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Intermediary Application

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Welcome to Cinagi Intermediary application process.

During this process we will require you to complete all the details required by our underwriter Infiniti Insurance to formally assess your application.

There are quite a few legislative requirements that will need to be completed and attached for the underwriter's review. To make things easier, you can save your application at any point and return at a later stage as we know it might take a bit of time to gather all requirements.

Once completed your application will be assessed and should your application be successful we will provide you with a formal Intermediary Agreement to be signed.


Responsible Person

Personal Detail*

Intermediary Information

Date business was established or incorporated
Type of Business:
Postal Address
Physical Address

FAIS License Details

Date license was obtained
License Categories you are accredited for*
Category I sub categories
Category II – Discretionary FSP
Category IIA – Hedge Fund FSP
Category III – Administrative FSP
Are there any restrictions placed on this license?
Please enter a number from 1 to 99.
Are any of the representatives, Juristic Representatives?*

Compliance Officer

Details of compliance officer*

Personal Indemnity Cover

Policy Inception Date*
Expiry or Renewal Date*

Banking Details

Current Arrangements

List the names of any Insurance company and / or Underwriting Managers with whom you are authorised to place business with.
Have any of the organisations key personnel (Including all KI's and Reps), ever been declared insolvent, placed in liquidation whether provisional or final or reached a compromise with creditors.
Are there any defaults and/or judgments against any of the organisations key personnel (Including all KI's and Reps) ?*
Do any of the organisations key personnel (Including all Ki’s and Reps, have any pending or criminal convictions or paid an admission of guilt fine other than speeding or parking offences?*
Has the company or any of the Partners/Members/Directors had any insurance intermediary agreement cancelled?*
Are there any material facts that are likely to influence the assessment of this application which will affect the decision made by Cinagi and/or Infiniti Insurance Limited (INFINITI) with regard to whether we do business with you or not ? If there are in any doubt as to whether a fact would be considered material, you should declare/explain it in order for us to make an informed decision.*

Supporting Documents

Please note any relevant information or attach any document to support this application. Below is a list of all the relevant documents we require to be uploaded in order to assess this application
Max. file size: 2 GB.
Max. file size: 2 GB.
Max. file size: 2 GB.
Max. file size: 2 GB.
Max. file size: 2 GB.
Max. file size: 2 GB.
Max. file size: 2 GB.
Max. file size: 2 GB.
Max. file size: 2 GB.
Max. file size: 2 GB.
Max. file size: 2 GB.
Max. file size: 2 GB.

Commitment to the following principles

This Intermediary Agreement application is being entered into on the clear understanding of the following principles, which are of critical importance:

  • Parties to conduct their affairs in accordance with all prevailing legislation, but over and above that, undertake to maintain high standards of honesty, integrity and transparency in their dealings with each other.

The parties further agree to:

  • maintain good administration and accounting standards and recognise that inefficiency in these areas ultimately result in problems for the business and the mutual relationship.
  • work together for the mutual benefit of all concerned, whilst never compromising fair dealing, honesty and speedy service to the policyholder.
  • advise of any conflicts as and when it happens.

In the event of these principles being breached, either party has the right to give notice to the other cancelling the agreement with immediate effect.

You further acknowledge that the sharing of information (including credit information) relating to intermediaries by Insurers is essential to enable the Insurance Industry to manage the business and to reduce the incidence of fraud, in the public interest. On behalf of yourself and on behalf of any person you represent herein, you hereby waive any right to privacy in any information provided by you or on your behalf in respect of the application to become an intermediary and you consent to such information being disclosed to any other insurance company or its agent.

You also acknowledge that the information provided by you may be verified against other legitimate sources or databases. You also waive any rights of privacy and consent to the disclosure of any information relevant to this application concerning yourself.

Consent*

Consent*


Important Notice: INFINITI will not accept responsibility for cover until written confirmation has been issued by Cinagi (Pty) Ltd of acceptance of this application. A formal Intermediary agreement will be entered into between INFINITI and yourselves, upon successful application and verification.

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).