Request a Quote

Have you or any member of your household had any application for insurance declined or insurance cancelled or renewal refused or not invited or had any special conditions imposed?

Have you or any member of your household been involved in any civil or criminal litigation in the past 5 years or have you any civil judgment against you?

Current Insurance:

Do you currently have short term insurance cover on household contents or vehicles etc?

How long have you been insured?

Claims and loses in the past 5 years (all claims need to be noted)?

Please note date of loss/claim and amount claimed for:

All risk items

Are there any laptops, cellphones, etc to be noted? Please provide a full description for each item and the replacement cost:

Vehicle details

Metalic paint

Regular driver(If not insured please provide initials, surname, ID number and relationship to person)

Cover

Usage

Car hire to be included

Tracking device fitted

Waiver of excess

Top up cover

Security:

Burglar bars on all opening windows including louvers that can be opened?

Security gates on all doors leading to the outside including slidng doors and interleading door from garage to house?

Alarm linked to a 24 hour control room with armed response?

Security complex (24 hour access control, 24 hour guards on duty and patrolling, electric fence all around the premises)?

House Owners

House Content:

Roof construction

Wall construction

Residential Address:

Thatch roofing on premises

To enable us to underwrite risk fairly and combat insurance fraud, we need to have your consent to verify and share policy information with ensurers and other institutions as well as to access credit information held by other institutions.

By checking the following box you consent to the above.