Home Company Profile Our Services Funeral Schemes Invest Capital Long Term Insurance (Categories A,B & C) Medical Aids And Health Care Funding Personal Retirement And Pension Planning Savings Plans To Maximize The Accumulation Of Capital School And University Fees Planning Short Term Insurance (Personal & Commercial Lines) Tax And Trust advice Downloads Quote Request Life Short Term News Q & A Contact Us Quote Request - Short Term     Personal Details Name Surname Telephone Number Fax Number Cell number Email Address Occupation I.D Number Postal Address How many claims/losses in the past 3 years whether insured or not? What is the total value of these losses? Has any policy ever been cancelled by an insurer? Yes No Select Here If yes, when and which insurer? Has any insurance/quote been refused by an insurance company? Yes No Select Here Has any terms or conditions been imposed by any insurer? Yes No Select Here Current insurer? - from when Previous insurer? - no of years? Details of Premises Type of building House No Yes Townhouse No Yes Block of flats No Yes Cluster No Yes Garden Cottage No Yes Other No Yes Street Address + Postal Code Area Type Residential suburb No Yes Plot No Yes Farm No Yes Security village No Yes CBD No Yes Adjacent to building Other buildings No Yes Vacant stand No Yes Park No Yes Open field No Yes River/Dam/Ocean No Yes Airport/Highway No Yes Construction of building Brick + Plaster - Titled Roof No Yes Brick + Plaster - Thatched Roof No Yes Other No Yes If other, please describe Burglaries in the past 12 months? No Yes Security measures at the premises Alarm to 24hr armed response No Yes Burglar bars No Yes Electric fencing No Yes 24hr access control No Yes Other No Yes If other, please describe Details of Cover Required Buildings â�� total replacement value Contents â�� total replacement value All risks â�� details of items to be covered: Quantity, Make/Mode/Serial Number, Sum insured please fill out like this : eg. : 2qty, Television+Serial, R20 000 List as many items as you need, 1 entry per new line Details of previous claims and incidents related to the above cover: Date of Loss, Value Claimed, Claimed for? (Yes/No), Description of Incident please fill out like this : eg. : 20 April 2009, R20 000, Yes, 2 Tv's Stolen List as many items as you need, 1 entry per new line Vehicle insurance requirements Complete this section if you want cover for passenger cars, LDVâ��s, commercial vehicles, motorcycles, trailers or caravans Details of Vehicles   Vehicle 1 Vehicle 2 Vehicle 3 Manufacturer Year model Model description Security Use (Private/Business) Day storage (locked garage/street) Day suburb Night storage ((locked garage/street) Night area type (residential/CBD) Night street address Sound Equipment Non-Standard Accessories Pool vehicle? Registered owner Usual driver ID of usual driver Retail value of vehicle Cover (Comp/TPFT/TPO) Details of previous claims and incidents related to the above cover: Date of Loss, Value Claimed, Claimed for? (Yes/No), Description of Incident please fill out like this : eg. : 10 May 2008, R10 000, Yes, Sound Equipment Stolen List as many items as you need, 1 entry per new line Accidental damage cover Sum insured Personal Accident Cover Number of employees to cover Sum insured per employee Comments & other requirements   Quick Downloads Broker Statutory Notice Amended 27.08.08 Broker Intermediary Disclosure Amended   Short Term - Service Providers   Life - Service Providers     Licenced Financial Services Provider - Licence No. 14060 Copyright © 2009   Disclaimer   Login Site Design & Programming : Versatile Designs