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Sign up as a Partner Agent for TOURMED

Please complete all fields below in order for your application to be successfully processed. Please ensure the correct email address is entered as the login details will be emailed to you.

Agency Details

Agency Name:

Phone:

Code:

Fax:

Code:

Street Address:

City:

Country:

Zip/Postal Code:

Website Address:

Primary Business:

Is the business registered?

If yes, Registration No.:

Do you already sell travel insurance?
If yes, who?
Do agents share commission?

Administrator Details

Please provide the name and email address of the person who will serve as administrator.

Contact - Principal person:

Email Address:

Please choose a password to be used by the agents and
administrator when accessing the TOURMED website:

Password:

Banking Details

Please provide the details of the account which commissions must be transferred to.

NOTE: Agent commissions are paid into a single account and monthly reports of commissions per agent will be submitted.

Bank:

Account Name:

Account Number:

Account Type:

Branch Code:

Swift Number (if applicable):

Agent Details

Please complete the personal particulars of all agents at your agency who will sell travel insurance through TOURMED.

First Name:

Surname:

First Name:

Surname:

First Name:

Surname:

First Name:

Surname:

First Name:

Surname:

Part One

The above named travel agency/business or travel agents (hereinafter Agency) acknowledges that it will abide by the policies and rules of SA-TOURMED.(Pty) Ltd (hereinafter TOURMED) at all times. The Agency cannot use the logos of TOURMED or any of the other TOURMED partners.
The Agency must ensure that it is licenced to sell Medical insurance in terms of regulations that govern its business in its country.
TOURMED agrees to provide the Agency with monthly service fee reports.
The Agency agrees to review monthly service fee report for accuracy.
Either Party may terminate this Agreement at any time upon written notice to the other.
Both the Agency and TOURMED agree that they are independent contractors. The Agency is not acting as an employee or an agent of TOURMED when selling the coverage.
The Agency cannot, for any reason, change or amend the insurance coverage. The Agency may not interpret or determine whether or not a claim should or would be paid. Any false or misleading statements made by the Agency about the coverage provided by TOURMED is the sole responsibility of the Agency.

Part Two

I. TOURMED agrees to:

Pay the Agent an amount equal to 15% of the total premium paid by the Agent’s Customer taking out the TOURMED Policy.
Pay into the Agent bank account within 30 days of the sale having taken place, all such commissions due to the Agent.
Should the Agent’s client cancel the policy by written notice to TOURMED within the specified time and conditions, TOURMED will refund to the client 75% of the premium the client paid.

II. The Agency agrees to:

Not to impose on the client any cancellation penalty in addition to that of TOURMED.
Refund to the client any and all amounts that may be returned by TOURMED to the Agency on behalf of the client.
Submit documentation of the client that may be required to finalize a claim.

This area serves as an electronic signature

BY: Name of Person completing this form:

Dated: 05/07/2008

If you have any questions about completing this form,
email: TOURMED Agent Service Centre, or
call: +27 21 979 4419 (8am-6pm, SA Time)

Please only click the Submit button once.


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