PROFESSIONAL INDEMNITY INSURANCE FOR REAL ESTATE AGENTS
PROPOSAL FORM


IMPORTANT NOTICE:
  1. Statement Pursuant to Section 25(5) of the Insurance Act. You are to disclose on this Proposal Form fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder may be void.
  2. Please note that this insurance is subject to the premium being paid and received in full by the Company (a) before the inception date where the Policy is issued to an individual; or (b) within the period specified in the Premium Payment Warranty applied to the Policy in all other instances, failing which there will be no liability under this cover.
  3. The liability of the Company does not commence until proposal is accepted.



Fields marked with * are required. 		 

PARTICULARS OF APPLICANT

Name:* Marital Status:
Address:* Date of Birth:*
IEA Member:*

  Since

CEHA Member:*

Real Estate Agency /
Firm: *		 Joined Profession Since:*
Other Occupation /
Business (if any):		 NRIC/Passport No:*
Nationality:* Email:*

Residential
Phone Number		 Office
Phone Number
Hand Phone Number*

COVERAGE REQUIRED

Period of Coverage
12 months commencing from the first day of - (first day) to

DECLARATION

I hereby declare that:

Professional Indemnity Insurance

  • I have not been a subject of disciplinary or criminal actions by the authorities or any Real Estate Agency/Firm whom I represent as a result of my professional activities.
  • During the last 5 years, there have not been any claims made against me, nor negligence alleged against me, nor are there now pending suits, claims, or proceedings against me.
  • I am not aware of any circumstances which may result in any claim being made against me.

I hereby declare that the statements and particulars in this proposal are true and that I have not misstated or suppressed any material facts, and that every reasonable effort has been made to obtain sufficient information to facilitate the proper and accurate completion of this proposal.

I will give notice to Tenet Insurance Company Ltd of any change in health, occupation, activities or country of residence or any material alteration to other facts whether occuring before or after completion of the contract of insurance. I agree that this proposal, together with any other information supplied by me form the basis of any contract between me and Tenet Insurance Company Ltd.


*  I agree to the above declaration.
Please charge  S$ (inclusive of GST)   to my  
Card No. *                    Expiry Date -



 
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