Quotations

Please complete the form below so we can supply you with the best possible quotation.

Title
First Name
Surname
ID Number
Date of Birth
Tel No & Code
Email
Occupation
Residential Suburb
Postal Code
Marital Status
Previous Insurer
Name of Insurer
How long in total?
Amount of Claims
Value of Claims
Current Premium

GENERAL DETAILS
Has an insurer ever refused you any proposal of yours, cancelled any policy (or part thereof), ever refused to renew a policy (or part thereof) or imposed any special conditions?
YES NO
If YES, please supply details below:

HOUSE CONTENTS
Type of Residence
Value of contents
Date that you moved in
Any burglaries?
YES NO
If YES, please supply date
Security Measures:
Burglar bars at all openable windows
Gates at all doors leading outside
Linked alarm (Monitoring)
Linked alarm (Armed response)
Electric fencing
Complex with controlled access
24-hour security guards
Claim free years

BUILDING
Used as
Residential Suburb
Postal Code
Insured Amount

ALL RISKS (UNSPECIFIED)
Insured Amount

ALL RISKS (SPECIFIED)
Item 1 description
Value:
Item 2 description
Value:
Item 3 description
Value:
Item 4 description
Value:
Item 5 description
Value:

VEHICLE 1
Year, Make & Model
Value
Overnight Parking
Vehicle Cover
Radio Cover Value
Vehicle Security:
Alarm/Immobiliser
Gearlock
Anti-hijack
Tracking Device
Details of Driver
License Obtained (indicate year)
Claim-free Years (of regular driver)

VEHICLE 2
Year, Make & Model
Value
Overnight Parking
Vehicle Cover
Radio Cover Value
Vehicle Security:
Alarm/Immobiliser
Gearlock
Anti-hijack
Tracking Device

Details of Driver
License Obtained (indicate year)
Claim-free Years (of regular driver)

OTHER ITEMS
Description & Value





Verification Code
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Sharenet :
EQUITES PROPERTY FUND LIMITED - Acquisition of Simba Logistics facility in Gauteng    | BANK WINDHOEK LIMITED - Interest Payment Notification - BWZJ21    | BANK WINDHOEK LIMITED - Interest Payment Notification    | IVUZI INVESTMENTS LIMITED - IVA863 - Listing of New Financial Instrument    | CORESHARES INDEX TRACKER MANAGERS (RF) PROPRIETARY LIMITED - Finalisation announcement - LVLTRX    | BANK OF CHINA LIMITED, JOHANNESBURG BRANCH - Interest payment notifications - BCJ14 BCJ15    | STENPROP LIMITED - Acquisition of multi-let industrial estate    | EXEMPLAR REITAIL LIMITED - Change in nature of associates holdings of the companys securities    | INGENUITY PROPERTY INVESTMENTS LIMITED - Dealing in securities by a director    | STEINHOFF INTERNATIONAL HOLDINGS N.V. - Hemisphere Lock-Up Agreement: Extension Of Long-Stop ...    | INTERWASTE HOLDINGS LIMITED - Unaudited Condensed consolidated financial results for the six ...    | DRDGOLD LIMITED - Notice of acquisition of a beneficial interest in securities    | ASHBURTON MANAGEMENT COMPANY (RF) PROPRIETARY LIMITED - Rebalancing of the Ashburton Inflation ...    | ORION MINERALS LIMITED - Drilling Commences on New High Conductance Target at Rok Optel, ...    | ARGENT INDUSTRIAL LIMITED - Disclosure of Acquisition of Securities    | KIBO MINING PLC - Completion of Second School Support Project    | SATRIX COLLECTIVE INVESTMENT SCHEME - Partial Delisting Of Satrix Stxemg Securities - STXEMG    | HAMMERSON PLC - Transaction in Own Shares    | INVESTEC AUSTRALIA PROPERTY FUND - Posting of Circular and Notice of General Meeting    | SATRIX COLLECTIVE INVESTMENT SCHEME - Listing of Additional Securities-STXWDM    | CAPITAL & REGIONAL PLC - Directorate Change    | HUGE GROUP LIMITED - Renewal of cautionary announcement    | MERAFE RESOURCES LIMITED - Interim results for the six months ended 30 June 2018 and cash ...    | GLENCORE PLC - GLN - Transactions in own shares 3 August 2018    | ROYAL BAFOKENG PLATINUM LIMITED - Condensed Consolidated Interim Results for the six months ...    | ABSA BANK LIMITED - Interim results and dividend announcement    | ABSA GROUP LIMITED - bsa Group Limited unaudited condensed consolidated interim financial ...    |