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Business Insurance
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Car & Household Insurance Quote

     
 
Personal/Driver Details
Title
Name
Surname
I.D Nr.
Mobile Phone Nr.
Work Tel. Nr.
Email Address
Marital Status
Suburb name
Area Code
Click here for area code
Vehicle Details
 
Vehicle 1
Vehicle 2
Vehicle Value
(Max 500 000)
Have you had your drivers licence for less than 2 years?
Is the driver less than 25 years of age?
Type of Licence Code
Vehicle Year
Make
Model
Are you currently comprehensively insured? Yes
No
Yes
No
If yes, how many claim free years?
Date of last claim
Overnight parking
Use of vehicle
Sound System cover?
( max R6000 )
Is there a tracking device installed? Yes
No
Yes
No
Note: Vehicle values over R200,000, tracking compulsory.
Car hire (extra R50/m) Yes
No
Yes
No
Household Owners / Building (Optional)
Value of home
(Max 3, 000, 000)
Household Contents Quote (Optional)
Value of house Contents?
( Max R400 000 )
Do you have burglar bars on all opening windows?
Yes
No
Do you have Security Gates on all exterior leading doors?
Yes
No
Do you have a Linked alarm system?
Yes
No
If the home is a flat is it above the ground floor? Yes
No
 
 
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