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THOMAS SMITH INSURANCE BROKERS LTD

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					                T HOMAS S MITH I NSURANCE B ROKERS L TD .

                                                                    BROKERS’ APPOINTMENT FORM

 By way of this Brokers’ Appointment Form, with immediate effect we appoint Thomas Smith Insurance Brokers Ltd to act as our Insurance Brokers
 within the scope of the Insurance Brokers and Other Intermediaries Act 1998.

 We require Thomas Smith Insurance Brokers Ltd to review and advise us on our business insurance policies or any insurance quotations in hand and, if
 considered necessary, obtain alternative quotations. We also request that you assist us in the placing and administration of insurance covers and of
 any claims that we may submit in the course of your appointment. We request that any insurance supplier provides you with assistance and information
 as may be required, including information of any claims notified before or after this appointment. We also authorise you to collect outstanding claim
 proceeds due to us.

 In addition this appointment provides our consent for Thomas Smith Insurance Brokers Ltd and/or its insurance brokers and/or authorised personnel at
 any insurance company, intermediary or surveyor or adjuster to process “personal or corporate data” provided that this processing relates to the
 underwriting or administering of insurance policies, the surveying, handling, adjusting and settling of claims, the keeping of statistics and the prevention
 and suppression of fraud, and as long as such processing complies with the Data Protection Act 2001.

 Furthermore and specifically in relation to ‘sensitive personal data’ required for medical and life insurance policies we in addition authorise any doctor,
 hospital, laboratory or other health or life assurance provider or their service providers to provide full medical information and details concerning myself
 or my dependents provided this information is requested in accordance with the consent provided above.

 We authorise you to keep me informed by mail, facsimile, e-mail or other electronic means, of your products and services, which you consider might be
 of interest to us. Should we wish to revoke this consent we will inform you accordingly. This appointment will remain valid until we advise you
 otherwise.

 THE ADVANTAGE OF AN INSURANCE BROKER
 Because we are an insurance broker, we work for YOU. This means that we provide continuous assistance to satisfy your insurance needs.
 When you talk to Thomas Smith Insurance Brokers, you deal with insurance professionals who know how to match your requirements with the
 right policy, and the right Company, at the right price.

 When you buy insurance through a broker, you are using the services of qualified professionals who understand your needs. We operate
 independently of any insurance company, and solely on your behalf.

 More importantly, we are not tied to any one insurance company. We have access to an extensive range of products offered in the insurance
 market.

 When you appoint Thomas Smith Insurance Brokers to act on your behalf, you are assured that we will do everything in our power to find the
 best protection to suit your specific needs.

 WHY IT MAKES SENSE TO TALK TO A BROKER
 An insurance broker offers you:
     Quick and easy access to the best policies from the major companies.
     Impartial advice on the coverage that is right for your needs.
     The most advantageous terms available in the market.
     Assistance with fast and satisfactory settling of claims.

 WE WORK FOR YOU… AND ONLY YOU
 Shopping around for insurance can be a bewildering task. Thomas Smith Insurance Brokers will make insurance buying much easier for you.
 By using our experience and expertise, we will assess the many policy alternatives available on the market.

 Then, guided by your requirements, we will work with you to select the coverage that provides you with the best value for money.

 WE SPEAK FOR YOU
 Speaking to a large insurance company can, at the best of times, be frustrating or intimidating. At Thomas Smith Insurance Brokers we build
 up a personal relationship with you, our client, and deal with Insurers on your behalf.

 Speaking to us is easy, and gets results.
 Remember, WE ARE ON YOUR SIDE.
 Client satisfaction is our number 1 objective. Our success and reputation depend on just that.

 Name:
 Address:
                                                                                                         E-mail:
 Phone/Fax Number:                                                                                       ID or company
                                                                                                         registration no:
 Signature                                                                                               Date:

*In the event that insurance cover is provided to named additional assureds or named policyholders that have or will be providing “personal data” or “sensitive personal data” within the
meaning of the Data Protection Act 2002 then this form of authority and consent must be signed by each named additional assured or named policyholder.



                   11A St. Christopher Street, Valletta VLT 1468, Malta Tel: 22058000 Fax: 22058289
                     e-mail: broker@tcsmith.com Website: www.tcsmith.com CO. REG NO. C40721

                                               Company Directors: J. Gerada, C.M. Gerada, D. Galea

				
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