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Surname:
Initials:
ID No
Tel.
Email:
Cel:
Insurance Type:
House Contents
Buildings
Motorcycle
Motors
All Risk (spec)
All Risk (unspec)
Caravan /Trailer
Boat
House Contents
Address:
Insured amount:
Burgular bars:
Y
N
Security Gates:
Y
N
linked alarm:
Y
N
Buildings
Address:
Insured amount:
Contruction:
Standard
Non Standard
Thatch
All Risk
Clothing & personal effects
Insured amount:
Specified Items
Insured amount:
Cell phones:
Jewellery > R1000
Bicycles
Motors
Make:
Year / Model
Insured amount:
Business use
Standard use
immobillisor
Gearlock
Tracking device
Insured amount:
Radio:
Another Vehicle?
Vehicle 2
Make:
Year / Model
Insured amount:
Business use
Standard use
immobillisor
Gearlock
Tracking device
Insured amount:
Radio
Motorcycle
Make / CC:
Year / Model
Ins amount:
Business use
Standard use
Comprehensive:
3rd Party:
Limited:
Caravan/ Trailer
Year / Model
Business use
Standard
Insured amount:
Cover:
Comprehensive:
3rd Party:
Limited:
Boat
Length:
Boat type
Insured amount:
Engine:
Equipment:
SHORT-TERM INSURANCE
LONG-TERM INSURANCE
Life cover
Medical aid
Retirement annuities