Professional Indemnity Insurance Cover for individuals and sole proprietors

If you move your mouse (hover slowly) over the blue questions marks that you see on the form below, you will see additional information about that particular question and hints or guidelines on how to complete the question.


Qualifying criteria
Claims or Complaints
This serves as further confirmation that you have declared that you comply with the qualifying criteria questions on the previous screen. If this is NOT correct, please click here to be taken to the appropriate screen in the registration process. ?
SACNASP Registration Details
Option 1:
Please enter your SACNASP Registration Number in order to confirm that you are a fully-paid up, registered scientist with SACNASP.
OR
Option 2:
If you have submitted your registration application to SACNASP and have not yet received official notification of registration enter the date of your submission of documents.


SACNASP Category of registration: ?
Primary Field of Practice as per SACNASP Registration: ?
Record of Advice Documents & Authority

Please do not proceed until you have read these documents in their entirety. This PDF Documents will open in a separate browser window/tab for you to read. When you have done so, come back to this window / tab to proceed to complete the form.


Please click on the name of the document (blue) to open it for reading (and saving to your computer).

(a) SPIIS Master Policy Document and Notes - General .
(b) SPIIS Additional Documents and Notes for Individual Cover .

I confirm that I have read, understood and agree to the contents of both the SPIIS Master Policy Document and Notes - General and SPIIS Additional Documents and Notes for Individual Cover.

I authorise and instruct CFP Brokers CC to place my professional indemnity insurance with the Hollard Insurance Company Limited
Indemnity Insurance
Your insurance history
Previous Insurance ? I have never had indemnity insurance before
I have had previous indemnity insurance
Previous Insurance company ?
Policy or certificate number of my expiring policy document. ?
Previous / Current Policy Expiry Date ?
Please enter the retroactive cover date that appears on your expiring (previous) policy schedule: ?
Indemnity Insurance Cover required
New Cover required
Limit of Indemnity required ? R 1,000,000 Cover (excess R 5,000.00 per claim)
R 2,500,000 Cover (excess R 5,000.00 per claim)
R 5,000,000 Cover (excess R 5,000.00 per claim)
R 10,000,000 Cover (excess R 10,000.00 per claim)
R 15,000,000 Cover (excess R 15,000.00 per claim)
R 20,000,000 Cover (excess R 20,000.00 per claim)
We require this cover to incept (start) on: -
Enter the date that you require this new Indemnity Insurance Cover to start.
Please ensure that if you have cover in place currently (or cover that has lapsed recently - less than 2 months ago on the CFP SACNASP Scheme policy) that this policy incepts from the day after the expiry date of you expiring policy. You should not leave any "gaps" in your cover as doing so could result in your forfeiting any retroactive cover that you are entitled to by virtue of your previous cover. If you are moving from another policy and your cover has lapsed, we would recommend that you purchase retroactive cover but please be aware that retroactive cover is not a gap infill.
?
Retroactive Cover required
I confirm that I have read and understood the contents of the document SPIIS Master Policy Document and Notes - General: Notes on claims-made and retroactive cover .    ?

Gaps in Indemnity Cover - Please select one of these options:

Option 1: I confirm that there are no gaps between my previous professional indemnity that is expiring and the date that I would like this cover to incept from.

Option 2: The company's previous insurance lapsed and there is therefore a gap in cover between this cover and the previous insurance that we had in place. Furthermore, I understand that, we have lost all the retroactive cover and that we are therefore not entitled to any retroactive cover under the SPIIS policy unless we choose to purchase retroactive cover under the SPIIS policy. I understand that a gap of even one day will cause the loss of all retroactive cover.

Option 3: I have never had insurance before.


Retroactive [backdated] cover should be taken out if you have been rendering services in the past without any cover in place or if there has been a ‘gap’ in your cover. If you have had existing cover on our SACNASP scheme policy the gap can be no longer than 2 months but if you have had other cover you cannot have a gap at all.

Please will you phone us to discuss this if you are not sure whether or not you need retroactive cover.

It is important to note that even if you do take out retroactive cover it will not cover you for claims arising from incidents that you are already aware of or which you should reasonably be aware of that could lead to a claim or complaint against you.

Please keep copies of your previous insurance certificates or policy schedules as proof of your retroactive cover entitlement.


I would like to purchase Retroactive Cover and understand that the annual premiums will be loaded by the percentage/value indicated in order to include this cover: 1 years retroactive cover – 20% per SACNASP registered member
2 years retroactive cover – 25% per SACNASP registered member
3 years retroactive cover – 30% per SACNASP registered member
I do not require any retroactive cover
Basic Details
First Name(s): ?
Surname: ?
E-Mail address - personal ?
Choose a password (6 or more chars) for the SPIIS system ?
Repeat your password ?
Identity Number: ?
Enter your trading name if you practice as a sole proprietor and would like your trading name on your certificate of insurance. ?
VAT Registration Number ?
Landline Telephone Number ?
Cell Phone Number ?
Website Address (or leave blank) ?
Address Details
Physical Street Address
Physical Street Address ?
Suburb ?
City or Town (no abbreviations) ?
Postal Address - must be completed or please repeat your Physical Address
P O Box Number/Street and Number ?
Suburb ?
City or Town (no abbreviations) ?
Province
Postal Code ?
Employment details
Employment details ? Self-employed     Employed        Not Employed
Employer ?
Describe the Services that you provide: ?
Confirmation of all conditions
If you are completing this application on behalf of the applicant,
please supply your full names. ?
I confirm, understand and accept the following conditions:

  1. There is an excess/deductible which is applicable to each and every claim. The excess is payable as soon as Insurers incur costs in your defence regardless of the final outcome of the claim. The main excess depends on your main limit of indemnity as indicated in the "New Cover required" section,
  2. That I will be charged the full annual premium regardless of when I make this application
  3. That I have read and understood the contents of these entire documents:
    (a) SPIIS Master Policy Document and Notes — General plus the document
    (b) SPIIS Additional Documents and Notes for Individual Cover
  4. I confirm that Hollard´s Disclosure Notice has been provided to me via access on the on-line registration system and/or in the Master Policy Document.
  5. Furthermore, I confirm that all information provided by me in this application is true and correct. I understand that my failure to provide true and correct information in this application could lead to my cover being voided.

Please carefully check all the information that you have provided on this form. Once you click the button below you will NOT BE ABLE TO MAKE ANY FURTHER CHANGES.

When you click the button, your Application data will be saved and you will be taken to the Payment Processor to execute your premium payment.