Personal Insurance

An Insurance Application serves as a basis for the Insurance Contract. The Insurance Application represents a client’s proposal on entering into the Life Assurance Contract on terms indicated in the Application, addressed to the Insurance Company. The Application makes part of the Insurance Contract; therefore certain requirements must be followed when filling it in.

Each Application is made in Ukrainian in a comprehensible and clear manner. True and fair answers shall be given to all questions. Incomplete applications or applications that contain mistakes can not be accepted and require for additional inquiries and processing that hinder the Application review and issue of the Policy.

Signatures made in the Application shall correspond to the signatures contained in identification papers of the Policyowner and the Assured.

Should additional pages to the Application exist, they shall ALSO be signed by:

à) the Policyowner;

b) the Assured (in case the Policyowner is not the Assured);

c) authorised representative of the Policyowner (the Insurance Agent).

Functions of the Insurance agent (hereinafter – the Agent) include advise on how to complete the application form accurately.

BLOCK 1

1.1. Field "Policyowner": is filled in if the Policyowner is not the person Assured – all relevant information shall be entered in to the respective column. If the Policyowner and the Assured is one and the same person, the field should be left blank. Special attention should be given to the field "Degree of Kindred with the Assured", which enables to establish and take into account the insurable interest of the Policyowner in relation to the Assured person. Columns «Area of Activity" and "Position" are used to indicate actual area of activity of the Policyowner to identify the paying capacity of the latter.

1.2. Field "Assured person" is compulsory. Relevant information shall be entered in the respective columns. To establish the risk group of the Assured person, actual area of the Assured person’s activity, rather than his/her acquired profession shall be indicated in lines "Area of Activity" and "Position".

1.3. This block contains 5 "Beneficiary" fields, i.e. the existence of several Beneficiaries is envisaged. When completing each of the fields, it is necessary to specify the insured event, which the respective Beneficiary is named for: in the event of the Assured person’s death or survival.

Data to be entered – first, middle and the last name, year of birth and share of each Beneficiary (expressed in percentage terms against the insured amount). If the Beneficiaries’ shares are not specified, the insurance indemnity is distributed between them in equal parts.

The amount of interest payable to the Beneficiary under the death insurance shall not be over 100%. If the amount of death insurance interest is less than 100%, the remaining amount of interest will be paid to the Policyowner upon the occurrence of the insured event.

The amount of interest payable to the Beneficiary under the endowment policy shall make up 100%. In the event of survival, the Beneficiary can be represented by the Assured or any other person.

For example, two Beneficiaries can be indicated in the application in the event of death –50% of the insurance indemnity each, and one Beneficiary, alias the Assured person, in the event of survival – 100% indemnity payment.

The order in which the Beneficiary acquires the right to inherit the insurance indemnity is indicated in column "Sequence I, II, III". For example, numerical letter "I", entered in this column, indicates that the given Beneficiary is the Primary Beneficiary. If there are several Beneficiaries of various succession indicated with reference to one and the same share of benefit within the same group of insured events (e.g., I and II succession Beneficiaries within 40 % of insurance indemnity in the event of death), such Beneficiaries are stated one after another in line with the increase in succession (i.e., Beneficiary I comes first and is followed by Beneficiary II). Secondary Beneficiary acquires the right to the insurance indemnity in the event of Primary Beneficiary’s death only.

Column "Irrevocable Right" is used to indicate the availability (or absence) of the Beneficiary’s irrevocable right to obtain the insurance indemnity through "yes" or "no" statement. In case the irrevocable right to insurance indemnity is granted to the Beneficiary, the Policyowner can change the Beneficiary only with consent of the Beneficiary.

BLOCK 2

Block 2 represents actual description of the insurance programme selected by the client and terms and conditions of insurance. Required data shall be entered into standardised table that envisages the entry of insurance terms and conditions under «Oranta-Life» basic programme and exemption from insurance contributions. The table serves as an appendix to Life Assurance Contract.

2.1 "Term of Insurance Contract" column: this column is used to indicate the expected term of the Insurance Contract in years. Term of contract shall correspond to the terms and conditions of insurance under "Oranta-Life" programme.

2.2 "Insurance Payment Period" column: period when insurance payments will be made. Insurance payment period shall equal the term of Contract.

2.3 "Currency of the Insurance" column: this column should be used to indicate the currency in which the parties’ commitments under the Contract will be denominated. The client, nevertheless, should note that all settlements between the parties under the Contract will be made in hryvnas at the NBU rate on the date of transaction.

2.4 "Insured Amount" column: insured amount can be denominated in both hard currency, e.g. US dollars or EURO, and hryvnas. All financial indicators are entered into the table in the currency of the insurance.

It should be noted that the amount insured under "Oranta-Life" programme, will, at the same time, be represented by the amount insured in each insurance event that make up the principal insurance coverage envisaged by this programme, namely: Survival and Death, Accidental Death, Motor Vehicle Accident Death. The Policyowner should be informed, that upon the occurrence of such insured event as Accidental Death and Motor Vehicle Accident Death, the insurance indemnity will be paid with reference to a number of insured events and will make up a double insurance amount (Death + Accidental Death) or triple insurance amount (Death + Accidental Death + Motor Vehicle Accident Death) respectively.

2.5 "Insurance Tariff" Column: insurance tariff applied with reference to the tariff matrix available from the Agent Folder and is based on sex and age of the Assured and terms of the Insurance Contract.

2.6 "Insurance Contribution" Column: data, which is required for this column, is calculated by multiplying the respective tariff by the amount insured in the currency of insurance.

If, when completing the Application form, the client is guided by the amount of insurance contribution that he/she is prepared to pay within the indicated period, the insurance contribution should be divided by the insurance tariff in order to calculate the amount insured.

2.7 "Additional Disability Insurance" field: is left blank, because, in compliance with the legislation, in order to obtain tax allowances, additional risks must be insured through making a separate Contract. The procedure of completion and sample form of application for steady loss of working ability are available below.

2.8 "Exemption" field: insurance tariff is taken from the tariff matrix available from the Agent Folder based on the age of the Policyowner and term of Insurance Contract.

Insurance Contribution Receipt