Broker Mandate I or We, the undersigned accordingly appoint EASYINSURE BROKERS (PTY) LTD, an authorised financial services provider (FSP no. 43413), to act as my/our Short Term Insurance Brokers effective from date of the undersigned <> The appointment will remain in force unless cancelled by myself or an authorised person in writing. This appointment is to be used as my/our authority to any underwriter to supply the appointee with details of all insurance covers held on my/our behalf, or associated companies to receive renewal invitations on my/our behalf until further advised by me/us. Organisation/Company Name(Required)Full Name(s) -Signatory(Required)Surname- Signatory(Required)ID Number-Signatory(Required)Designation/Role in OrganisationExecutive MemberManaging DirectorShareholderPower of AttorneyAppointed ProxySignature(Required)Date DD slash MM slash YYYY
