PI Cover & Surety Bond Application

Are you ready to get started with Shackleton Risk? Please click on the desired tab below & complete the applicable form:

Surety Bond Application

Professional Indemnity & Associated Cover Application

MedMal Cover Quick Application

General Enquiry

Surety Bond Application

Surety Bonds Application Form

Instagram

This field is for validation purposes and should be left unchanged.

Personal Particulars

First Name(Required)

Last Name

ID Number(Required)

Residential Address(Required)

Home Telephone Number

Business Physical Address(Required)

Business Postal Address(Required)

Business Telephone Number(Required)

Cell Phone Number(Required)

Email(Required)

Profession(Required)

Attorney

Liquidator

Business Rescue Pratitioner

Non-professional

Fiduciary Practitioner

Other

Full Name of Employer (if self-employed please provide your business name)(Required)

Name of admin person handling the Payment of Premiums(Required)

Solvency

Have you ever been declared insolvent, or did you ever have to reach an agreement with your creditors? If so, state name(s) and address(es) of the trustee or distributor(s)?(Required)

Professional Membership

Are you a member of any professional organisations/bodies?(Required)

Law Society

SAICA

FISA

N?A

If so, please provide your member number:(Required)

Experience in Handling of Liquidations, Curatorships, Deceased Estates and/or Trusts

How would you rate your level of experience in estate matters?(Required)

Excellent

Good

Fair

Are you on the Masters panel?(Required)

Yes

If YES, which panel?

Liquidator

Curator

N/A

How long have you been on the Masters panel?(Required)

Have you ever been relieved of any appointments? If so, for what reason?(Required)

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:(Required)

Facility

What type of estates will you be requiring this facility for? (if more than one, please provide a percentage breakdown of total facility)(Required)

Do you currently have court bond facilities with other insurers? If so, state the name of the insurers:(Required)

Has any application ever been declined" If so, provide reasons:(Required)

General

How did you hear about us?(Required)

Insurance Provider

Digital Advert

Print Advert

Web Search

Word of Mouth

Industry Event

Shackleton Broker

Please provide the renewal date for your Professional Indemnity Insurance:(Required)

Are you insured in terms of Fidelity Insurance? If so, please state the name of the insurer and sum insured:(Required)

Are you insured in terms of Misappropriation of Trust Funds? If so, please state the name of the insurer and sum insured:(Required)

May we contact your broker for a copy of the policy? I so, kindly provide your broker's details:(Required)

If you are an attorney you enjoy primary imsurance cover through the Attorney.'s Indemnity Insurance Fund. Are the fees which you earn from estates that we issue guarentees on, paid to your law practice or to antoher entity?

Do you accept that the information provided above is accurate?(Required)

Yes

Please note for your application, the following documents would be needed:

Copy of Identity Document, Proof of Residence, Copy of PI Cover of Current Fidelity Fund Certificate.

File

Max. file size: 64 MB.

Professional Indemnity & Associated Cover Application

Professional Indemnity & Associated Cover Application Form

Comments

This field is for validation purposes and should be left unchanged.

For Attorney, Fiduciary and Business Rescue Practioners

First Name(Required)

Last Name(Required)

Email(Required)

Phone Number(Required)

Company Name(Required)

Address(Required)

Contact Person(Required)

Contact Email(Required)

Contact Phone Number(Required)

Take Note:

Do you currently have PI cover in place outside of that offered by the AIIF?(Required)

Yes

If YES: Name of Insurers(Required)

Indeminty Limit your firm currently receives through the Attorneys Insurance Indemnity Fund(Required)

Indemnity Limit firm currently receives through the Attorneys Insurance Indemnity Fund(Required)

Indemnity limit above the Attorneys Insurance Indemnity fund(Required)

Excess (each and every claim)(Required)

Previous Year's Premium(Required)

Date of Expiry of Cover(Required)

Did you make Monthly/Quartelry/Annual premium payments? Please specify:(Required)

Has your firm had any claims in the past 5 years?(Required)

Yes

If YES, please provide details(Required)

Number of principals(Required)

Total number of staff including principals(Required)

Business Activities

Select the activities your firm practices(Required)

Conveyancing

Commercial

Estates

Criminal

Matrimonial

Patents

MVA Claims

Litigation

Investment Advice

Tax Advise

Liquidations

Trusts

Other

If you checked OTHER, please specify(Required)

Current Gross Fee Income(Required)

Estimated Gross Fee Income for the coming 12 months(Required)

What is your staff compilation? e.g: 20 staff members(Required)

Professional Indemnity

Limit Required(Required)

Optional Extensions Required (Attorney's)(Required)

AIIF Excess Infill

Correspondent Attorneys

Cyber Liability Extension

Investment Advice Extension

Outside Directors & Officers

Fidelity Guarentee

Limit Required(Required)

Blanket Basis/Named Basis(Required)

Blanket Basis

Named Basis

If 'named basis', please provide the names(Required)

Misappropriation of Trust Fund Cover

Limit Required(Required)

Blanket Basis/Named Basis(Required)

Blanket Basis

Named Basis

If 'Named Basis', please provide the names (1)

Declaration(Required)

I agree to the declaration.

I/we heeby declare that the above statements and particulars contained in this application are treu and complete and that at the present time, other than stated, I/we have no reason to anticipate any claim under the insurance now being requested.

Final acceptance is subject to receipt of:

Full Proposal, Copy of Identity Document, FF Certificates of All Principals ,Copy of Current Policy Schedule, Full Claims Experience.

Please upload the above supporting documents(Required)

Max. file size: 64 MB.

How did you hear about us?(Required)

Insurance Provider

Digital Advert

Print Advert

Web Search

Word of Mouth

Industry Event

Shackleton Broker

MedMal Cover Quick Application

MedMal Application Form

Let's Get You Covered

First Name(Required)

Last Name(Required)

Email(Required)

Phone Number(Required)

Medical Specialisation(Required)

Province(Required)

City/Town

General Enquiry

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This field is for validation purposes and should be left unchanged.

First Name(Required)

Last Name(Required)

Email(Required)

Phone Number(Required)

Province(Required)

Gauteng

Western Cape

Kwa-Zulu Natal

Eastern Cape

Northern Cape

Free State

Limpopo

Mpumalanga

North West

How Can We Help?(Required)

CAPTCHA

PI Cover & Surety Bond Application

Surety Bonds Application Form

Personal Particulars

Solvency

Professional Membership

Experience in Handling of Liquidations, Curatorships, Deceased Estates and/or Trusts

Facility

General

Please note for your application, the following documents would be needed:

Professional Indemnity & Associated Cover Application Form

For Attorney, Fiduciary and Business Rescue Practioners

Take Note:

Business Activities

Professional Indemnity

Fidelity Guarentee

Misappropriation of Trust Fund Cover

Final acceptance is subject to receipt of:

MedMal Application Form

Let's Get You Covered

General Enquiry

Need more information?

Contact Your Local Broker

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