Test LSG Insurance Posted on March 10, 2020 by LambertMarch 10, 2020 Contact Us Premium Table Revenue Per Annum Limit of R1m Annual Premium Limit of R1m Monthly Premium Limit of R2.5m Annual Premium Limit of R2.5m Monthly Premium Limit of R5m Annual Premium Limit of R5m Monthly Premium R1 – R500k 5,500 458.33 9,500 791.66 14,000 1,166.66 R500k – R1m 6,000 500.00 10,000 833.33 14,500 1,208.33 R1m – R1.5m 6,500 541.66 10,500 875.00 15,000 1,250.00 R1.5m – R2m 7,000 583.33 11,000 916.66 15,500 1,291.66 Excess: R10,000 For revenue per annum in excess of R2m please refer to simon@lsginsurance.co.za Extentions Cover First Amount Payable Limit of Indemnity Loss of Documents R25,000 5% of the main PI limit of indemnity maximum R500,000 in the aggregate Defamation (Libel and Slander) R10,000 R1,000,000 in the aggregate Statutory Defence Costs Nil R 250,000 in the aggregate Liability for Subcontractor Duties Follows PI Excess Follows PI Limit Participation in Joint Ventures Follows PI Excess Follows PI Limit Regulatory Body Defence Costs Follows PI Excess Follows PI Limit Risk Management Services Included Service Benefit to Client Crisis Communication & PR Public relations support and media disaster management Legal Support Contract vetting and management Private Arbitration Alternative options to costly litigation in commercial and employment disputes Insured PersonName of agency (If sole proprietor use name)* Registration number (If sole proprietor use identity number)* VAT number Company Registration Number Physical address*Postal address (if different from physical address)Telephone number* Fax Email* Website TurnoverTurnover*1-500,000500,000 – 1,000,0001,000,000 – 1,500,0001,500,000 – 2,000,000Greater than 2,000,000Limit of Indemnity*Please choose an option if you wish to pay annuallyAnnual Revenue R1 – R500k – Limit of R1m Annual PremiumAnnual Revenue R1 – R500k – Limit of R2.5m Annual PremiumAnnual Revenue R1 – R500k – Limit of R5m Annual PremiumAnnual Revenue R500k – R1m – Limit of R1m Annual PremiumAnnual Revenue R500k – R1m – Limit of R2.5m Annual PremiumAnnual Revenue R500k – R1m – Limit of R5m Annual PremiumAnnual Revenue R1m – R1.5m – Limit of R1m Annual PremiumAnnual Revenue R1m – R1.5m – Limit of R2.5m Annual PremiumAnnual Revenue R1m – R1.5m – Limit of R5m Annual PremiumAnnual Revenue R1.5m – R2m – Limit of R1m Annual PremiumAnnual Revenue R1.5m – R2m – Limit of R2.5m Annual PremiumAnnual Revenue R1.5m – R2m – Limit of R5m Annual PremiumLimit of Indemnity*Please choose an option if you wish to pay monthlyAnnual Revenue R1 – R500k – Limit of R1m Monthly PremiumAnnual Revenue R1 – R500k – Limit of R2.5m Monthly PremiumAnnual Monthly R1 – R500k – Limit of R5m Monthly PremiumAnnual Revenue R500k – R1m – Limit of R1m Monthly PremiumAnnual Revenue R500k – R1m – Limit of R2.5m Monthly PremiumAnnual Revenue R500k – R1m – Limit of R5m Monthly PremiumAnnual Revenue R1m – R1.5m – Limit of R1m Monthly PremiumAnnual Revenue R1m – R1.5m – Limit of R2.5m Monthly PremiumAnnual Revenue R1m – R1.5m – Limit of R5m Monthly PremiumAnnual Revenue R1.5m – R2m – Limit of R1m Monthly PremiumAnnual Revenue R1.5m – R2m – Limit of R2.5m Monthly PremiumAnnual Revenue R1.5m – R2m – Limit of R5m Monthly PremiumIf turnover greater than R2m please confirm turnover and we will send you a quote. Split business activity by revenue as a percentageResidential Sales %Commercial Sales %Residential Rentals %Commercial Rentals %Who is your current broker? Who are your current insurers / underwriters? When does your current policy expire? What was your last premium paid (inclusive of VAT)? Has any application for insurance of this nature ever been declined, cancelled or has renewal been refused or have special terms been imposed?:* Yes No If YES, please provide the reason for this below.4. CLAIMS OR CIRCUMSTANCES THAT COULD LEAD TO A CLAIMOver the past 5 years are you aware of the following against you* – Any claim/s being made or settled? – Any circumstance/s that could lead to a claim being reported to Insurers? Yes No If YES, please provide the reason for this below.After having made full enquiries, are you aware of ANY circumstances, no matter how remote, which may result in any claim being made against you which has not already been reported to Insured's?* Yes No If YES, please provide the reason for this below.I hereby authorise Camargue Underwriting Managers (Pty) Ltd or its authorised administrator to debit my account with the agreed monthly Insurance premium and collection fee. I understand that should my payment not be received by Camargue Underwriting Managers (Pty) Ltd or its authorised administrator by the 15th, there is no Insurance cover from the 1st day of that month and the Insurance policy will be cancelled, unless prior arrangements have been made.Total R0.00 Bank* Branch Code* Branch* Type of account* Account Number* Name of Account Holder* Notice: Debits cannot be raised through FNB Savings, Master Card Holders or account numbers exceeding 13 digitsDebit order date* 1st 15th I/we declare that after proper enquiry the statements and particulars given above are true and that I/we have not miss-stated or suppressed any material fact. I/we agree that this Proposal Form, together with any other material information supplied by me/us shall form the basis of any contract of insurance affected thereon. I/we undertake to inform underwriters of any material alteration to these facts occurring before the completion of the contract. I/We understand that submitting this electronic declaration form will from the basis of this contract. I/We understand that the premium includes regulated commission, charged at 20% of the gross premium, payable to the broker for services provided. I/we consent to a R80.00 broker fee* and either a R11.40 debit order charge or R15.00 cash deposit charge (whichever is applicable).*Explained in LSG Financial Services Guide. Insurance is not bound until accepted by insurers Only property in South Africa Insurers share information with each other regarding policies and claims with a view to prevent fraudulent claims and obtain material information regarding the assessment of risks proposed for insurance. By reducing the incidents of fraud and assessing risks fairly, future premium increases may be limited. This is done in the public interest and in the interest of all current and potential policyholders. The sharing of information includes, but is not limited to information sharing via the Information Data Sharing System operated by TransUnion ITC on behalf of the South African Insurance Association. By the insurer accepting this insurance, you or any other person that is represented herein, gives consent to the said information being disclosed to any other insurance company or its agent. You also similarly give consent to the sharing of information in regards to past insurance policies and claims that you have made. You also acknowledge that information provided by yourself or your representative may be verified against any legally recognised sources or databases. By insuring you hereby not only consent to such information sharing, but also waive any rights of confidentiality with regards to underwriting or claims information that you have provided or that has been provided by another person on your behalf. In the event of a claim, the information you have supplied with your application together with the information you supply in relation to the claim, will be included on the system and made available to other insurers participating in the Information Data Sharing System. When you enter into this policy you will be giving us your personal information that may be protected by data protections legislation, including but not only, the Protection of Personal Information Act, 2013 (“POPI”). We will take all reasonable steps to protect your personal information. You authorise us to: Process your personal information to Communicate information to you that you ask us for. Provide you with insurance services. Verify the information you have given us against any source or database. Compile non-personal statistical information about you. Transmit your personal information to any affiliate, subsidiary or re-insurer so that we can provide insurance services to you and to enable us to further our legitimate interests including statistical analysis, re-insurance and credit control. Transmit your personal information to any third party service provider that we may appoint to perform functions relating to your policy on our behalf. You acknowledge that this consent clause will remain in force even if your policy is cancelled or lapsed. Copy of policy wording available on request. Share this post