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_q_ Short-term broker appointment - 1 April 2011

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					A Juristic Representative of FSP 8933


                          NOTICE OF APPOINTMENT AS SHORT TERM INSURANCE ADVISER

I _______________________________________________ [Full names], ID: ______________________________________

& ______________________________________________ [Full names], ID: _____________________________________

in my personal capacity or, where applicable, in a representative capacity for and on behalf of

______________________________________________________________ [state if not applicable]

hereby appoint
                         _____________________________________________________________________
                                           [FULL NAMES OF INSURANCE ADVISER]

                                      A representative of Accredinet Financial Solutions (Pty) Limited
                                 Accredinet is an authorized financial services provider, FSP number 8933

as my/our insurance Adviser and authorize them to perform all the necessary acts, to enable them/him to advise me/us to the
best of their ability.

I/We accept that –

1.         This appointment revokes any existing short-term Adviser appointment;

2.         The revocation of this appointment is subject to 30 days mutual written notice;

3.         This appointment grants Bwise Financial Solutions rights to all my/our information and authorizes all my/our
           documents, which were in possession of the previous Broker, to be transferred to me.

4.         Bwise Financial Solutions shall execute this mandate with reasonable care and expertise;

5.         To ensure continuous cover, a new policy will be issued through Bwise Financial Solutions in accordance with and
           based on the insured items as reflected on the latest policy schedule of my existing policy.

6.         Any change in respect of the risk, underwriting or personal information relevant to the insurance will be disclosed to
           Bwise Financial Solutions as soon as possible and that Bwise Financial Solutions will not be liable for any damage
           resulting from my/our breach of this duty

7.         My/our existing policy(s) with ______________________________________________ in future must be overseen in
           terms of this appointment as from __________________________________ and the adviser relationship to be
           transferred to Bwise Financial Solutions.

8.         For the purpose of obtaining one or more insurance quotations and in order to enable fair underwriting of insurance
           risks, I/we hereby authorise Bwise Financial Solutions and/or the relevant Administrator and/or the Insurer to access
           my credit information held by one or more of the registered credit bureaux as well as to verify and share policy and
           insurance claims information with insurers and other institutions. I/we understand that this consent may possibly
           have a restricting influence on my/our constitutional right(s) to privacy.

Signed _____________________________                                 Date _________________________________________

Designation _________________________________________________________________________________

DETAILS OF INSURED

Title ________               Initial _____________       Surname _____________________________________________

Name of Business                 ________________________________________________________________________

Identity number / Ck number / Company registration number: ________________________________________

Telephone             ( ) ______________________________________ ( ) Cell ______________________________

				
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