• that by completing and submitting this form I am authorised by the employer to enter into this agreement and establish a group scheme for the employer.
• that the employer will facilitate the deduction of premiums from employees, where applicable,and pay these across to Cinagi by the 1st working day of each month.
• that the member participation and payment terms and conditions outlined above are accurate.
• that the employer will provide Cinagi with updated staff details each month (where applicable).
• that the appointed intermediary may assist Cinagi with updating membership & billing information if required.

By providing the information in this form or any annexures hereto and having applied for cover on behalf of the employees of your organisation you agree that Cinagi (Pty) Ltd and its underwriter, Infiniti Insurance Ltd may :

• use this information to provide the employees of your organisation with administrative and insurance services.
• disclose this information to persons and entities that it is necessary to disclose this information to in order to provide the employees of your organisation with the aforementioned services.
• have the right to communicate with the employees of your organisation electronically about any changes or general information relating administrative processes or changes to policy benefits and premiums.
• only transfer personal information outside South Africa if the provided email addresses are hosted outside South Africa or to administer certain services, for example, cloud services and/or the Medical Second Opinion service.

You further agree that:

• by submitting personal infromation relating to employees and/or their dependents’ of your organisation, you are duly authorised to share such information with us. We will furthermore process their information for the purposes and in the manner as set out in our Privacy Statement
• specific consent has been obtained from each employee as defined in the Act, or
• in the absence of specific consent that the purpose for processing personal information as outlined in the Cinagi Privacy Statement is compatible with or in accordance with the purpose for which the personal information of each employee was collected in the first place.

You also acknowledge that that you have read and agreed to the Cinagi Privacy Statement and the contents thereof.