Vehicle / Home Quote

Contact Details

Phone

Client Information:

Title

Name

Surname

ID Number

Gender

Marital Status

Physical Address

Postal Address

Vehicle:

Regular Driver

Currently Insured?

Years of Continuous Cover

Last Claim Submitted

Overnight Parking & Daytime Parking Address & Security

License period

Is the vehicle Financed?

Security device

Sound system

Use: Private, Business, Occasional Bus, Carpooling, Commuting

Car Hire

Value: Trade, Market or Retail?

Paint Colour & Type:

Home Contents:

Type of dwelling

Value of contents

Period of residence at this address

Burglaries / Losses

Linked alarm

Thatched?

Portable Possessions:

All Risks Unspecified amount: (R4400 free)

All Risks Specified

Cellphones

Prescription Glasses

Bicycles

Swimming Pool Equipment

Building:

Value

Number of Geysers

Subsidence and Landslip Required?

Funeral Cover