Application Requirements

Dear Prospective Signio Clients, kindly take note of the following requirements when submitting an application to Signio:

Mandatory Requirements:

1.  The Signio Application Form must be completed in full.

2.  Each page of the application form must be initialed by the applicant as well as a witness.

3.  Each Signio Application Form must be signed in the appropriate spaces by the applicant as well as a witness.

4.  Each Signio Application Form must be accompanied by a signed letter from the Dealer Principle stating that Signio is the preferred vendor, and that Signio may activate the applicable bank dealer codes.

Please complete the forms in accordance with the requirements above, in order to avoid delays in processing your application.

Company Information

Dealer Name
Company Reg No
VAT No
FSP No
Physical Address
Postal Address
Tel No
Fax no

Dealer Principle Information

(Please attach a copy of ID)

DP Name and Surname
DP Email Address
DP Contact No
DP Signio Access Y/N

Finance and Insurance Manager Information

(Please attach a copy of ID and NCA card)

F&I Name and Surname
F&I Email Address
F&I Contact No

Finance and Insurance Manager Information

(Please attach a copy of ID and NCA card)

F&I Name and Surname
F&I Email Address
F&I Contact No

Finance and Insurance Manager Information

(Please attach a copy of ID and NCA card)

F&I Name and Surname
F&I Email Address
F&I Contact No

Finance and Insurance Manager Information

(Please attach a copy of ID and NCA card)

F&I Name and Surname
F&I Email Address
F&I Contact No

Dealer Codes

Please provide a confirmation letter from the DP that the dealer codes can be activated on Signio

**Please specify if there’s more than one dealer code per bank**

Dealer Code 1 / Dealer Code 2 / Dealer Code 3
Absa
Wesbank
Standard bank
MFC
African Bank
SA taxi
Alphera finance
Capitec

Compliance Officer & Key Representative

Compliance Officer
Name and Surname
Telephone Number
Fax Number
E-mail Address
Key Representative
Name and Surname
Telephone Number
Fax Number
E-mail Address

IGF Requirements

(Please select one of the options below)

Please mark with X
Both Professional Indemnity and Fidelity Guarantee
Only Professional Indemnity And No Fidelity Guarantee
No Professional Indemnity and Only Fidelity Guarantee
No Professional Indemnity and No Fidelity Guarantee

Value Added Products and Insurance

Supplier Name / Product Name

Insurance Supplier

Applicant Signature

Name:

Surname:

Signature:

Witness Signature

Name:

Surname:

Signature:

Signio (Pty) Ltd | Registration Number 2003/001508/07

T: +27 (0)12 684 6600 | F: +27 (0)12 684 6629

Southdowns Office Park, Block B 2nd Floor, Cnr John Vorster Drive & Karee Street, Highveld, Centurion

Directors: A E J Pentz, A H Miller, J G Williams

A Lightstone Company Page | 2