Free Quote for comprehensive short term insurance


Insurance Quote
 

Form for free short term insurance quote

 
  Title
     
  Mr
  Mrs
  Miss
  Ms
  Dr
  Prof
  Other
   
  Please complete the fields below:
     
  Name:
  Surname:
  ID Number:
  Tel no and code:
  Cell no:
  email:
  Occupation
  Residential Adress
  Postal Code
     
  Marital status:
     
  Maried
  Single
  Divorced
  Widowed
     
  Previous insurer(s):
     
  Never been insured
  Santam
  Auto & General
  Mutual & Federal
  Outsurance
  Dial direct
  Hollard
  Other
     
  How long in total?:
     
  Less than 1
  1-2
  3-4
  4-5
  5-6
  More than 6
     
  Amount of claims:
     
  No claims
  1
  2
  3
  4
  5
  More than 5
     
 
     
  Value of claims R
  Current Premium R
     
  GENERAL DETAILS Has an insurer ever refused any proposal of yours, cancelled any policy (or section thereof), refused to renew any policy (or section thereof) or imposed any special conditions?:
     
  Yes:
  No:
     
  (If YES, supply details below):
 
   
  House Contents:
     
  House
  Townhouse
  Flat on ground
  Flat above ground
  Guest House
     
 
     
  Value of contents R
  Date you moved in
     
  Any burglaries?:
     
  Yes
  No
     
  If Yes 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:
     
  0
  1
  2
  3
  4
  5
   
  BUILDING:
     
  Main Residence
  Holiday Residence
  Other Residence
   
 
     
  Residential suburb :
  Postal code :
  Insured amount R:
     
  ALL RISKS (UNSPECIFIED) Insured amount R:
 
   
  ALL RISKS (SPECIFIED):
     
  Item1:
  Value R:
  Item2:
  Value R:
  Item3:
  Value R:
  Item4:
  Value R:
  Item5:
  Value R:
     
  VEHICLE 1:
     
  Year, make & model :
  ValueR :
  Radio cover value R :
     
  Overnight parking:
     
  Locked garage
  In yard-behind locked gates
  In yard-no gates
  Carport in secure complex
  In street
     
  Vehicle cover:
     
  Comprehensive:
  Third party Fire and Theft:
  Third party only
   
 
     
  Private:
  Business:
   
  Vehicle security:
     
  Alarm/Immobiliser
  Gearlock
  Anti-hijack
  Tracking device
     
  VEHICLE 2:
     
  Year, make & model :
  Value R :
  Radio cover value R :
     
  Overnight parking 2:
     
  Locked garage
  In yard-behind locked gates
  In yard-no gates
  Carport in secure complex
  In street
   
  Vehicle cover 2:
     
  Comprehensive:
  Third party Fire and Theft:
  Third party only
   
 
     
  Private:
  Business:
   
  Vehicle security 2:
     
  Alarm/Immobiliser
  Gearlock
  Anti-hijack
  Tracking device
     
  OTHER ITEMS Description and value:
   
 
   
 


 
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