I hereby declare that the above account number is correct for settlement of referral fees payable to me for every valid referral*. I further irrevocably undertake to not hold Dotsure Limited liable, should I not receive any referral fees paid to me due to providing incorrect banking details as per the information given above.

I further declare that: I am under no obligation to render any services to Dotsure Limited; I am not the effective cause of the sale of any insurance product that involve Dotsure Limited; I am not employed by Dotsure Limited, nor do I work from its premises; any remuneration received from Dotsure Limited is not my main source of income; and I am aware that I am responsible to declare this income for income tax purposes.