BnB Sure - The Only Insurance Policy Created By B&B and Guesthouse Owners for B&B's and Guesthouses

Agency Application Form

1. Name
2. Nature of Legal Entity: Company/close corporation/partnership/other (specify)
3. If not a Company, list principals, partners or members
4. Registration Number (if applicable)
5. Vat Number (if applicable)
6. FSP Licence Number (please forward copy of certificate)
7. Telephone Number
8. Cellular Telephone Number
9. Telefax Number
10. E-Mail address (general correspondence)
E-Mail address (commissions)
E-Mail address (claims)
E-Mail address (underwriting)
11. Business address
12 Postal Address
13. Any Business other than insurance?
If yes please specify
14. Bank Details
Bank
Branch
Name of account holder
Account Number
Branch code
Type of account
15. Which other Insurers Represented?
16. Have you ever had an insurance agency cancelled?
If Yes, provide full details
17. Has any provisional or final liquidation or insolvency order ever been issued in respect of any director/partner/member thereof?
If Yes, provide full details
18. Are you a guarantee agent ?
If Yes I.G.F registration number Guarantee amount
19. Do you have Fidelity guarantee Insurance? Limit of Liability
20. Do you have Professional Indemnity Cover ? Limit of Liability
Conditions of appointment:
1. Commission is paid on two levels. You will receive 12.5% for motor classes and 20% for non motor classes.
2. You are not authorised to grant cover for any class of insurance, nor may you bind the Company in any way except as specifically authorised in writing
3. You undertake to deliver, post or e-mail all proposals to the Company immediately as they are received.
4. You agree to observe all instructions received from the Company.
5. All documents, rate books, stationery and publicity material supplied to you shall at times remain the property of the Company. Furthermore no pamphlet, advertising or printed matter should be issued by you referring to the Company’s name or business without the Company’s prior consent. Upon termination of the agency all such documents must be returned to the Company forthwith.
6. You may not transfer this agency without the formal consent of the Company
7. The Company will not in any way hold itself responsible for or be bound by any act committed by you beyond the terms of the authority recorder herein or
specifically granted in writing. In the event of the Company incurring liability
whatsoever as a result of your unauthorised act you will indemnity the Company
against such liability.
8. Either party may terminate this appointment at any time without prior notice.
9. All premiums must be paid direct to the Company, on or before the date on which
the premium becomes due.
10. You are not authorised to extend credit on behalf of the Company
11. You are not authorised to admit any claim submitted under the policy
12. In the event of your entering into any compromise with creditors or if any
provisional or final insolvency or liquidation or judicial management order is
issued against you then this appointment will automatically be terminated.
By clicking on the submit button We hereby make application for an agency with BnB Sure (Pty) Ltd and warrant that the foregoing is correct and agree and undertake to abide by and comply with all the terms and conditions if this application is approved.

I agree with the terms and conditions