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2. Verify your email

Enter the six-digit code sent to your email address. The code expires after 10 minutes.

3. Register a password

Use your email address as your username. Your password must be at least 8 characters long and contain at least one uppercase letter, one lowercase letter and one digit.

Use at least 8 characters with one uppercase letter, one lowercase letter and one digit.

4. Personal details

5. Broker and referral

6. Product selection

Choose up to 30 products. When you choose a type, the next product row appears.

7. Current insurance

Add up to 10 current insurance policies.

8. Needs analysis

9. Disclosure by the financial services provider

10. Authorisation to obtain insurance information

I hereby authorise LANDCOR FSP (Pty) Ltd and any duly authorised representative acting on behalf of the company to obtain, receive, verify, discuss and exchange information regarding my/our insurance affairs with insurers, underwriting managers, administrators, previous brokers and any other authorised parties where reasonably necessary for:

• Obtaining quotations
• Policy reviews
• Preparing financial advice
• Arranging insurance cover
• Policy amendments
• Assistance with claims
• General administration and servicing of policies

This authorisation includes obtaining the following information:

• Existing insurance policies
• Claims history
• Premium history
• Risk information
• Policy schedules
• Underwriting information
• Previous advice records where applicable

11. Consent under the Protection of Personal Information Act (POPIA)

Your privacy matters

We respect your right to privacy and undertake to process your personal information responsibly under the Protection of Personal Information Act, 2013 ("POPIA"), the requirements of FAIS and any other applicable legislation.

Collection of information

I/We understand that the FSP may collect and process the following personal information:

• Identity and contact details
• Financial information
• Insurance information
• Claims information
• Risk-related information
• Bank details
• Information required by legislation or insurers

Purpose of processing

Personal information may be processed for:

• Financial advice
• Obtaining quotations
• Underwriting purposes
• Policy administration
• Claims handling
• Compliance with legal obligations
• Record keeping
• Fraud prevention
• Risk assessment

Sharing information

I/We consent to personal information being shared with:

• Insurers
• Underwriting managers
• Administrators
• Reinsurers
• Compliance officers
• Regulatory authorities
• Ombuds
• Service providers involved in financial services

Such disclosure will be limited to what is reasonably necessary to achieve the intended purpose.

Storage and security

The FSP undertakes to implement reasonable technical and organisational measures to protect personal information against loss, unauthorised access, disclosure, alteration or destruction.

Client rights

I/We understand that I/we have the right to:

• Access my/our personal information
• Request correction of incorrect information
• Object to certain processing activities
• Lodge a complaint with the Information Regulator where applicable

12. Client rights

I/We understand that I/we have the right to:

• Access my/our personal information
• Request correction of incorrect information
• Object to certain processing activities
• Lodge a complaint with the Information Regulator where applicable

13. Broker declaration

I, André van der Linde, am a duly appointed representative of LANDCOR FSP (FSP number 55687), an authorised financial services provider regulated by the FSCA under FAIS and licensed to provide financial advice and intermediary services relating to short-term insurance products.

My activities include providing advice, placing and administering short-term insurance policies in accordance with clients' risk and insurance needs.

I operate under the supervision of LANDCOR FSP, which includes oversight of my advice and intermediary activities, ongoing compliance monitoring and responsibility for regulatory compliance.

LANDCOR FSP accepts full responsibility for all services I provide within the scope of my appointment.

Since 2002 I have provided financial advice and intermediary services in the following areas:

• Commercial short-term insurance
• Personal short-term insurance

Authorised product categories (Category I)

• Personal short-term insurance
• Commercial short-term insurance

Product providers and accreditation

LANDCOR FSP holds written mandates and product agreements with approved short-term insurers authorising the marketing, distribution and placement of their products.

I am duly accredited to market these products and provide intermediary services.

Approved product providers include, among others:

Santam, OMI, King Price, Discovery, Indequity, Momentum, Cross Country, Auto & General, Verseker, First for Woman, HIC, Consort, Leppard.

All recommendations and placements are made in accordance with clients' needs analyses, applicable mandates, FAIS, FSCA and the principles of Treating Customers Fairly (TCF).

14. Client declaration

I/We declare and confirm the following:

15. Final review and submission

When you submit, the system creates a PDF reference record with your data, consents, date and electronic signature.

After submission, the record is stored, the PDF is created and a follow-up reference is generated.