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Lionel Isaacs Insurance Brokers (Pty) Ltd ("LIIB") is offering the iTOO [MY]CYlution Cyber Personal lines benefit. The details are fully displayed in the playbook provided and your dedicated underwriter is also available to discuss these benefits with you.
The form needs to be completed before this benefit can be placed on cover.
Please fill out the below mentioned client details to ensure appropriate personal information is obtained for risk purposes.
Your authorisation to Lionel Isaacs Insurance Brokers (Pty) Ltd as well as mandated insurance companies:
LIIB is a registered Financial Services Provider (FSP #13343) as a short-term insurance broker.
LIIB earns a binder fee of 3.5% on the premium as well as commission of 20% for every iTOO [MY]CYlution Cyber Insurance policy placed on risk by way of a binder agreement entered into with The Hollard Insurance Company.
LIIB levies an operations fee for risk and claims advice and service, as more fully set out in our comprehensive Guide to Financial Services (a copy of which is available on request). This operations fee also includes a recovery for certain costs related to acting as your independent intermediary, including training, information technology expenditure, audit costs and compliance expenditure. The relevant operations fee is fully disclosed in the policy documentation and/or schedule.
I hereby warrant that the details contained in the above particulars and statements are true and contain all information known to me affecting the risks insured and that this and any other statement made by me or on my behalf for the purpose of the proposed insurance shall be the basis of and incorporated in the contract between me and the insurer.
It is important that you should disclose all material facts, that is, those facts that would influence an insurer in the acceptance or assessment of your proposal. Failure to disclose such facts may result in claims not being met. If you are in any doubt about whether a fact is material you should disclose it. You should keep a record (including copies of letters) of all information supplied to us for the purpose of entering into this contract.
1st Floor, 33 Scott Street Waverley Johannesburg, 2090
Tel: (011) 483 1802 Fax: (011) 728 4350