Name of Projects/Brand of CarDeveloper/DealerNo. of Units Sold



Child Name Child Date of Birth


I hereby certify that the above data are true and correct. I commit to abide by AutoProtect Insurance Agency and Services Inc. rules and regulations for referrer accreditation.

I agree


I do hereby undertake to abide by the following terms and conditions for referrer accreditation.

1. I acknowledge that accreditation is at the sole description of Autoprotect Insurance Agency and Services Inc. (AutoProtect), which may grant or deny acrreditation in this sole judgement and regardless of the outcome of my performance during that period. I agree that I have no cause of action against AutoProtect for the grant or denial of accreditation.
2. I am not an agent, joint venturer, nor a partner of AutoProtect with regard to my function as independent contractor. Likewise any person that I may hire or contract shall not be considered an AutoProtect employee, agent, or sales representative. AutoProtect shall deal directly with me alone regard to my function as independent contractor.
3. I shall ensure that all signages, IDs, calling cards, stationaries and other similar materials to be used and not privided by AutoProtect (or AutoProtect subsidiary/Affiliates) do not include marks, logos and /or corporate brand prints. I further agree that I shall not use or refer or allow the use of reference to the name, mark and/or logo of AutoProtect (or any AutoProtect subsidiary/affliliate) or any of its products in any advertising or marketing material or correspondences (whether via mail, SMS or any other mode of communication, whether verbal or written), without the prior written consent of AutoProtect.
4. I shall ensure to follow up from my prospects the requirements deemed necessary for the processing of their applications with AutoProtect.
5. I shall safeguard according to stricts standards of security and confidentiality, any information my customer shares with me.
6. I shall ensure that the details contained in the application forms are complete and accurate to the best of my knowledge and that photocopies of documents are true reproductions of the original.
7. I understand that approval or disapproval shall be subject to the sole or absolute discretion of AutoProtect. I shall have no right to object to the exercise of discretion by AutoProtect.
8. AutoProtect is hereby authorized to terminate unilaterally my accreditation in case of failure on my part to comply with the terms and conditions set by AutoProtect.
9. I understand that in the event of termination , I shall return within 24 hours from notice of termination of AutoProtect all materials pertaining to AutoProtect programs, including but not limited to prospect lists, communication and others and that I shall not thereafter use for any purpose, any material which bears AutoProtect's name and/or logo/trademark.
10. I understand that I shall no longer be credited for approved and or/ booked applications after the date of termination of my accreditation.
11. I understand that in the event that I shall decide to dispose of, or cease or discontinue my business, I shall give AutoProtect at least thirty (30) days prior written notice.
12. I understand that my accreditation shall be subject to review every twelve (12) months or as often as deemed necessary by AutoProtect.
13. I hereby agree to indemnify and hold AutoProtect, its parent company affiliates, subsidiaries, and their respective officers, directors, employees and representative, free and harmless from any loss claim damage , cost or expense of any kind including reasonable attorney's fees that may arise as a result of my acts.
14. I shall conduct my business and regulate my operations in a way that will maintain and increase the goodwill and reputation of AutoProtect. I shall conform with and abide by all laws, rules ethics , regulations and procedures required by AutoProtect.
15. I shall comply with all laws, rules and regulations in relation to the conduct of my business and shall conduct my business properly. In the practice of my profession. I shall observe fairness, good faith and honesty in dealing with my clients including AutoProtect.
16. I shall not engage in false advertising and shall ensure that all my advertisements, brochures, announcements and other collaterals shall present the true picture of the property to be sold.
17. I hereby represent and warrant that I have no unpaid past due obligation with AutoProtect or any of its subsidiaries or affiliates. AutoProtect is hereby authorized to unilaterally cancel my accreditation in the event that I fail to promptly pay or comply with any of my obligations with AutoProtect or any of its subsidiaries and affiliates.
18. I further irrevocably authorize and empower AutoProtect, without need of any prior notice to me, to apply any commission, fees or all other such amount which may be due me in relation to my accreditation with AutoProtect or which may be in the possession of AutoProtect to the payment of any of my unpaid obligations with AutoProtect. This authority is coupled with interest and may not be revoked by me at will.
19. I hereby authorized AutoProtect to automatically credit my commision, fees or all other such amounts which may be due me in relation to my accrediatation with AutoProtect.
20. I hereby authorize AutoProtect to obtain relevant information from other institutions/persons concerning my referrer accreditation and agree that all such data, information, or document obtained by AutoProtect in relation to my referral shall remain AutoProtect's property.
21. I understand that any amount is subject for return or reimbursement when the subject account is proven fraudulent and/or inexistent or when the premium are left unpaid 5 days after due date.
I hereby affirm and confirm that I have carefully read the foregoing, fully understood the contents thereof, and have freely and knowingly signed my name hereon on the date stated below.

I agree