You have paid up to that time, providing You have not made a claim. ii. Cancellation If cover is cancelled after the 30 days cancellation period, there will be no refund of premiums paid. We can cancel this Certificate: a. By giving You 30 days written notice by recorded delivery to Your last known address. In such an event We will return the Premium paid for the unused Period of Insurance. b. For non-payment of Premium by giving You seven days written notice by recorded delivery to Your last known address. In such circumstance this Certificate is void from the inception date or the last paid instalment Fraud Any fraud, deliberate dishonesty, or hiding information connected with a claim, will make this Certificate invalid. If this happens, You or the Insured Person will lose any Benefit due to them and they must repay any Benefits that We have already paid. If this happens, We will not refund any Premiums. We may also inform the Police Misrepresentation and Non-disclosure i. In deciding to accept this insurance and in setting the terms and Premium, We have relied on the information You have given Us. ii. If We establish that You deliberately or recklessly provided Us with false or misleading information We will treat this insurance as if it never existed and decline all claims. Page 15 of 48

14 iii. If We establish that You were careless in providing Us with the information We have relied upon in accepting this insurance and setting its terms and Premium, We may: a. Treat this insurance as if it had never existed and refuse to pay all claims and return the Premium paid. We will only do this if We provided You with insurance cover which We would not otherwise have offered; b. Amend the terms of Your insurance. We may apply these amended terms as if they were already in place if a claim has been adversely impacted by Your carelessness; c. Charge You more for Your insurance or reduce the amount We pay on a claim in the proportion the Premium You have paid bears to the Premium We would have charged You; or d. Cancel Your Certificate in accordance with the right to cancel condition above. We or Your insurance advisor will write to You if any of the above have occurred Several Liability The liability of Insurers is several and not joint and is limited solely to the extent of their individual share as shown in the Schedule. Insurers are not responsible for the share of any co-subscribing Insurers who for any reason do not satisfy all or part of their obligations Change of occupation You must notify Us promptly in writing of any subsequent material change to Your Occupation to a Declined Occupation during the term of this insurance. If Your new Occupation is one of the Declined Occupations Your insurance will terminate immediately upon Your new Occupation becoming effective and any premiums paid after that date will be refunded. We will write to You at Your last known address to inform You of the termination of Your insurance. If We are notified that Your Occupation is one of the Declined Occupations when a claim is submitted for assessment, Your claim will be declined, Your insurance will terminate immediately and any premiums paid after the date Your new Occupation became effective will be refunded. We will write to You at Your last known address to inform You of the decline of Your claim and the termination of Your insurance. If You are unclear about whether You can claim, or how to claim, please contact Us using the contact details above Changes to the Certificate We reserve the right to make any change or alteration to the terms and conditions of this Certificate for the following valid reason: in the event of any change in the law affecting this Certificate or Us. We will give You 30 days notice of any changes by writing to You at Your last known address. If You are not happy with the alteration, You have the right to cancel Your insurance (see the section headed Cancellation) Residence The Benefits under this insurance are only available whilst the Insured Person is a UK Resident. If You cease to be a UK Resident, Your Insurance will terminate immediately without value. Page 16 of 48

15 3.22 Rights to Medical Records and Medical examination Following notice of a claim, the Insured Person shall provide when requested by Us all authorisations necessary to obtain an Insured Persons medical records. We have the right to have an Insured Person examined by a physician or vocational expert of Our choice and at Our expense when and as often as We may reasonably request Payments All premiums and Benefits are payable in Sterling in the UK Interest on Benefit payable No Benefit amount payable in connection with any claim under this insurance shall carry interest Payment of Benefit Any Benefit payable in accordance with this insurance, except Benefit payable in respect of death, will be paid to You. Payment of any death Benefit will be payable to the executor(s) or personal representative(s) of the deceased Insured Person's estate. Payment of Benefit in respect of an Eligible Child will be paid to You if living or otherwise to the Eligible Child's legal guardian at the time of claim Term of insurance The cover provided by this insurance commences on the Start date, and will normally continue in force (and stop on) the earlier of the following: You reaching Your 65th birthday; the payment of Total Permanent Disablement Benefit to You; You ceasing to be a UK Resident; Your death; or You changing Your Occupation to a Declined Occupation. The above is also subject to the clause Payment of premium in the section titled General Conditions Eligibility You must be aged years old in order to be eligible to purchase this insurance. You must be a UK Resident Your Occupation must not be a Declined Occupation Only one Certificate is permitted per person. If an Insured Person is covered by another Family Accident Insurance with Us the amount that We pay You or an Eligible Child will not exceed 5 Units of Cover. In this event we will return to You the premium for any Units of Cover in excess of this amount. Page 17 of 48

16 4 General Exclusions We shall not pay any claim where the claim is any way caused or contributed to by: 1. Any period which falls within a Deferment Period or which extends beyond a Benefit Period shown in the Schedule; 2. Any amount which falls within an Excess or which exceeds the maximum amount payable as shown in the Schedule; 3. A claim or potential claim or event, incident or circumstance that has or may result in a claim that is made later than 24 consecutive months after the event, incidence or circumstance; 4. War; 5. The actual or threatened use of pathogenic or poisonous biological or chemical materials by any person(s), committed for political, religious, ideological or similar purposes with the intention to influence any Government and/or to put the public or any section of the public in fear; 6. Nuclear reaction, nuclear radiation or radioactive contamination; 7. An Insured Person engaging in flying of any kind other than as a passenger; 8. An Insured Person engaging in active service of any kind in any of the Armed Forces of any nation; 9. An Insured Person committing or attempting to commit Suicide or inflicting self-harm or being in a state of insanity; 10. Any actual or attempted fraudulent, dishonest, criminal or wilful act by You, the Insured Person, Employee, director, business partner or an Authorised Representative of Yours; 11. An Insured Person travelling to, travelling through or being in any of the excluded countries and/or territories stated on the Schedule. 12. Sickness or disease. This exclusion does not apply if the claim is for: Hospitalisation Benefit and this insurance has been in force for more than 12 months; for a contracted infectious illness as a result of occupational exposure; Eligible Child Cancer Benefit; or death by a non-accidental cause and this insurance has been in force for more than one year; 13. Psychiatric illness, depression, mental or nervous disorders, or stress-related conditions; 14. Infection by any human immunodeficiency virus (HIV) or antibodies to such a virus; 15. For any Major Bone Fracture or Minor Bone Fracture Benefits, osteoporosis, brittle bone disease, osteoarthritis or other degenerative bone disorder; 16. For any Minor Bone Fracture or the nose or a tooth. 17. Unreasonable failure to follow medical advice; 18. Alcohol or solvent abuse, or drug taking (unless taken as prescribed by a registered medical practitioner and not for the treatment of drug addiction); 19. Participation in contests of speed, mountaineering or rock climbing needing ropes or guides, pot holing, professional sports, or commercial diving; Page 18 of 48

17 20. You or the Insured Person working in a Declined Occupation. 21. Benefit will not be paid for Hospitalisation claims caused directly or indirectly in whole or in part by, or resulting in whole or in part from Optional Surgery, or for Hospital stays in a Hospital that is not a UK Hospital. 22. If optional child cover has been selected, Benefit for Cancer in respect of an Eligible Child will not be payable in any of the following circumstances: a. If the Eligible Child has been diagnosed as having any Cancer prior to the Start date; b. If the Eligible Child is diagnosed as having any Cancer and this insurance has been in force for less than 90 days; c. If the Eligible Child has any tests or investigations during the first 90 days this insurance has been in force which subsequently lead to the diagnosis of Cancer; d. If the Eligible Child has any tests or investigations prior to the Start date which subsequently lead to the diagnosis of Cancer after the Start date. i. Any claim for Hospitalisation Benefit for an Eligible Child will not be payable if it is directly or indirectly resulting in whole or in part from a Congenital Illness. 23. We shall not pay any claim arising directly or indirectly from or relating to: a. Illness or post-traumatic stress arising other than as a direct result of Bodily Injury; b. Repetitive stress and/or repetitive strain injury or syndrome or any gradually recurring cause. Page 19 of 48

18 5 Cover under this insurance The Schedule states the level of cover You have selected and the Benefit amounts payable in total if You or an Insured Person suffers an Insured Event during the term of this insurance. If a single Accident results in a claim for multiple Benefits including: Accidental Permanent Injuries; Total Permanent Disablement; Major Bone Fracture or Minor Bone Fracture; Accidental Death; Hospitalisation; in respect of an Insured Person, the maximum that We will pay will be the Benefit for Total Permanent Disablement. Any Accident that results in a claim for an Insured Event must occur during the term of this insurance. The total maximum Benefit payable for Accidental Death and Total Permanent Disablement in respect of all policies that You hold with Us will be subject to maximum limits as specified in the Schedule. The maximum level of cover in respect of Insured Persons is 5 units across all policies You hold with Us. 5.1 Accidental permanent injuries We will pay this Benefit if an Insured Person sustains Bodily Injury, which causes any of the injuries listed below within 12 months of the date of the Accident and during the term of this insurance. Paralysis of Limbs - total and irreversible Blindness - permanent and irreversible in both eyes Loss of Hands or Feet - permanent physical severance Deafness - permanent and irreversible in both ears Loss of Use - of elbow, hip, shoulder, knee, ankle or wrist Loss of one Hand or Foot -permanent physical severance Loss of Thumb Deafness - permanent and irreversible in one ear Loss of Major Organ (kidney, spleen, lung, pancreas, urinary bladder or stomach) Blindness - permanent and irreversible in one eye Loss of Tongue Loss of Speech - permanent and irreversible Third-degree Burns - covering 20% of the body's surface area Loss of Forefinger Loss of other Finger or a Toe The Benefit amount payable in respect of each of these injuries is detailed on the Schedule. Page 20 of 48

19 If an Insured Person has a Accident where more than one of the specified injuries occurs, We shall not pay more than 100% of the largest Accidental permanent injuries Benefit for any one Insured Person. Benefit will only be payable for permanent injuries if the Insured Person survives for at least 28 days after the date of the Accident. 5.2 Total Permanent Disablement We will pay this Benefit if the Insured Person sustains Bodily Injury, which causes Total Permanent Disablement of the Insured Person within 24 months of the date of the Accident and during the term of this insurance. The amount of Benefit payable will be reduced by any Benefit already paid in respect of that Insured Person for the Accident that caused the Total Permanent Disablement. Payment of Total Permanent Disablement Benefit automatically removes the Insured Person concerned from cover under this insurance. If the Insured Person is the Certificate-holder, payment of this Benefit automatically terminates this insurance. 5.3 Bone Fracture We will pay this Benefit if the Insured Person sustains Bodily Injury which causes a Major Bone Fracture or a Minor Bone Fracture during the term of this insurance. The Benefit amount payable in respect of a Major Bone Fracture and a Minor Bone Fracture is detailed on the Schedule. We shall not pay more than 100% of the Benefit detailed on the Schedule if more than one bone is fractured in the same Accident. 5.4 Accidental Death We will pay this Benefit if an Insured Person sustains Bodily Injury, which causes their death within 12 months of the date of the Accident and during the term of this insurance. The amount of Benefit payable will be reduced by any Benefit already paid in respect of that Insured Person for the Accident that caused the Accidental Death. Payment of Accidental Death Benefit automatically removes the Insured Person concerned from cover under this insurance. If the Insured Person is the Certificate-holder, payment of the Benefit automatically terminates this insurance. 5.5 Hospitalisation (caused by an Accident) We will pay Hospitalisation Benefit if an Insured Person is admitted to Hospital: as an inpatient for at least 24 hours during the term of this insurance; and the admission to Hospital is caused by an Accident occurring during the term of this insurance. The amount of Benefit payable for each day after the first 24 hours is specified in the Schedule, and is payable from day one of the Insured Person's stay for up to a maximum of 90 days per Insured Event. If You are admitted to Hospital as an inpatient as a result of an Accident for a period of at least 24 hours, and are then admitted again because of the same Accident, this is considered by Us to be a continuation of a Page 21 of 48

20 previous admittance to Hospital. Benefit is payable for such periods of Hospitalisation for up to the maximum of 90 days (complete and uninterrupted periods of 24 hours). Periods of less than 24 hours will not be regarded as complete days. 5.6 Hospitalisation (caused by Sickness) After this insurance has been in force for at least 12 months, We will pay Hospitalisation Benefit if an Insured Person is admitted to Hospital: as an inpatient for at least 24 hours during the term of this insurance; and the admission to Hospital is caused by Sickness. The amount of Benefit payable for each day after the first 24 hours is specified in the Schedule, and is payable from day one of the Insured Person's stay for up to a maximum of 90 days. A day is a complete and uninterrupted period of 24 hours and periods of less than 24 hours will not be regarded as complete days. If You are admitted to Hospital: as an inpatient for at least 24 hours during the term of this insurance; and the admission is caused by Sickness. and You are then admitted again because of the same Sickness, this is considered by Us to be a continuation of a previous Hospital admission. Benefit is payable for such periods of Hospitalisation for up to the maximum of 90 days. A day is a complete and uninterrupted period of 24 hours and periods of less than 24 hours will not be regarded as complete days. Hospitalisation as a result of the voluntary donation of one or more of Your organs to Your parent(s), sibling(s) (including legally adopted siblings and step-siblings) or children (including legally adopted children and stepchildren), is included even if it occurs within the first 12 months of the term of this insurance. 5.7 Funeral Benefit Funeral Benefit is provided under this insurance and if it has been in force for at least one year, We will pay this Benefit if You die from any natural cause during the term of this insurance. If death occurs before this insurance has been in force for at least one year, We will refund the total premiums paid under this insurance. We will pay the Funeral Benefit in the circumstances of an Accidental Death claim that is excluded from cover under this insurance. We will not pay this Benefit in respect of Eligible Children whether or not optional child cover has been selected. Payment of the Funeral Benefit automatically terminates this insurance. 5.8 Child Cancer Benefit The lump sum Child Cancer benefit will be payable 30 days after first diagnosis by a registered medical practitioner subject to survival of the Insured for that period and the exclusions listed in section 4. Page 22 of 48

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