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Insurance Quotations
Online quotation form for your convenience
Please complete the form below if you need a quotation on Car and Household Insurance as well as any additional items.

No quote is less expensive than a free one, so please make use of the form to make sure that you make full use of this opportunity.

Please contact us should you require any specific attention. We are standing by for your call!
 
*Fields marked with (*) is required
Title
First Name*
Surname*
ID Number*
Tel no & code*
E-mail
Occupation
Residential Address*
Postal Code*
Marital status
Previous insurer(s)
How long in total?
Amount of claims
Description
Value of claims
Current Premium
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
Type of residence 
Value of contents 
Date you moved in 
Any burglaries? Yes  No  If yes, date:  
Security measures  Burglar bars at all open able 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 
BUILDING
Used as 
Residential suburb
Postal code 
Insured amount 
ALL RISKS (UNSPECIFIED)
Insured amount
ALL RISKS (SPECIFIED)
Item 1 description   Value:
Item 2 description   Value:
Item 3 description   Value:
Item 4 description   Value:
Item 5 description   Value:
VEHICLE 1
Year*
Make & model
Value
Overnight parking
Vehicle cover  
Radio cover value
Vehicle security Alarm/Immobiliser
Gear lock
Anti-hijack
Tracking device
Details of driver
License Obtained* (indicate day, month and year)
License Code*
Claim-free years (of regular driver)
VEHICLE 2
Year*
Make & model
Value
Overnight parking
Vehicle cover  
Radio cover   value
Vehicle security Alarm/Immobiliser
Gear lock
Anti-hijack
Tracking device
Details of driver
License Obtained* (indicate day, month and year)
License Code*
Claim-free years (of regular driver)
OTHER ITEMS
Description & value
 
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