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Appointment of Short Term Insurance Brokers

    I/We, the undersigned






    (If completing on behalf of a company or organisation)



    On this date




    By completing this form (electronically or otherwise) you hereby appoint Dougall Insurance Brokers (PTY) Ltd t/as Crawford Dougall Insurance Brokers (“Crawford Dougall”) to act as your insurance brokers and risk consultants to, inter alia, obtain, manage and maintain your insurance portfolio as agreed upon.


    I/We confirm and accept that:

    • This appointment revokes any previous short-term insurance broker’s appointment.


    • This appointment shall entitle Crawford Dougall to arrange insurance cover as required by me/us and to obtain whatever information may be required from my/our previous broker or insurer.


    • I/We agree to furnish whatever information is necessary which may in any way affect the assessment of the risk and, in turn, the decision of the insurer to insure the risk, as well as the premium payable.


    • I/We will notify Crawford Dougall as soon as reasonably possible of any change in circumstances or information which is material to the risk.


    • Failure on my/our part to provide any such information timeously will render your policy of insurance null and void.


    • The obligation of disclosure is not only limited to material circumstances or information of which I am/We are aware but also extends to those circumstances which I am/We are to be aware of in the ordinary course and scope of my/our business.


    • I/We acknowledge that the decision as to what to insure, the classes of insurance to be insured and the values or limits to be insured are my/our responsibility alone.


    • Crawford Dougall does not offer legal opinion or valuation services.


    • All Premiums Due shall be paid to Crawford Dougall prior to the inception of your policy or in accordance with your policy conditions.


    • Fees earned by Crawford Dougall are strictly in accordance with the PPR (Policy Holder Protection Rules). Crawford Dougall hereby confirms that additional service fees are charged, including but not limited to Risk Management Advice, Claims Negotiation, Broker Consulting comprising but not limited to Annual, Quarterly or Monthly meeting discussions and non Policy / general advice. I/We acknowledge that Crawford Dougall reserves the right to charge the abovementioned additional fees and disbursements for the services rendered, at a rate not greater than 10% of the Gross Premium.


    • On the happening of any event which may result in a claim under my/our policy of insurance I/we shall at my/our own expense give notice to Crawford Dougall as soon as reasonably possible and provide whatever particulars are necessary in relation to the claim.


    • I/We accept that late notification of any claim or loss may prejudice reimbursement and could lead to a complete repudiation of a claim.


    • In the event of a loss occurring, I/we agree to take all reasonable steps to mitigate or minimise my/our loss and or damage. Failure to do so may affect the outcome of my/our claim.


    • On the happening of any event in respect of which a claim or potential claim may be made under your policy of insurance, I/we acknowledge that I/we are duty bound not to admit liability, offer to pay any amount, or indemnify a third party with the written consent of my/our insurer.


    • As a professional organisation, Crawford Dougall’s Professional Indemnity Liability is limited to R5-Million for any single claim. Should you wish Crawford Dougall to purchase an increased limit on your behalf, this may be done on request.


    • I/We confirm that this letter of Appointment supersedes any previous Letter of Appointment duly signed between myself/ourselves and Crawford Dougall.


    • Acceptance of this letter of Appointment is prima facie evidence that the signatory is authorised to appoint Crawford Dougall as my/our insurance broker.


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