“An Insurance Agent who assists an applicant to complete application or proposal form for insurance shall be deemed to have done so as the agent of the applicant – Section 54 (2) Insurance Act, 2003”.
Please Answer ALL questions in full. Use CAPITAL LETTERS
Name of Proposer:
Email Address (*)
Phone Number (*)
2. Valid ID (Driver’s License/National ID/International Passport):
4. Form CO2:
5. Form CO7:
6. Memorandum & Article of Association:
7. Authorization to Operate from Relevant Regulatory Bodies:
8. Shop Inventory:
I/We, hereby declare that the above particulars and answers are true and complete in every respect and that no information has been suppressed or withheld. I/We further declare that if such statements and particulars are in the writing of any person other than myself/ourselves such person shall be deemed to have been my/our agent for the purpose of filing the form.