BASIC INFORMATION:
Country:
Province:
City:
Suburb:
Title (Business Name)
URL (Website Adress)
Street Adress:
Postal Adress:
Code:
FSB License Number:
BEE Rating:
Business Telephone:
Business Fax:
Business Afterhours:
Business email:
Any Other Information:
REGISTRATION FORM
Web Directories
Email: info@smashpro.co.za
Office: +27 (0) 12 403 0120 / Fax: 086 759 2532
PO Box 11976, Queenswood, Pretoria, 0121
CONTACT PERSONS FOR PUBLICATION:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
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PERSON RESPONSIBLE FOR FINANCE & ADMINISTRATION:
INSERT CONTACT PERSON
Contact Person:
Designation:
Phone:
Email:
SHORT TERM
INSURANCE
AA Insurance Services JDG MICRO INSURE
ABSA DIRECT KING PRICE INSURANCE
ABSA INSURANCE RISK MANAGEMENT KINGFISHER
ACE INSURANCE LIMITED KHULA CREDIT GUARENTEE AECI CAPTIVE INSURANCE COMPANY LANDMARK INSURANCE
AFRICA REINSURANCE CORPORATION LEGALWISE - LEGAL EXPENSES INSURANCE
AIG SOUTH AFRICA LION OF AFRICA
ALEXANDER FORBES LLOYDS INSURANCE
ALIANZ GLOBAL CORPORATE & SPECIALITY MARSH INSURANCE
AON SOUTH AFRICA MI WAY
AUTO & GENERAL MMELA
BIDVEST INSURANCE MOMENTUM
BoE PRIVATE CLIENTS MUA
BOTSWANA INSURANCE MUTUAL AND FEDERAL
BROLINK NATSURE
BUDGET INSURANCE NEDCOR
CENTRIQ INSURANCE NEW NATIONAL ASSURANCE
CIB INSURANCE ADMINISTRATORS OAKHURST COFACE SOUTH AFRICA INSURANCE ONE INSURANCE
COMPASS INSURANCE ORICO
CONSTANTIA INSURANCE OUTSURANCE
CORPORATE GUARENTEE SA PENDING
CREDIT GUARENTEE INSURANCE PINNAFRICA CTU CLAREDON TRANSPORT UNDERWRITERS PSG INSURANCE
DIAL DIRECT INSURANCE QUICKSURE
DIRECT AXIS INSURANCE RAND MUTUAL
DISCOVERY INSURE LIMITED REGENT
EMERALD INSURANCE RENASA
EMERITUS REINSURANCE RMB
ENPET AFRICA INSURANCE CORPORATION SA HOMELOANS ETANA INSURANCE - HOLLARD SA UNDERWRITERS
EXPORT CREDIT INSURANCE SAFIRE
FIRST FOR WOMEN INSURANCE SANTAM
FNB INSURANCE SASRIA
FSP SOLUTIONS SAXUM
G4S INSURANCE SCOR AFRICA
GENERAL REINSURANCE AFRICA SMART INSURANCE
GLENRAND MIB STANBIC
Guard Risk TELESURE
HANNOVER RE AFRICA UNITRANS
HDI GERLING INSURANCE UNITY
HOLLARD INSURANCE LIMITED VIRGIN HOME LOAN GUARANTEE COMPANY NPC VIRSEKER
I WYZE (Old Mutual) WESTERN UNION
IEMAS FINANCIAL SERVICES WORKERS LIFE INDEQUITY SPECIALISED INSURANCE XL INSURANCE CO
LIFE
INSURERS
1 LIFE INSURANCE LIMITED ABSA LIFE
AFRICAN UNITY INSURANCE LIMITED AIG LIFE SOUTH AFRICA
ALEXANDER FORBES LIFE ALLAN GRAY LIFE
ASSUPOL LIFE
AVBOB MUTUAL ASSURANCE SOCIETY BIDVEST LIFE
BOPHELO LIFE BENEFIT SERVICES CADIZ LIFE
CENTRIQ LIFE INSURANCE COMPANY CHANNEL LIFE LIMITED
CITADEL LIFE
CLIENTELE LIFE ASSURANCE COMPANY CONSTANTIA LIFE & HEALTH ASSURANCE CORONATION LIFE ASSURANCE COMPANY DISCOVERY LIFE
FEDGROUP LIFE LIMITED FEMA
FIRSTRAND LIFE ASSSURANCE LIMITED FRANK.NET LIFE LIMITED
GUARDRISK LIFE LIMITED HANNOVER LIFE AFRICA
HOLLARD LIFE ASSURANCE COMPANY INVESTEC ASSURANCE INVESTMENT SOLUTIONS JDG MICRO LIFE METROPOLITAN LIFE MOMENTUM LIFE NEDGROUP LIFE NESTLIFE ASSURANCE NETCARE LIFE
NEW ERA LIFE OASIS CRESCENT OLD MUTUAL LIFE PRESCIENT LIFE
PROFESSIONAL PROVIDENT SOCIETY - PPS PRUDENTIAL PSG LIFE REGENT LIFE RGA REINSURANCE RMA LIFE RMB STRUCTURED LIFE SAFRICAN SANLAM LIFE STANDARD GENERAL STANLIB
STRATEGIC INVESTMENT SERVICE LIFE SWISS RE LIFE AND HEALTH AFRICA SYGNIA LIFE
UNION LIFE LIMITED
VIVA LIFE INSURANCE LIMITED VODACOM LIFE
WORKERS LIFE ASSURANCE COMPANY ZURICH LIFE SA
KGA LEWENS BEPERK
LAND BANK LIFE INSURANCE LIMITED LIBERTY LIFE GROUP LIMITED
LION OF AFRICA LIFE ASSURANCE LOMBARD LIFE INSURANCE COMPANY
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FEMA KingFisher
CAR & HOME INSURANCE
LIFE & MEDICAL
ART AND COLLECTABLES INSURANCEBUILDING INSURANCE CAR / VEHICLE TRACKING CAR INSURANCE
CARAVAN INSURANCE
HOUSEHOLD CONTENT INSURANCE LEGAL AID INSURANCE
MARINE AND BOAT INSURANCE MOBILE DEVICE INSURANCE MOTORCYCLE INSURANCE MOUNTAIN BIKE INSURANCE PET INSURANCE
POTHOLE INSURANCE ROAD BICYCLE INSURANCE
CREDIT LIFE INSURANCE COVER DIABILITY INSURANCE EMERGENCY SERVICES FINANCIAL PLANNING FUNERAL COVER HOSPITAL PLAN IDENTITY THEFT KEYMAN INSURANCE LIFE INSURANCE COVER MEDICAL AID
MEDICAL INSURANCE
ROAD ACCIDENT INSURANCE SALLARY PROTECTION SERIOUS ILLNESS COVER SCRATCH AND DENT INSURANCE
INVESTMENT
SMALL HOLDINGS INSURANCETRAVEL INSURANCE
VIDEO & PHOTOGRAFIC EQUIPMENT
FINANCIAL PLANNING VINTAGE VEHICLE INSURANCE
BUSINESS INSURANCE
AGRICULTURAL INSURANCEANIMALS & LIVESTOCK INSURANCE APRAISORS & EVALUATORS
AVIATION INSURANCE
BUILDINGS AND PREMISES INSURANCE CASH IN TRANSIT INSURANCE COVER EMPLOYEE BENEFITS
ENGINEERING INSURANCE ENVIROMENT HAZMAT COVER FIRE INSURANCE
FUEL RETAILER INSURANCE
HOSPITALITY INDUSTRY INSURANCE IN TRANSIT - TRANSPORT INSURANCE KEYMAN INSURANCE
MARINE AND BOAT INSURANCE MUNICIPAL INSURANCE
OWNER DRIVER SCHEMES PUBLIC LIABILITY INSURANCE TAXI INSURANCE
TRAVE INSURANCE TRUCK INSURANCE VEHICLE TRACKING
ASSET MANAGEMENT
ANY OTHER SERVICES
FOREX
SAVING PLANS
TAX CONSULTING
UNIT TRUST
GROUP SCHEMES TESTAMENT / WILL PROFFESIONAL INDEMNITY•SMASH-PRO (Pty) Ltd t/a WEB DIRECTORIES • Regno: 2013/005016/07 • VAT No: 4200267682 • PO BOX 11976, Queenswood, 0121 • +27 (0)12 403 0120 or +27 (0) 713371635
Revised:14 April 2015
BUSINESS NAME
: CLIENT NUMBER: (Office Admin)We welcome you as a valued client on the Web Directories
!We are ready to ensure that your business benefit continuously from increased customer service delivery and the leverage power of the WEB to direct new customers to your doorstep - unlocking business opportunities for your business!
To enable us to deliver accurate and swift service , we ask that you please help us to conclude this easy registration process – it is also required by SA Bank rules
Check on-line @the applicable URL provided below
that your application data was captured correctly
Sign this mandate and mail or fax a copy to: o E-mail: info@smashpro.co.zao Fax: 086 759 2532
AGREEMENT
Implementation of this agreement is subject to client’s approval of the Information to be inserted and hosted on the applicable business page in the Agreed Directory /s. The client accepts full responsibility for information displayed, specifically relating to Industry Contracts & Endorsements.
WEB DIRECTORIES AGREES TO:o Host and promote the client’s information on the web based database/s in the standard format as displayed on the chosen Directory – please indicate with mark in the applicable tick box/es:
(A) PANELBEATERS DIRECTORY - http://www.panelbeatersdirectory.co.za
(B) TOWING DIRECTORY - http://www.towingdirectory.co.za
(C) BROKER DIRECTORY - http://www.brokerdirectory.co.za
(D) AUTO REPAIR DIRECTORY - http://www.autorepairdirectory.co.za
o Initialize & update such information from time to time, as & when requested to do so THE CLIENT AGREES TO:
o Supply accurate information in the format requested & continuously check the info displayed on the relevant page/s to be correct – specifically regarding contractual agreements and endorsements
o Payment of the agreed service fee in advance. Amount/s as indicated below (All amounts indicated is VAT Excluded) Monthly Debit order
or EFT: (A) +(B) +(C) +(D) =TOTAL
Annual cash
collection or EFT: (A) +(B) +(C) +(D) =TOTAL
Once of Design & Programming Fee of R 200 per Business Page. Number x R200 =TOTAL
= TOTAL FIRST MONTH D/O: + VAT = MONTHLY THEREAFTER:
(VAT Incl.)
o If payment for services is to be done via EFT it should be made to the following company bank account
Smashpro FNB Pinnacle Branch Code: 250016 Account No: 62393019396 Reference: Client number.
Proof of Payment: to finance@smashpro.co.za Banking details also available on Invoice documentation
RENEWAL & CANCELLATION:o Monthly agreements - automatic renewed monthly, on a continuous basis. Cancellation with one(1) calendar month’s written notice
o Annual agreements – deemed to automatically renew annually on anniversary date, unless a cancellation notice is received with one (1) calendar month’s written notice.
o Change in membership fees (if any) communicated to the client’s nominated e-mail address:
Month-to-month agreements: one (1) calendar month
Annual contracts : one (1) calendar month before annual renewal date
BANK DEBIT ORDER INSTRUCTIONNAME (Business Name - Debtor) : ADDRESS:
CONTACT PERSON:
CONTACT PERSON – E-MAIL:
DEBIT AMOUNT
(in advanced – Excluding VAT)
ONCE OFF DESIGN & PROGRAM FEE
( payable with first debit / EFT, Annual fee)
MONTHLY* / ANNUALY: COMMENCEMENT DATE: ACCOUNT TYPE:
BANK:
BRANCH CODE:
BANK ACCOUNT NAME: ACCOUNT NO:
VAT NO:
This signed Authority and Mandate refers to our agreement as dated as on signature hereof. I / We hereby authorise you to issue and deliver payment instructions to the bank for collection against my / our abovementioned account at my / our above mentioned bank (or any other bank or branch to which I / We may transfer my / our account) on condition that the sum of such payment instructions will never exceed my / our obligations as agreed to in this document and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me / us by giving you notice in writing of no less than 20 ordinary working days, and delivered to your address indicated above.The individual payment instructions so authorised to be issued must be issued and delivered as follows
Monthly; on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not be more or less that the obligation due; In the event that the payment day falls on a Saturday, Sunday or recognized South African public holiday, the payment day will automatically be the very next ordinary business day. Further, if there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account;
Annually; on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not be more or less than the obligation due;
I / We understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.
MANDATE: I / We acknowledge that all payment instructions issued by you shall be treated by my/our above mentioned bank as if the instructions had been issued by me/us personally.
CANCELLATION: I / We agree that although this Authority and Mandate may be cancelled by me / we, such cancellation will not cancel the Agreement. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.
ASSIGNMENT: I / We acknowledge that this Authority and Mandate has been ceded to Netcash (Pty) Ltd as per your agreement with Netcash (Pty) Ltd, but in the absence of such assignment of the Agreement, this Authority and Mandate will be null and void.
FOR BUSINESS– Duly authorised
Signed at __________________________ on the ______day of ___________________________ 20____
