PERSON RESPONSIBLE FOR THE ACCOUNT Maximum Risk Protection Doc No: FIN-DOC-002 Compiler: Member J.J Swarts Rev (Amdt) No: 7 Approving Officer: Member J.J Swarts Effective Date: 16/01/2015 PERSON RESPONSIBLE FOR ACCOUNT Surname / Business Name : Full Names : Street Address : Postal Address : Code: ID Number / Business Reg : VAT Number : Email : Payment Method : CASH CHEQUE EFT DEBIT ORDER Insurance Company : Policy Number : By electronically submitting this document, I accept the terms and conditions as explained in this document. I agree to the contents of the document without applying my signature to it. I AGREE 18.190.156.212