Apply to become a CTU Approved Broker

We want to work with you!

But before we can, we need to know more about you.

Please complete this form and provide all additional documentation as advised.

Please note that by completing and submitting this form, you are consenting to us storing and processing the information provided. The information will be stored as long as it is required or relevant. Upon expiration of its relevance, it will be destroyed.

Agency Application Form

Business Addresses

Is Postal Address same as Physical?

Contact Details

Email Addresses

Full Names and ID numbers of Directors

Do you have professional indemnity cover?

Please upload confirmation of professional indemnity cover

Upload File

Provide the name of any other short term insurance companies -

For which you are currently acting:

For which you have acted in the past:

Are you a VAT Vendor?

If you are a VAT Vendor, we require your VAT number and a copy of your VAT certificate.

Upload VAT Certificate

What will be the estimated premium income we may expect from your agency per annum?

Are you a member of any broking or insurance association?

Have you ever been insolvent, placed in liquidation, declared bankrupt or reached a compromise with any of your creditors?

Does any party to this application have any defaults and / or judgements against them?

Does any party to this application have any pending or criminal convictions, paid an admission of guilt fine? (Other than speeding or parking offences)

Has the company or any of the Partners / Members / Directors had an insurance agency cancelled previously?

In general terms, please describe how you propose to obtain new business

Have you embraced TCF principles at the highest management level?

Do you have a formal TCF program in place?

Who is in charge of your TCF program?

Who is / are the key individual/s in your business?

Are all persons who will provide advice on our products registered as representatives with the FSB?

Are representatives under supervision monitored as required by FAIS legislation?

Do you require training for your staff on our products?

Do you undertake to ensure that all communications, policy docuemnts and information provided by us will be given to mutual clients without delay?

What is the company procedure for handling queries or complaints from clients?

Do you have any formal in-house training programme/s?

Do you have any informal training programme/s? e.g. Mentorship / transfer of knowledge programmes?

Do you make use of any outsourced training programmes?

Do you use any other means of conveying knowledge and keeping employees up-to-date? e.g. newsletters, internet resources, communique?

How often are these mediums utilised?

Do you have a clear understanding of your duties as specified in the short term insurance Policyholder Protection Rules?

Does your company see itself as being PPR compliant?

Do you need hollard to provide any further training with regard to PPR issues?

Accreditiation

Will you be able to individually accredit all employees who are deemed to be competent and proficiemt in marketing or varying Hollard products?

Will only accredited people market or vary any Hollard products?

Will you be able to keep an ongoing register of all such people accredited by you?

Will you be able to provide such a register to Hollard on at least a quarterly basis?

If you have answered "No" to any of these accreditation questions, please provide more information.

Please upload the following additional documents that we require.

FAIS License

Upload File

BBBEE Certificate

Upload File

Proof of Banking Details

Upload File

Please also download, complete, commission and re-upload the following affidavit document.

BBBEE Affidavit.pdf

Completed B-BBEE Affidavit

Upload File

Thank you for applying! We will consider your application and get back to you as soon as possible.

We want to work with you!

Agency Application Form

Business Addresses

Contact Details

Email Addresses

Full Names and ID numbers of Directors

Do you have professional indemnity cover?

Provide the name of any other short term insurance companies -

Are you a VAT Vendor?

Are you a member of any broking or insurance association?

Accreditiation

Please upload the following additional documents that we require.

Please also download, complete, commission and re-upload the following affidavit document.

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CTU is an authorised financial service provider FSP Licence No.5010

CTU is underwritten by The Hollard Insurance Company Limited (Reg. No. 1952/003004/06), a Licensed Non-Life Insurer

and an authorised Financial Services Provider.

Clarendon Transport Underwriting Managers