REGISTRATION FORM BASIC INFORMATION: Country: Province: City: Suburb: Title (Business Name) URL (Website Adress) Street Adress: Postal Adress: Code:

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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

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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:

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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

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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

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CAR & HOME INSURANCE

LIFE & MEDICAL

ART AND COLLECTABLES INSURANCE

BUILDING 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 INSURANCE

TRAVEL INSURANCE

VIDEO & PHOTOGRAFIC EQUIPMENT

FINANCIAL PLANNING VINTAGE VEHICLE INSURANCE

BUSINESS INSURANCE

AGRICULTURAL INSURANCE

ANIMALS & 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

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•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.za

o 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.)

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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 INSTRUCTION

NAME (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____

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