Last updated 29 September 2026
Terms of use
These terms apply to the Loss of Support Form. By completing and submitting it you accept them. If you do not accept them, please telephone the practice instead — nothing here obliges you to use the form.
1. What this form is
A way to give Dr Pretorius Inc (“the practice”) the particulars of a person who died in a road accident, of everyone who depended on that person, and of the accident itself, so that the practice can prepare a report in connection with a claim for loss of support. It is a convenience. You may give the same information by telephone, by email or in person, and nothing is lost by doing so.
2. It does not, by itself, engage the practice
Submitting this form does not create a doctor–patient relationship and does not oblige the practice to accept your matter or to report on it. A relationship begins only when the practice confirms in writing that it has accepted the matter, on terms agreed with you.
Until then, do not assume the practice is acting on any deadline in your matter. Claims against the Road Accident Fund are subject to strict time limits, and those limits continue to run whether or not you have sent this form.
3. Nothing here is legal or medical advice
The form collects information. It does not assess your claim, advise you on your prospects, diagnose anything, or tell you what to do next. Any opinion will come from the practice after it has accepted the matter, and any legal advice must come from your own attorney.
4. What we ask of you
- Give information that is true and complete as far as you know it. A claim can be damaged by an inaccuracy given in good faith just as easily as by a deliberate one.
- List every dependant. A person left off this form may never have their claim brought at all. If you are unsure whether someone counts, put them in and say why — that is not for you to decide.
- Submit only your own information, or information you are entitled to give — as a spouse, parent, guardian, executor, or someone acting under a power of attorney. By submitting you confirm that you are entitled to give the details of the deceased and of every dependant you have listed, and that you will tell any adult dependant that you have done so.
- Upload only documents and photographs relevant to this claim, and only ones you are entitled to share.
- Do not attempt to interfere with the form, submit automatically, or use it for anything other than its purpose.
5. Your saved progress file is yours to look after
“Save progress” downloads a file to your own device so you can continue later. That file contains everything you have entered — including the identity numbers of the deceased and of every dependant you have listed, and any document you have attached. It is not sent to the practice or stored anywhere by this website.
Keeping it safe, and deleting it when you no longer need it, is your responsibility. If you are using a shared or public computer, do not use this feature.
6. Availability
The form is provided as it is. The practice does not promise it will always be available or free of faults. It may be taken down for maintenance, or paused, at any time and without notice.
If it matters that your information reaches the practice by a particular date, do not rely on this form alone. Telephone the practice on [TELEPHONE NUMBER] and confirm it arrived.
7. When a submission counts as received
Your browser will confirm on screen once the form has been sent successfully. That confirmation means it was delivered to the practice's email system — not that anyone has yet read it or acted on it.
If you do not see that confirmation, assume it did not arrive and telephone the practice.
8. Limits on liability
To the extent the law allows, the practice is not liable for loss arising from the form being unavailable, from a submission failing to arrive, or from information being entered incorrectly. Nothing in these terms limits liability that cannot lawfully be limited — including for death or personal injury caused by negligence, or for fraud.
Nothing in these terms affects your rights under the Consumer Protection Act, 2008 where it applies to you.
9. Your privacy
How your information is handled — including what is collected, where it goes and what rights you have under POPIA — is set out in the privacy notice, which forms part of these terms.
10. Intellectual property
The design, wording and code of this form belong to the practice and to Innovation for the Future Consultants. The information you enter remains yours.
11. Changes
These terms may change. The version that applies to your submission is the one published when you submitted it, shown by the date at the top.
12. Governing law
These terms are governed by the law of the Republic of South Africa, and the courts of South Africa have jurisdiction.
13. Contact
Dr Pretorius Inc
[PHYSICAL ADDRESS]
[TELEPHONE NUMBER]
[EMAIL ADDRESS]
These terms describe how the form works, in plain words. They are not legal advice, and they should be reviewed and adopted by the practice before being relied upon.