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ID Number
Residential Address
Home Telephone Number in International Format
Business Physical Address
Business Postal Address
Business Telephone Number
Cell Telephone Number
Email *
Full Name of Employer (if self-employed please provide your business name)
Name of Admin Person Handling the Payment of Premiums
If so, please provide your member number
How long have you been on the Master's panel?
Have you ever been relieved of any appointment? If so, for what reason? *
Has the Master ever refused or reduced your remuneration as a result of misconduct or incompetence or inefficiency?
Has the Master of the High Court ever called up any Bonds of Security on which your name has appeared, either as a sole appointment or in a joint capacity? If so, provide details
What type of estates will you be requiring this facility for? (if more than one, please provide a percentage breakdown of total facility)
Do you currently have court bond facilities with other insurers? If so, state name of insurers
Has any application ever been declined? If so, provide reasons
Do you have Professional Indemnity Insurance (P.I.)? If so, please state the name of the insurer and the limit of cover:
Please provide the renewal date for your Professional Indemnity insurance:
Are you insured in terms of Fidelity Insurance? If so, please state the name of the insurer and sum insured:
Are you insured in terms of Misappropriation of Trust Funds? If so, please state the name of the insurer and sum insured:
May we contact your broker for a copy of the policy? If so, kindly provide your broker's details:
If you are an attorney you enjoy primary insurance cover through the Attorney's Indemnity Insurance Fund. Are the fees which you earn from estates that we issue guarantees on, paid to your law practice or to another entity?
