REFER A CLIENT. We are here ready to assist you. Become A Referral Agent THANK YOU Appreciate the help. About referral fingerprint Agent Code Read me If you have been referred through an agent please make sure you add the Agent Code here for you to enjoy any further benefits. person Name person Surname email Your Email Address We won't share your information with anyone unlawfully. phone Your Cellphone Number accessibility_new Clients Name accessibility_new Clients Surname email Clients Email Address phone Clients Cellphone No —Please choose an option—Eastern CapeFree StateGautengKwaZulu-NatalLimpopoMpumalangaNorthern CapeNorth WestWestern Cape flag Select Client Province —Please choose an option—Cold Call ClientFamilyFriendOtherSelfSpouse pan_tool Select Relationship To Client —Please choose an option—Various InsuranceCar InsuranceCyber InsuranceHome InsuranceBuildings InsuranceProfessional Indemnity InsuranceLife InsuranceTaxi InsuranceUber Insurance3rd Party Liability Insurance format_list_bulleted Select Type Of Insurance Required Finish up Best Time to call client provide, 3 possible dates and times that the client is available event event event Additional Notes Feel free to add any questions or notes or best dates or times to contact you so that we can address all your questions when we arrange for a online meeting. Email Consent Note that the client will be receiving an automatic generated email from this submission. Client Consent & Declaration I confirm that I have without prejudice or duress found value in the services XINIX (Pty) Ltd offers its clients. I confirm that I am referring a potential client to XINIX (Pty) Ltd purely for the purpose of XINIX (Pty) Ltd contacting them to market their services, provide quotations or provide advice to the person, in line with their service offerings and as allowed by their FSP license. I confirm that the client being referred has been contacted by me and the necessary consent has been received to share their contact details with XINIX (Pty) Ltd. I understand that only authorised personnel at XINIX (Pty) Ltd will be acting on my request, and ONLY for the purpose of gathering information and that such information will be treated confidentially. I confirm, regardless of the outcome of my referral of a client, where you are not an authorised agent there will be no monetary reward due from XINIX (Pty) Ltd to me in any way, shape, or form. To this end, I consent and give authority to XINIX (Pty) Ltd, to use my details when calling the person referred to by me and as part of their introduction call/contact being made to such potential client. Submit Previous step Next step ready to do a quote now? Come on. QUOTE ME
