Request For a Short-Term Insurance Quotation:

Thank you for your interest,
Please tell us who referred you to us?:

Name:
Surname:
ID / Passport Number:
Contact Number:
Fax / Email Address:
Occupation:
Current Insurance Company:
How long have you been insured?:
Has your cover ever been cancelled by an insurer?:
If so please provide details:

Provide dates, description and amounts for all losses / cliams past 3 years, insured or not:
Type & Date of Loss Amount Short Description of event

House contents forms the basis of the policy & is compulsory cover

House Contents:
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Suburb and postal code for your residence:
Residential / Holiday home / Commune:
Value (VAT included):
Roof Construction (eg.tile):
Wall Construction:
Do you have current house contents insurance?
Current no claim discount:
Security arrangements (yes or no):  
Burglar bars at all openable windows:
Security gates at all external doors:
SAIDSA approved alarm radio linked to armed response:
Security village / access control:

The insured amount should reflect the cost to replace all items in your home with similar new items.
The amount should include values on all items that you would take with you if you moved.

Average:If it is determined, in the case of a claim, that the insured amount is not sufficient to replace the entire contents with similar new items you will be considered your own insurer for the difference and the insurer will only settle your claim preporsionally. For example if the replacement cost for your contents is R150 000, but it is only insured for R100 000 it means that you are 33% under insured an thus the insurer will only pay 66% of your claim.

The following sections are optional

Building (if no bond insurance is in place)
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Address and Postal code:
Residential / holiday:
Value (VAT included):
Roof Construction (eg.tile):
Wall Construction:
Do you require cover for any of the following:  
Subsidence and landslip cover:
Accidental damage to machinery:

Select this section if the building itself is not insured by the bond holder or body corporate. The building should be insured for the amount it would cost to rebuild. Please note that professional fees, the removal of debris, etc. should also be taken into consideration. Loss due to wear and tear, rust, etc is not covered.

All Risk Cover (cover away from your house)

Unspecified Items: Insured Amount
Clothing and personal effects:

This section covers items that may be lost/damaged away from your home. Unspecified clothing and personal effects will cover items normally carried on a person, but not including cell phones, laptops, CDs and motor radios. The cover is limited to 20% of the insured amount or R1 000, whichever is greater. The limit is applied per item or pair with the insured amount as the maximum cover per claim.

Specified Items Description Amount

Under this section you can specify items with a value over R1 000 or items excluded under unspecified all risk. Again this section covers items lost/damaged away from your home and items that you feel might be at risk of loss/damage outside your home should be specified here.

Vehicles
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Address where vehicle is normally kept at night:
Make and year of manufacture:
Model (eg Corolla 1.6 GLi A/T):
Has the vehicle been modified in any way:
If so, What has been done:
Driver date of birth:
Date driver's license was issued?:
Registered owner:
Where is vehicle normally kept at night (eg.garage):
Vehicle Use (eg.private):
Value of radio:
Current no claim bonus:
Market Value:
Security device installed (eg.factory immobilizer / gear lock):
Do you require car hire cover?:
Is the vehicle a code 3 or a rebuild?:
Do you wish to take an additional voluntary excess which will afford you discount on your monthly premium?:
If so, please chose an amount: R500 / R1 000 / R3 000 / R4 000 / R5 000:  
 

Your vehicle will be insured for the retail value as determined by the Auto Dealer's Guide, therefore the complete model description must be provided. This value does not reflect any extras that the vehicle might have, the value of these must be added to the retail value. Radios and car phones must be specified in order to enjoy cover.

Note & disclaimer :This document is for quotation purposes only and must be read in conjunction with the policy wording.

 




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