COMMERCIAL PROPOSAL
QUOTE / CLOSINGS - COMMERCIAL INSURANCE POLICY

Name of Company    
Broker / Agent    
Inception Date of Policy    
Insurance Company    
Risk Address: Postal Address:
Postal Code Postal Code
   
The Business / Occupation:
       
Client ID No / Company Reg No  
Vat Registration Number  
Contact Person    
Cell Telephone No
Fax No    
Email Address    
Previous Insurer    
   
Previous 3 Years Claims History
 
DEBIT ORDER DETAILS
Bank
Branch
Branch Code
Account Holder
Type of aAcount
Account Number
   
Signature of Account Holder
 
TOTAL PREMIUMS    
     
TOTAL PREMINUM Annual Monthly
Fire
Buildings Combined
Office Contents
Business Interruption
Accounts Receivable
Theft
Glass
Money
Fidelity Guarantee
Goods in Transit
Business All Risks
Accidental Damage
Public Liability
Employers Liability
Group Personal Accident
Stated Benefits
Electronic Equipment
Motor
Motor Traders Internal
Motor Traders External
Car Hire
     
SUB TOTAL    
     
SASRIA Fire
SASRIA Motor
Administration Fee
Policy Fee
TOTAL PREMINUM
     
FIRE AND ALLIED PERILS SECTION    
     
Desciption Sum Insured Premium - Monthly/Annual
     
Column 1    
Buildings including landlords fixtures & fittings therein and thereon, walls (except dam walls), gates, posts and fences
     
Column 2    
The number of months rent / rental value stated in the schedule.
     
Column 3    
Plant, Machinery, Landlords fixtures & fittings for which the insured is responsible and all other contents excluding property more specifically insured.
     
Column 4    
Stock & Materials in Trade
     
Column 5    
Miscellaneous as Described
     
Extensions and Optional Additional Perils:
Additional Claims Preparation Costs    
Geyser
Escalator Clause Extension
SASRIA
Leakage - First Loss Limit
Leakage - Total Sum Insured
Subsidence & Landslip
Theft of landord's fixtures and fittings
Deterioration of Stock (Temprature Clause)
TOTAL - FIRE SECTION  
     
FIRE AND ALLIED PERILS SECTION    
     
Automatic Additional Perils:
Earthquake Yes No  
Special Perils Yes No  
Malicious Damage Yes No  
     
Warranties    
Stock Declaration Conditions Yes No  
Disposal of Salvage Yes No  
Fire Appliance Warranty Yes No  
     
It is warranted that all appliances (including but not limited to hand fire extinguishers and fire hoses) will be serviced and maintained on an annual basis by an approved SABS 1475 Company.
It is further warranted that all appliances are wall-mounted with symbolic signage indicating their position and kept free from obstruction and easily accessible at all times.
     
Pallet Warranty Yes No  
     
It is warranted that all stocks are raised at least 150mm off the floor and placed on pallets, racks or the like. In the event of non compliance with this warranty, the Company shall not indemnify the insured in respect of water damage to such stocks.
     
Lightning First Amount Payable Yes No  
     
All loss or damage to insured property being Electronic Equipment and arising through the power source from Lightning Strikes will be subject to a First Amount Payable (in addition to any other First Amount Payable) of 10% of claim, subject to a minimum of R1,000 and a maximum of R5,000.However, should such insured property be fully protected against electrical supply variations with safeguards approved by the S.A.B.S. (or similar authority) then this First Amount Payable will be waived
     
Basic First Amount Payable Yes No  
     
% of claim, Minimum R , Maximum R
     
BUILDINGS COMBINED SECTION      
       
Premises & Desciption Sum Insured Rate Premium - Monthly/Annual
     
Additional Claims Preparation Costs
Escalation Clause Extension
Geyser
Theft of Landlord's fixtures and fittings
       
Extensions      
Subsidence & Landslip
Liability
SASRIA
       
First Amounts Payable
       
TOTAL - BUILDINGS COMBINED
       
       
OFFICE CONTENTS SECTION      
 
Premises & Desciption Sum Insured Rate Premium - Monthly/Annual
Contents - excluding computers      
     
Rent (25% of the sum insured of Contents)      
Legal Liability Documents
Increase in Cost of Working Extensions
Additional Claims Preparation Costs
Extensions      
Theft by Forcible Entry (25% of Contents SI)      
     
Full Theft Cover
SASRIA
       
First Amounts Payable      
Basic    
Theft    
Lighning    
       
Burglar Alarm Warranty Applicable? Yes No    
       
TOTAL - OFFICE CONTENTS    
       
       
BUSINESS INTERRUPTION SECTION
       
Desciption Sum Insured Rate Premium - Monthly/Annual
1) Gross Profit
Additions Basis / Difference Basis
2) Gross Rentals
3) Revenue
4) Additional increase in cost of working
5) Wages
No. of weeks basis - No. of weeks
Additional claims preparation costs
       
Indemnity Period      
SASRIA
       
Extensions      
Specified Suppliers / Sub Contractors
Unspecified Suppliers / Sub Contractors
Specified Customers      
Prevention of Access
Prevention of Access - Extended Cover
Public Liabilities
Public Utilities - Extended Cover
Public Telecommunications
Public Telecommunications - Extended Cover
Accidental Damage
       
TOTAL - BUSINESS INTERRUPTION  
       
THEFT SECTION      
 
Premises & Desciption Sum Insured Rate Premium - Monthly/Annual
Covering lossed accompanied by forcible and violent entry into or exit from the insured building or following violence or threat of violence.
Limit of Indemnity (First loss basis)
     
Extensions      
Buildings Increased Limit
Malicious Damage
       
Burglar Alarm Warranty Applicable? Yes No    
       
First Amounts Payable      
Basic    
Other    
       
TOTAL - THEFT SECTION    
       
MONEY SECTION      
 
Premises & Desciption Sum Insured Rate Premium - Monthly/Annual
Major Limit
(During normal business hours per situation)
     
Seasonal Increase      
Period:- (Please specify)      
     
In Custody a Collector, Roundsman or Petrol Attendant      
SASRIA Yes No    
       
Outside business hours in an approved safe R1500    
While in the resedidence of the Insured or a Partner, Director or Employee of the insured R1500    
In Custody of any Partner, Director, Employee while away from premises on a business trip R1500    
Crossed Cheques or Postal / Money Orders (payable in additional to the sums insured under the above items R100 000    
       
Extensions automatically included      
Clothing R2000    
Receptables R2000    
Locks and Keys R2000    
       
Extensions (Optional)      
Personal Accident
 - Capital Sum
 - Weekly Sum
 - Medical Expenses
Additional Claims Preparation Costs
       
First Amounts Payable      
Basic    
Armed Robbery / Hold up    
Other    
       
TOTAL - MONEY SECTION    
       
GLASS SECTION      
 
Premises & Desciption Sum Insured Rate Premium - Monthly/Annual
Major Limit
On Internal / External Plate Glass including Mirrors, Glass Shelving and Signwriting.
     
Additional Claims Preparation Costs
SASRIA Yes No    
Extensions      
Special Re-instatement Yes No    
       
First Amounts Payable      
First Amounts Payable    
       
TOTAL - GLASS SECTION    
       
       
BUSINESS ALL RISKS SECTION      
 
Item Desciption Sum Insured Rate Premium - Monthly/Annual
Miscellaneous Tools & Equipment - Maximum Value any one item.
     
SASRIA Yes No    
       
Extensions and Clauses      
Burglar Alarm Warranty Applicable Yes No    
Replacement Value Conditions Yes No    
Increase in Cost of Working Extension Yes No    
Lightning First Amount Payable Yes No    
       
First Amounts Payable      
Tools    
Cell Phones    
Laptops    
Other    
       
TOTAL - BUSINESS ALL RISKS SECTION    
       
GOODS IN TRANSIT SECTION      
 
Desciption of Goods Sum Insured Rate Premium - Monthly/Annual
Goods Consigned (Including ropes, tarpaulins and packing materials in connection with the transit) .
Limit and one Load / Conveyance      
Estimated Annual Carry      
       
Type of Goods      
     
       
Means of Conveyance      
     
       
       
Extensions and Clauses      
Debris Removal Yes No
Fire Extinguishing Charges Yes No
Fire, Explosion, Collision and derailment Limitation Yes No
Fire, Explosion, Collision and derailment, and theft resulting therefrom limitation Yes No
SASRIA Yes No
       
First Amounts Payable      
Basic
Hijack
Other
       
TOTAL - GOODS IN TRANSIT SECTION
       
ACCIDENTAL DAMAGE SECTION      
 
Premises & Description Sum Insured Rate Premium - Monthly/Annual
     
Defined Events (i)      
Accidental physical loss of or damage to the insured property at or about the premises by any cause not excluded by this section or otherwise insured or for which insurance is available and described in terms of any section (other than Business All Risks) listed in the index of this policy.
Limit of Indemnity
       
Defined Events (ii)      
Accidental physical loss of or damage to the insured property caused by discharge or leakage from Tanks, Pipes or Apparatus of Chemicals, Oils, Liquids, Fluids, Gases or Fumes (including loss of such Chemicals, Oils, Liquids, Fluids, Gases or Fumes) other than loss or damage resulting from wear and tear or other gradually operating causes of the Tanks, Pipes or Apparatus.
Limit of Indemnity
       
Extensions      
Leakage of oils / chemicals / fumes Yes No    
Additional Claims Preparation Costs Yes No    
       
Memoranda      
Average Yes No
Re-instatement Yes No
First Loss Average Yes No
Excluded Property (Describe) Yes No
       
First Amounts Payable      
Basic    
Other    
       
TOTAL - ACCIDENTAL DAMAGE SECTION    
       
PUBLIC LIABILITY SECTION      
 
Premises & Description Sum Insured Rate Premium - Monthly/Annual
General, Tenants & Workaway Liability      
Work Away Liability Limit      
Products Liability      
Annual Turnover      
Defective Workmanship      
Annual Wages      
EEC Liability      
Other      
     
Additional Claims Preparation Costs      
Legal Defence Costs R10 000 N/A Included
Wrongful Arrest & Defamation R50 000 N/A Included
(R50 000 per event - R100 000 per annual period of insurance)
       
First Amounts Payable      
Products Liability: % of Claim, minimum R , maximum R
Defective Workmanship: % of Claim, minimum R , maximum R
E.E.C. Liability: % of Claim, minimum R , maximum R
Basic / Other: % of Claim, minimum R , maximum R
       
Retroactive Date      
Retroactive Date:    
       
TOTAL - PUBLIC LIABILITY SECTION    
       
MOTOR SECTION
 
Description of Vehicle Cover Sum Insured Rate Premium - Monthly/Annual
Please included Year; Make & Model; Registration, Vin and Engine Numbers, any extras fitted (include in the sum insured) and SECURITY in the vehicle (tracking etc)
       
CAR HIRE        
14 Days 30 Days
PVT Type: R60 p/m p/v
LDV's: R75 p/m p/v		 PVT Type: R120 p/m p/v
LDV's: R150 p/m p/v
       
         
Total Number of PVT Type Vehicles (list vehicles if not all)      
Total Number of LDV's (list vehicles if not all)      
         
         
SASRIA (Private type etc - R2.00)        
SASRIA (LDV's, Commercial Vehicles Etc - R4.50)        
         
Extensions (Automatic)        
Windscreen
Yes      
Loss of Keys
Yes      
Wreckage Removal
Yes      
Radios / Tape players etc.
Yes      
Telephones Yes      
         
EXTENSIONS (Optional)        
Credit Shortfall Yes No      
Loss of Keys - Increased Limit Yes No      
         
TOTAL - MOTOR SECTION      
         
Description of Vehicle 0        
Registration Number:
Extras fitted & Values
VIN / Chassis Number
Engine Number
Registered Owner
Interest Noted (e.g. Finance House)
Regular Driver
Regular Driver ID Number
Type of Cover
Class of Use
Security Fitted (i.e. F/Fitted, Tracking etc)
COMPREHENSIVE TP, FIRE & THEFT TP ONLY
Business Private
                                                                                                                                                       
 
MOTOR TRADERS INTERNAL SECTION
 
Premises & Description Sum Insured Rate Premium - Monthly/Annual
Damage to any vehicle owned by the Insured and/or their Customers including Dealers Stock and Accessories and Spare Parts whilst thereon occurring whilst the vehicle is in or on the Insured's premises.
       
Loss or Damage to insured vehicles - Limit of Liability      
     
Liability to Third Parties - Limit of Indemnity      
     
Extensions and Limitations      
Work Away from Premises Yes No
Car Hoists Yes No
Third Party Only Limitation Yes No
Windscreen Cover Yes No
       
First amounts payable      
Basic: % of Claim, minimum R
Windscreen: % of Claim, minimum R
       
TOTAL - MOTOR TRADERS INTERNAL
       
MOTOR TRADERS EXTERNAL SECTION
 
Details Sum Insured Rate Premium - Monthly/Annual
Loss of or damage to an insured vehicle and it's accessories and spare parts whilst thereon, including Customers Vehicles and Dealers Stock, occurring whilst the vehicle is:
a)  on the road
b)  temporarily garaged elsewhere than in or on any business premises owned by or in the occupation of the insured.
       
Basis of Insurance - Wages Basis      
Loss or Damage to Insured Vehicle - Limit of Indemnity      
Liability to Third Parties - Limit of Indemnity      
       
Extensions and Limitations      
Social, Domestic & Pleasure purposes Yes No
Named Persons (if applicable)
     
     
Courtesy Vehicles Extension
 Yes No
Loss of Use of Customers Vehicles Yes No
Windscreen Yes No
Unauthorised Use by Employees Yes No
Legal Liability of Passengers for acts of negligence Yes No
Legal Liability in respect of Passengers (Motorcycles/Scooters) Yes No
Driving of Motorcycles Yes No
Cover for Motorcycles/Scooters only Yes No
Cover for Special Type Vehicles only Yes No
Exclusion of Own Vehicles Yes No
Exclusion of Demonstration Risk Yes No
Exclusion of Legal Liability in respect of Passengers  Yes No
Restricted Cover (Third Party, Fire & Theft) Yes No
Third Party Only cover Yes No
       
First amounts payable    
Basic    
Theft    
Windscreen      
       
MOTOR TRADERS EXTERNAL SECTION
       
ELECTRONIC EQUIPMENT SECTION
 
Premises / Description Sum Insured Rate Premium - Monthly/Annual
Sub-Section A - Material Damage
     
Sub-Section B - Consequential Loss      
Increased Cost of Working      
Time Excess: 24 hours
Indemnity Period: 3 Months
       
Reinstatement of Data      
       
Extensions  
Transit to and away from premises Yes No
Telkom Access Lines Yes No
Failure of Electricity Extension Yes No
SASRIA Yes No
   
First amounts payable      
Reinstatement of Data
Basic
Laptops / Portable Equipment
Lightning / Powersurge
Other
       
TOTAL ELECTRONIC EQUIPMENT SECTION
       
ACCOUNTS RECEIVABLE SECTION
 
Description Sum Insured Rate Premium - Monthly/Annual
Outstanding Debt Balances
Additonal Claims Preparation Costs      
       
Are Duplicate records maintained and stored at different premises from the originals? Yes No
Are records kept in fire-resistant safe, cabinet or strong room? Yes No
       
Transit Extension  
Duplicate Records Yes No
Protections Warranty Yes No
   
TOTAL ACCOUNTS RECEIVABLE
       
FIDELITY GUARENTEE SECTION
 
Description Sum Insured Rate Premium - Monthly/Annual
Blanket Basis
Limit of Indemnity      
Number of Employees      
Named Basis      
Limit of Indemnity      
List of Employees & Positions
     
Additional Claims Preparation Costs      
       
Extensions  
Retroactive Cover - 12 months Yes No
Superseded Policy - years Yes No
Details
Insurer
Polcy Number
Sum Insured
Voluntary First Amount Payable Yes No
   
Cost of Recovery (where loss exceeds sum insured) Yes No
Computer Losses Extension Yes No
   
First amounts payable    
       
TOTAL - FIDELITY GUARENTEE
       
EMPLOYERS LIABILITY SECTION
 
Description Sum Insured Rate Premium - Monthly/Annual
 
Limit of Indemnity
       
Retroactive Date
       
Employees details Estimated Annual Earnings    
   
     
       
TOTAL - EMPLOYERS LIABILITY SECTION
       
DECLARATION
 
I warrant that the answers given are true, and I do not know of any material facts, even though specific questions about them have not been asked, that should be communicated to the Insurer. I have never been refused insurance for the risks I now wish to insure nor have I had any policy in which I have or had an interest, cancelled or restricted.
 
On my behalf and on the behalf of any person I represent herein, I hereby waive my right to privacy with regard to underwriting or claims information (including credit information) that I provide or that is provided by another person on my behalf in respect of any insurance policy or claim made or lodged by me. I acknowledge that the insurance information provided by me may be stored in the shared database and used as set out above as well as for any decision pertaining to the continuance of my policy or the meeting of any claim I may submit.
 
I consent to such information being disclosed to any other insurance company or its agent.
I acknowledge that the information may be verified against legally recognised sources or databases.
 
I AGREE THAT this proposal shall be the basis of the contract between the insurer and myself.
I WILL ACCEPT the insurer’s standard Commercial policy.
I UNDERSTAND THAT this insurance will not start until this proposal has been accepted by the insurers.
 
If you are unable to sign this declaration without qualification, please give your reasons here
 
 
CONTRACT OF APPOINTMENT
     
BETWEEN COMPENDIUM INSURANCE GROUP (PTY) LTD AND
     
This document contains the following:
  1. Disclosure Notice
  2. Statement of Terms of Business
  3. Complaints Procedure
     
DISCLOSURE NOTICE
INFORMATION ABOUT THE INTERMEDIARY  
Compendium Insurance Group (Pty) Ltd (referred hereafter as “Compendium”) is a registered Financial Services Provider under licence numbers 10409 and 10405, is a member of the Financial Intermediaries Association and possesses an Intermediaries Guarantee Facility, as well as Professional Indemnity cover. We also have Directors’ and Officers’ Liability and Fidelity Guarantee Cover.
     
Compendium’s contact details
2nd Floor, Compendium House
5 The Crescent, Westway Office Park
Westville
Kwa-Zulu Natal
South Africa
     
Tel: 031 2426 800
Fax: 031 2426 850
E-mail: info@cig.co.za
Website: www.cig.co.za
     
Legal status:    
Private Company with limited liability.    
     
IN THE INTERESTS OF DISCLOSURE

Compendium Investment Holdings (Pty) Ltd is the major shareholder of Compendium. The Hollard Insurance Company has a 30% equity stake in Compendium Investment Holdings (Pty) Ltd.

Cignet Administration Services (Pty) Ltd is a subsidiary of Compendium Investment Holdings (Pty) Ltd and receives remuneration for various administrative duties performed on behalf of several Insurance Companies.

The ultimate decision in regard to your policy / policies, premiums and claims is made by your Insurer. They are subject to the ruling by the Registrar of Short Term insurers and the Short Term Insurance Ombudsman.

Compendium does not receive more than 30% of its revenue from any one Insurer.
     
COMPENDIUM UNDERTAKES TO:
  • Deliver services honestly and with diligence.
  • Protect the Client’s insurance interests.
  • Communicate information that is clear, factually correct and not misleading.
  • Manage conflicts of interests and disclose the same to the Client.
  • Provide information that allows the Client to make an informed decision.
  • Deal with Client information in a confidential manner.
     
COMPENDIUM WILL:
  • Explain the scope of cover, the costs involved as well as any significant restrictions, exclusions or conditions that
    may apply.
  • Arrange cover in accordance with the Client’s instructions, disclose details of the participating Insurers and provide
    the Client with a policy together with all related documentation.
  • Ensure that premiums received from the Client, in terms of cover provided by the policy, are paid over to Insurers.
  • Provide the Client with guidance on instituting a claim under the provisions of the policy, manage the claim and
    update the Client on the progress.
  • Upon receipt of the Insurers claim's settlements, make payment to the client on behalf of the Insurer.
  • Disclose commission and fee earnings flowing from the Client’s insurances.
     
AS THE CLIENT, I UNDERTAKE TO:
  • Disclose all material information when obtaining cover. (Information is deemed “material” if it could affect the
    Insurer’s assessment of the risk). Insurers have the right to void the policy and reject claims should any information
    deemed material be omitted or misrepresented.
  • Accept ultimate responsibility for the accuracy of the information submitted to Compendium or the Insurers, and
    shall have no claim against Compendium for any damage, financial or otherwise, arising from the failure to submit
    information deemed to be material, including belated submissions.
  • Notify Compendium of any changes to my / our risk profile or business throughout the term of the policy.
  • Submit all instructions to Compendium in writing. Oral communication must be followed up with a written
    instruction.
  • Complete a proposal form and / or risk questionnaire where required by Compendium and / or the Insurer.
  • Pay premiums on time in accordance with the payment terms, remembering that non-payment or late payment
    may result in the prejudicing of a claim.
  • Report incidents, which may give rise to a claim, to Compendium.
  • Act in good faith at all times.
     
HOW TO INSTITUTE A COMPLAINT

Any complaint must be reported to the Compendium Complaints Department. Compendium undertakes to
investigate the complaint fully and register it in their complaints register. Contact:

Compendium Complaints Department
PO Box 2800
Westway Office Park
3635
Email: complaints@cig.co.za
     

If the matter is not satisfactorily resolved by the Compendium Complaints Department, you can then contact the Ombud:

Short Term Insurance Ombudsman
PO Box 74571
Lynwood Ridge
0040

Tel: 012 470 9080
Fax: 012 3483 447
E-mail: info@osti.co.za

If you have a complaint regarding our services as brokers, contact:

Financial Advisory and Intermediary Services (FAIS)
Ombudsman
PO Box 74571
Lynwood Ridge
0040

Tel: 012 470 9080
Fax: 012 3483 447
Email: info@faisombud.co.za
     
Signed by (full name)
at on this day of 20
Signature
 
 
       
IN TERMS OF POLICYHOLDER PROTECTION LEGISLATION, IT IS AN OFFENCE FOR ANYBODY OTHER THAT THE PROPOSER TO SIGN THE PROPOSAL FORM.
SASRIA COVER WILL BE AUTOMATICALLY INCLUDED WHERE APPLICABLE UNLESS OTHERWISE STATED
WE REMIND YOU NOT TO SIGN ANY BLANK OR PARTIALLY COMPLETED FORMS.
REMEMBER, NO LIABILITY WILL ATTACH TO THE INSURER UNTIL THIS PROPOSAL HAS BEEN ACCEPTED BY THE INSURER.