Broker Appointment Form

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Broker Appointment Form

Name(Required)

First Last

ID Number(Required)

Policy Number(Required)

Email(Required)

Member Cell Number(Required)

Date from which the appointment applies(Required)

Details of Advisor

Advisor Name(Required)

Name Surname

Brokerage(Required)

Brokerage FSP Number(Required)

Email(Required)

Cell Number

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Cinagi (Pty) Ltd is an authorised financial services provider (50104), an underwriting manager underwriting on behalf of Infiniti Insurance Ltd, an insurer licensed to conduct non-life insurance business and an authorised financial services provider (35914), and on behalf of Bryte Life Co Ltd, an insurer licensed to conduct life insurance business and an authorised financial services provider (17705).