Request for policy information Thank you for reaching out to us. Please fill in the details below to get your policy documents emailed to you. Once submitted we will validated your membership and send your documents. You can expect to receive your documents within 24 hours. Sharing of Personal Information Declaration By providing the information in this form you agree that Cinagi (Pty) Ltd and its underwriter, Infiniti Insurance Ltd may : use this information to provide you 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 you with the aforementioned services. have the right to communicate with you electronically about any changes or general information relating administrative processes or changes to the Cinagi policy benefits and premiums. only transfer your personal information outside South Africa if you have provided an email address that is hosted outside South Africa or to administer certain services, for example, cloud services and/or the Medical Second Opinion service. You further agree that: if submitting your dependents’ relevant personal information, you hereby confirm that 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 if you are giving consent for a person under the age of 18 years (a minor), you confirm that you are a competent person and that you have authority to give their consent on their behalf. You also acknowledge that that you have read and agreed to the Cinagi Privacy Statement and the contents thereof. Consent(Required) I agree to above declaration as it relates to my personal information Personal Information(Required) First Last ID or Passport number(Required)Cell Number(Required)Cinagi Policy Number(Required)
