Premium Financing - SMOOTHWAY INSURANCE BROKERS

CONDITIONS FOR PREMIUM FINANCING

We finance your premium on the following terms and conditions.

You pick and/or decide your desired insurance cover by completing the data form below and
We advise the annual premium due and
You pay 20% of the gross premium (non-refundable) (by cheque or transfer) and
You issue, in favour of “SMOOTHWAY INSURANCE BROKERS LTD”, not more than 9 post-dated cheque(s) with not more than 28 days interval as will be advised and
You sign (check) the attached (please download) Declaration Form below and

We deliver your insurance policy to you as soon as possible.

Please take note:

PREMIUM TO BE FINANCED

INDIVIDUAL: N100,000.00 (AND ABOVE) PER ANNUM

CORPORATE: N250,000.00 (AND ABOVE) PER ANNUM

IN THE EVENT OF CLAIM, THE TOTAL OUTSTANDING PREMIUM AS AT DATE BECOME PAYABLE IMMEDIATELY.

CUSTOMER DATA
Name
First Last
Email*
Enter Email Confirm Email
Phone*
Home Address
Office Address
Date Of Birth
Date Format: DD slash MM slash YYYY
Name of Employer or Company if Self Employed
Date joined employment or start self-employment
Date Format: DD slash MM slash YYYY
Position in the Employment
Name of Banker and Branch
RISK DETAILS
Class of Insurance
Name of Insured:
Preferred Insurance Company
From
Date Format: MM slash DD slash YYYY
To
Date Format: MM slash DD slash YYYY

Maximum is 12 months
Value of Assets to be insured
Description + Location Address of Assets to be insured
Registration Number and Make & Model for Motor Vehicles
Declaration*
- I do solemnly declared and state that the information hereby supplied are complete and correct and hereby agreed that the insurance cover hereby financed by this program is subject to the AUTOMATIC CANCELLATION clause which allows SMOOTHWAY INSURANCE BROKERS LTD or its agent or representative to cancel without any further notice the insurance policy related thereto and obtain full premium refund accrued from the cancelation and only in the event of the post-dated cheques being lodged for the financing of the premium is been dis-honoured for payment for whatever reasons notwithstanding the facts that the insurance is still active.
By checking the submission box herein, you or your agent or representative have agreed to the terms and conditions of this scheme whether expressed or implied.