BrokersElevate Admin2021-10-12T12:43:19+02:00 Apply now to start selling Elevate products! INTERMEDIARY HOUSE DETAILS Company Type PartnershipCCLTD CompanySole proprietorOther Same as above Category/ies of insurance associated with your FAIS Licence Category ACategory B1Category B1 -ACategory B2Category B2 -ACategory CNone of the above Holder of Professional Indemnity insurance? YESNO Did you earn 30% or more of total commission for the previous year from a specific Insurer Product Provider? YESNO Do you own 10% or more of issued shares directly/indirectly in any Insurer/Product Provider? YESNO Are you an associated company of any Insurer/Product Provider? YESNO Does your organisation meet the FAIS operational requirements? YESNO Does your organisation comply with FAIS financial soundness requirements? YESNO KEY INDIVIDUAL (KI)/AUTHORISED SIGNATORY DETAILS Key Individual/Authorised Signatory details ×Remove × Do all KI’s of your organisation meet FAIS fit and proper requirements? YESNO COMMISSION PREFERENCE As and whenInstalmentUpfront VAT DETAILS Is intermediary house registered for VAT? YESNO Does your turnover exceed R1 000 000 p.a.? YESNO COMPLIANCE OFFICE (CO) DETAILS - WHERE THERE IS NO IN-HOUSE CO FSCA registered? YESNO DIRECTORSHIP DETAILS - INCLUDES MEMBERS, DIRECTORS, PARTNERS, OWNERS Add another Director / Member / Partner / Owner ×Remove × Have any partner/ Director/Member or Owner ever been insolvent, under provisional liquidation or compromised with creditors? YESNO Have any partner/ Director/Member or Owner ever been found guilty or any crime, or any civil or criminal legal proceedings in action against any partner/ Director/Member or Owner? YESNO DEED OF SURETY - APPLICABLE TO ALL THOSE STANDING SURETY INCLUDING SPOUSES Add another Surety ×Remove × EXISTING CONTRACTS WITH OTHER INSURERS Commission Type UpfrontAs-and-whenInstalment/AnnualisedNot Applicable Add Existing Contract with Another Life Insurer ×Remove × Has any previous insurer declined to grant you or your intermediary house a contract? YESNO If yes, Why? POLICYHOLDER PROTECTION RULES (PPR) Does your house comply with PPR? YESNO If no, please provide details Do you send all statutory notices to clients? YESNO Do you disclose all admin fees? YESNO Do you disclose all commissions? YESNO Contact us : firstname.lastname@example.org × Thank you for the information. An Elevate consultant will be in contact shortly to complete the application process. All Elevate Life policies are underwritten by Centriq Life Insurance Company Ltd. (“Centriq”), a licensed life insurer and authorised financial services provider (FSP 7370).