Get Za Ampath Laboratories Insurance Consultant/broker Registration Form 2008-2025

Completing the ZA Ampath Laboratories Insurance Consultant/Broker Registration Form online is a crucial step for consultants and brokers to register effectively. This guide will walk you through each section of the form, ensuring a smooth and successful submission.

Follow the steps to complete your registration form.

1. Click ‘Get Form’ button to acquire the registration form and open it in your preferred digital document viewer.
2. In the Consultant/Broker Details section, fill in your full name in the 'Name' field and your last name in the 'Surname' field. Provide both your primary and secondary email addresses in the respective fields.
3. Enter your complete street address in the 'Street Address' field, and provide your office telephone number, cell phone number, and fax number in the designated fields.
4. Select your province from the list available in the 'Province' field and provide your postal address in the 'Postal Address' section.
5. Input your Financial Service Provider (FSP) number. This is your accreditation number. Include your ID number in the required field.
6. Indicate whether you require pre-printed request forms by checking the relevant option, and if applicable, enter your broker code.
7. Specify your preferred Ampath notification method in the appropriate section. Include the name of the insurance company you are affiliated with.
8. In the Consent section, enter your name to give consent to the Ampath Group to e-mail the names of your clients. Acknowledge that you will inform Ampath of any changes to your email address.
9. Indicate the date you are submitting the form in the 'Date Submitted' field.
10. After completing all fields, click the 'Submitting Registration' button. Follow the on-screen instructions to ensure your registration form is sent via your email application without any alterations.

Complete the ZA Ampath Laboratories Insurance Consultant/Broker Registration Form online today.