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Phone: +27 11 326 4775       Help Center

Insure Safe Advisors

Bringing Fitness to You

Proposal Form Fitness Instructors

Insure Safe Advisors

Names and Qualifications of Principals


Types Of Instruction Given


Personal TrainerGroup TrainerSwimmingWalkingOther
Type of Instruction

FOR THE TYPE OF INSURANCE NOW BEING PROPOSED, HAS ANY INSURER EVER:


CLAIMS


SUM INSURED REQUIRED


R1m – Premium R421.67 per annum plus a R25 admin fee = R446.67


R2,5m – Premium R615.86 per annum plus a R25 admin fee = R640.86


R5m – Premium R781.30 per annum plus a R25 admin fee = R806.30


Broker Information

Broker Name: Mrs S Botha

Company: Insure Safe Advisors cc

Contact number: 011 326 4775

Email: sophia@insuresafeadvisors.co.za


Declaration

To the best of my knowledge and belief the information provided in connection with this Proposal, whether in my own hand or not, is true and
I have not withheld any material facts. I understand that non-disclosure or misrepresentation (whether innocent or not) of a material fact will
entitle the Underwriters to void the Insurance.
I understand that the signing of this proposal does not bind me to complete the insurance but agree that, should a contract of Insurance be
concluded, this Proposal and the statements and representations made herein shall form the basis of the insurance contract.


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+27 11 326 4775

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