Broker Appointment

Name and Surname of Person completing this form

The person completing this field will be the policyholder or the representative of the policy holder if a legal entity.

ID Number

Email address of person completing this form

Phone

If the policyholder will be a Legal entity, complete the following:

Name of Company, CC or Trust

Registration Number of Legal entity

I hereby appoint Mooirivier Specialised Brokers FSP No. 54431 as my/our authorised insurance broker for the purposes of administering and managing my/our Tenrisk Rental and Eviction Cover policy/ies.

This appointment authorises Mooirivier Specialised Brokers (Pty) Ltd to:

Act on my/our behalf in all matters related to the initiation, servicing, amendment, and claims handling of the policy.
Act on my/our behalf in all matters related to the initiation, servicing, amendment, and claims handling of the policy.
Communicate directly with the insurer on my/our behalf, including the receipt and delivery of documentation.
Provide me/us with policy advice, premium updates, and risk management support relevant to the Tenrisk product.

I/We understand and confirm that:

This appointment does not preclude me/us from appointing another broker in the future but remains in effect unless revoked in writing.
Mooirivier Specialised Brokers (Pty) Ltd acts in accordance with the Financial Advisory and Intermediary Services Act (FAIS) and is a registered financial services provider.
All information submitted to the broker will be treated as confidential and processed in line with POPIA (Protection of Personal Information Act).

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