NAPTOSA Single Need Indemnity Form
MEMP Financial Services (Pty) Ltd 27 Mangold Street, Newton Park, Port Elizabeth, 6045, South Africa P O Box 34053, Newton Park, Port Elizabeth, 6055 Tel: +27 (0)41 363-7333 Facsimile: +27 (0)86 723-4635 E-mail : [email protected] Authorised Financial Services Provider SINGLE NEED CLIENT ADVICE INDEMNITY PLEASE READ AND SIGN THIS DECLARATION. I, __________________________________________________ (client name), confirm that I have been advised by ___________________________________ of ______________________________(FSP name) that, as an authorized financial services provider, he/she must, prior to providing me with financial advice and for the purposes of the advice, undertake reasonable steps to seek from me appropriate and available information to conduct an analysis of my financial needs. I confirm that I have DECLINED the offer of such an analysis and or have indicated a single need and/or product and/or product supplier which I have identified myself. I have been duly and properly advised of the implications of my actions and having considered same, I still wish to proceed with the implementation of my choice. SIGNATURE OF FINANCIAL ADVISOR SIGNATURE OF CLIENT DATE DIRECTOR: RS IMMELMAN ASSOCIATES: PERIX HEALTHCARE CONSULTANTS T/A MEMP HEALTHCARE CONSULTANTS EAST LONDON - EAST LONDON: FSP 8978
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