Request a Quote

First Name *
   
Cell *
   
Home *
   
Your E-mail *
   
I.D Number *
   
Gender *
   
Marital Status *
   
Occupation *
   
Residential Address *
   
Postal Address *
   
 

Cover Required
 

Building
   
House Owners (Building) *
   
House Contents *
   
Type of Residents *
   
Building Construction *     
   
If other: Please specify *
   
Residential Security * Windows Fully Barred
All external doors barred
Alarm
Electric Fence
24 hour security gaurd
   
Occupied By *
   
Occupied during working hours *
   
All risk Cover Required *
   
Unspecified all risks: Value *
   
Specified all risks: Description *
   
Specified all risks: Value *
   
Claims History Description: Date *
   
Claims History Description: Amount *
   
Claims History Description: Type *
   
 

Motor Vehicle/s
   
Make: Vehicle 1 *
   
Model: Vehicle 1 *
   
Year of Manufacture: Vehicle 1 *
   
Reg Number (Optional): Vehicle 1
   
Engine Number (Optional): Vehicle 1
   
Chassis Number: Vehicle 1 *
   
Colour of Vehicle: Vehicle 1 *
   
Vehicle Security(Tracker, alarm, etc.) *
   
Registered Owner: Vehicle 1 *
   
Overnight Parking: Vehicle 1 *
   
Day Parking: Vehicle 1 *
   
Manual/Automatic: Vehicle 1 *
   
Regular Driver I.D Number *
   
Regular Driver Licence Issue Date *
   
Any Licence Endorsements *
   
Regular Driver Gender(Vehicle 1) *
   
Use of Vehicle (Private / Business) *
   
 

Vehicle 2
   
Make: Vehicle 2 *
   
Model: Vehicle 2 *
   
Year of Manufacture: Vehicle 2 *
   
Reg Number (Optional): Vehicle 2
   
Engine Number (Optional): Vehicle 2
   
Chassis Number: Vehicle 2 *
   
Colour of Vehicle: Vehicle 2 *
   
Vehicle Security(Tracker, alarm, etc.) *
   
Registered Owner: Vehicle 2 *
   
Overnight Parking: Vehicle 2 *
   
Day Parking: Vehicle 2 *
   
Manual/Automatic: Vehicle 2 *
   
Regular Driver I.D Number *
   
Regular Driver Licence Issue Date *
   
Any Licence Endorsements *
   
Regular Driver Gender(Vehicle 2) *
   
Use of Vehicle (Private / Business) *
   
 

Vehicle 3
   
Make: Vehicle 3 *
   
Model: Vehicle 3 *
   
Year of Manufacture: Vehicle 3 *
   
Reg Number (Optional): Vehicle 3
   
Engine Number (Optional): Vehicle 3
   
Chassis Number: Vehicle 3 *
   
Colour of Vehicle: Vehicle 3 *
   
Vehicle Security(Tracker, alarm, etc.) *
   
Registered Owner: Vehicle 3 *
   
Overnight Parking: Vehicle 3 *
   
Day Parking: Vehicle 3 *
   
Manual/Automatic: Vehicle 3 *
   
Regular Driver I.D Number *
   
Regular Driver Licence Issue Date *
   
Any Licence Endorsements *
   
Regular Driver Gender(Vehicle 3) *
   
Use of Vehicle (Private / Business) *
   
 

Other Cover Required
   
Description (Optional) *
   
 

Notes
   

* Car hire will be automatically included
** Roadside Assistance will be automatically included
*** This is not a named driver policy - meaning anyone with a valid SA Drivers Licence can Drive - However additional excess will apply if Driver is under 30 years of age.

   
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