|
Please provide the following information |
|
Name of Organization : |
|
|
Trading Address1 : |
|
|
Address 2 : |
|
|
Contact Name (s) : |
|
|
Telephone: |
|
|
Fax : |
|
|
E-mail : |
|
|
Website Address : |
|
|
Principal Trading Activities :
|
|
|
Date Business Established : |
|
|
If less than 2 years please give previous relevant experience below and two business
references : |
|
Reference 1 : |
|
|
Reference Address 1 : |
|
|
Reference 2 : |
|
|
Reference Address 2 : |
|
|
Are you regulated under any statutory or professional body ? |
|
|
If yes, please give us details : |
|
|
Do you have professional indemnity insurance ? |
|
|
If yes, please give us name of insurance company : |
|
|
Expiry date of policy : |
|
|
Policy number : |
|
|
Have you ever had an agency declined or terminated ?
|
|
|
Please give the name of two other agencies that you hold : |
1.
2.
|
|
|
|
|