Premium Relief Application Form Company PLEASE NOTE THAT ALL FIELDS ARE REQUIRED! Name of Insured * Policy Number * Broker * Nature of Business * Estimated Annual Turnover (e.g: R 000 000.00) * Reason for applying for premium relief * Contact Email Address * DISCLAIMER * I agree to Consort's Disclaimer We reserve the right to amend, alter or amend the terms of this temporary relief programme at any time during or after the lockdown period. SASRIA * I agree to the SASRIA terms & conditions It must be noted that Consort has no jurisdiction or authority over SASRIA cover nor any premium relief programme, therefore unless specific dispensation is granted in writing from SASRIA, all clients / intermediaries must ensure that their SASRIA premium commitments are maintained and paid in accordance with SASRIA terms and conditions but moreover in terms of the Insurance Act. FINANCIERS / LENDERS - INSURABLE INTEREST * I agree to the Financiers / Lenders terms & conditions Where clients / insureds have contractually mandatory requirements laid down by Financiers / Lenders in terms of loan or financial agreements wherein full comprehensive cover is required to be maintained during the full term of the financial agreement. It is the responsibility of the client’s / Insured to adhere to these contractual mandatory requirements. If any client / Insured is in breach of a contractual requirement by reducing cover through the Premium Relief Plan, Consort cannot be held liable for the consequences of any loss or damage to Insured Property / Property Insured. Client’s / Insureds are responsible to make application to their Financiers / Lenders for dispensation during this lockdown period.