• Benefactor.life™ Life Cover – Medical Questionnaire

    Your legacy, our priority. Thank you for considering Benefactor.life™ life cover. Please answer the questions below honestly and completely. Your answers help your adviser determine whether you qualify and obtain an accurate quote. There are no medical tests – just these questions. It takes about 5 minutes.
  • BENEFACTOR.LIFE™ – YOUR LEGACY, OUR PRIORITY
  • Life cover without the needles, nurses or clinic visits.
  • If you're healthy, you've already done the hard part. Answer 21 simple questions from your phone and we'll tell you if you qualify.
  • • No blood tests. No medical exams. No trips to a clinic or waiting for a nurse to visit – underwriting is based on 21 medical questions only. • Cover of up to R5 million to protect the people who depend on you. • About 5 minutes to complete, on your phone or computer. • Competitive monthly premiums – see how it compares below.

  • How the price compares

  • Example: Male, age 42, non-smoker, R2.4 million life cover – monthly premium compared with 6 other major South African life insurers
  • Insurer Monthly premium
    Insurer A R416.00
    Benefactor.life™ R474.99
    Insurer B R477.72
    Insurer C R487.68
    Insurer D R510.09
    Insurer E R517.27
    Insurer F R706.68
  • In the provider's comparison of 8 example profiles against 6 other major South African life insurers, Benefactor.life™ had the 2nd-lowest premium in 7 of the 8 examples.

  • Designed for healthy lives

  • Why this is different

  • Benefactor.life™ is built for people in good health, at a healthy weight and with no chronic conditions – and both smokers and non-smokers can qualify. If that sounds like you, this is one of the fastest ways to get proper life cover in place. If you do have a medical history, still complete the form – your adviser will tell you honestly whether this is the right product for you.
  • Please answer every question honestly and completely. Accurate answers protect your family if a claim is ever made.
  • Benefactor.life™ is administered by Capital Legacy Solutions (Pty) Ltd, an authorised financial services provider, and underwritten by Guardrisk Life Ltd, a licensed life insurer. Advice provided by Natasha Agnew of Waardevast Finansiële Advies en Dienste (Pty) Ltd, a juristic representative of an authorised financial services provider (FSP 51872).

  • Personal Details

  • Date of birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Gender*
  • Format: (000) 000-0000.
  • Employment status*
  • Highest level of education*

  • Medical Questions

  • 3) What best describes your smoking habits within the last 6 months?*
  • Answer Y/N to the following questions:
  • 4) Do you regularly drink more than 36 beers, 5 bottles of wine or 2 bottles of spirits per week?*
  • 5) Have you ever been admitted to or been recommended to be admitted to an alcohol or drug rehabilitation centre?*
  • 6) Have you ever submitted a life insurance claim or applied for life insurance and were declined, charged an extra premium or had an exclusion applied to your policy, whether the policy was issued or not?*
  • 7) Have you ever tested positive for HIV?*
  • 8) Have you ever been diagnosed with diabetes, insulin resistance, raised blood sugar, or sugar in the urine, etc. whether you are medicated for it or not?*
  • 9) Have you ever been diagnosed with any form of cancer or any malignant tumours?*
  • 10) Have you ever been diagnosed with or received treatment for any cardiovascular condition, including but not limited to myocardial infarction (heart attack), heart failure, stroke, coronary artery disease requiring stents or angioplasty, heart surgery, arrhythmias, chest pain, or heart murmurs?*
  • 11) Have you ever been prescribed or advised to take medication to control your blood pressure?*
  • 12) Have you ever been prescribed medication or advised to take medication in order to improve the control of your cholesterol levels?*
  • 13) Have you ever been diagnosed with or had a stroke, brain haemorrhage, brain aneurysm, transient ischaemic attack or blockages in the blood vessels in your neck?*
  • 14) Have you ever been diagnosed with or treated for bipolar disorder, schizophrenia, or attempted suicide?*
  • 15) Have you ever been diagnosed with chronic kidney disease, such as kidney failure, polycystic kidney disease, glomerulonephritis, excessive protein in your urine or any other form of progressive loss of kidney function?*
  • 16) Have you ever been diagnosed with or had any of the following chronic conditions affecting your liver or bowel: bowel obstruction, ischaemia of the bowel (reduced blood flow to the bowel), portal hypertension, pancreatitis, bloody stools that are not caused by haemorrhoids, cirrhosis of the liver, cholangitis or chronic relapsing hepatitis?*
  • 17) Have you ever been diagnosed with a chronic lung disease or shortness of breath?*
  • 18) Have you ever been diagnosed with a blood disorder, or bone marrow disorder?*
  • 19) Have you ever been diagnosed with any of the following autoimmune illnesses: Rheumatoid Arthritis, Systemic Lupus, Myocarditis, Psoriatic Arthritis, Crohn's disease, Ulcerative Colitis, Sarcoidosis, Pulmonary Fibrosis or Pulmonary Alveolar Proteinosis (PAP)?*
  • 20) In the past 5 years, have you stayed more than 4 consecutive nights in hospital or have you been absent from work for more than 3 consecutive weeks due to illness or surgery other than already stated, excluding childbirth, dental surgery, bone fractures, gastro-enteritis, hysterectomy or an appendectomy?*
  • 21) Do you have any signs or symptoms of a medical problem for which you are still intending to seek medical advice, or are awaiting a diagnosis, or have been advised to undergo tests or investigations by a health practitioner to establish a diagnosis?*

  • Declaration and Consent

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: