You are on page 1of 1

Broker Update Form

Kindly complete and return this form to mabenan@sha.co.za

Do you have a Santam agency agreement? Yes


If Yes, what is your Santam code and branch Various codes
Registered name of the business with the FSP Accensure Insurance Brokers
Key contact person Deon Hughes
Region Western Province
Postal address P O Box 12061, N1 City, Goodwood
Postal code 7463
81 Vasco Boulevard, Goodwood
Physical address

Postal code 7460


Telephone number (work) 0215920122
Telephone number (cell) 0824586638
Fax number 0215920122
E-mail address deon@accensure.co.za
Contact person for commission statements Deon Hughes
E-mail address for commission statements deon@accensure.co.za
Telephone number for commission contact person 0215920122
Contact person for marketing Henry D. Williams
E-mail address for marketing henry@accensure.co.za
Telephone number for marketing 0215920122

Stalker Hutchison Admiral (Pty) Ltd


The Pavilion,
Tel: +27 (0)11 731 3699
The Wanderers Office Park, Co. Reg. No.: 1985/000368/07
Fax: +27 (0)11 447 0080
52 Corlett Drive, Illovo, 2196 VAT No.: 4310103082
www.sha.co.za
P O Box 55347, Northlands, 2116

Stalker Hutchison Admiral (Pty) Ltd is an authorised financial services provider (FSP 2167).
SHA is a wholly owned subsidiary of Santam Limited. Santam is a level 3 BBBEE company.