MiPet Buy Online

1Personal Details

2Banking Details

3Terms & Conditions

MiPet Unlimited Pet Cover

We will cover up to 4 claims per policy year per household, up to a sub maximum of R1500.00 per claim in the event of illness, and up to a sub maximum of R5000.00 per claim in the event of accidental injury.

For R160.00 per month for all pets

Your Personal Details

Title

Name

Surname

Phone No

Email Address

ID Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Bank Details

Name of Account Holder

Bank Name

Account Type

Branch

Branch Code

Account No

Debit Date

Disclosure - Please note that the policy will remain active for as long as the premium is paid, should the premium not be collected there will be no cover for that month. If there are two consecutive non-payments the policy will automatically cancel.
Cancellation disclosure - This policy may be cancelled at any time by either party upon giving one months written notice. The cancellation shall then be effective from the first day of the calendar month following the notice.

Terms & Conditions

Policies always start from the 1st of the following month
I request and authorise Renasa Insurance Co Ltd to draw against the above mentioned account, the amount necessary for payment of the monthly premium, as and when, required. This amount will debit every month until this arrangement is cancelled in writing by either party.
I accept that, if the debit date falls on a weekend, I will be debited on the subsequent working day. If no debit date is selected
P.UMA reserves the right to select the last working day of each month
Renasa Insurance Company Ltd – Reg. No. 1998/000916/06– Authorised Non-Life Financial Services Provider (FSP No. 15491)

Policy Amount - R160pm(Required)

I declare and understand that this policy will debit an amount of R160.00pm

Deduction Authority(Required)

I consent to the deduction

I hereby authorise Renasa Insurance Co Ltd to affect the soonest monthly deduction of the Grand Total (current and/or arrears including amendments that may be made in terms of master policy) and an annual increase if applicable from my salary, current bank account or any future bank account I might have, and to continue such deductions until written notice of cancellation is received.

Client Validation by Electronic Signature

Declaration(Required)

I agree to these terms

I hereby confirm that all details supplied above are true and correct to the best of my knowledge. NB: Any false disclosure could result in the policy being made void. This policy will be rendered on 1 June each year. You will be informed of any changes 30 days prior to renewal.

By signing below, I hereby accept all terms and conditions related to this policy and authorise the premium to be debited off my account.

By completing this application form, you consent to us obtaining any veterinary histories required from your treating vets in order for us to underwrite the risk.

All your information will be treated in the strictest confidence at all times.

Client Signature(Required)

CAPTCHA