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Home
About
Services
Physical Asset Insurance
Medical Cover
Life & Disability insurance
Investments
Bespoke financial advice
Media
Contact
Home
About
Services
Physical Asset Insurance
Medical Cover
Life & Disability insurance
Investments
Bespoke financial advice
Media
Contact
Menu
Home
About
Services
Physical Asset Insurance
Medical Cover
Life & Disability insurance
Investments
Bespoke financial advice
Media
Contact
Home Building Insurance
Capture your details and we’ll get an expert to respond with some options and guidance for you.
A problem was detected in the following Form. Submitting it could result in errors. Please contact the site administrator.
Would you like to attach your existing policy? (If you attach an existing policy you can reduce the amount of information we need to capture.)
Please select…
Yes
No
Please attach your current policy schedule
Please attach a copy of your ID
Who is your current insurance company?
What is your current policy number?
What is your current insurance premium?
Who was your previous insurance company?
For how many years have you been insured?
Your insurance company prior to current (if any)?
Personal Details
Insured First Name
Insured Surname
Gender
Please select…
Male
Female
Other
Nationality
ID Number
Occupation
Residential Address
Postal Address
Cellphone Number
Email Address
Marital Status
Please select…
Married
Co-Habit
Divorced
Widowed
Single
Are you co-insured (i.e. another person with an interest in insuring this asset)?
Please select…
Yes
No
Co-Insured Name & Surname
Co-Insured Gender
Please select…
Male
Female
Co-Insured ID Number
Co-Insured Occupation
Has an insurance company ever cancelled your entire policy or part of a policy?
Please select…
Yes
No
Has special conditions ever been attached to your Insurance?
Please select…
Yes
No
Claims
Please include detail of any short term claims you've had in the last 5 years
Date of Claim
Type of Claim (Vehicle, Home, Assets etc)
Description
Amount paid out by your insurance company
Have you had another claim in the last 5 years?
Please select…
Yes
No
Date of Claim
(Vehicle, Home, Assets etc)
Description
Amount paid out by your insurance company
Have you had another claim in the last 5 years?
Please select…
Yes
No
Date of Claim
(Vehicle, Home, Assets etc)
Description
Amount paid out by your insurance company
Building
Sum insured for building ie replacement value
Construction
Please select…
Standard: bricks and plaster
Non-standard: thatch or timber or pre-fab
Roof
Please select…
Tiles / Corrugated Iron
Thatch / Timber
Bank which financed your bond?
Physical Risk Address
Is this your Primary residence or Holiday Home?
Please select…
Primary residence
Holiday Home
Type of Dwelling 1
Please select…
House
Flat / apartment
Townhouse / Duplex
Type of Dwelling 2
Please select…
Free standing
Semi-detached unit
Neither
Do you rent the property out to tenants?
Please select…
Yes
No
Accidental damage to fixed machinery
Yes R20 000
Yes R25 000
Yes R30 000
Yes R40 000
Yes R50 000
Yes other amount
No
Power Surge cover
Yes R25 000
No
Number of geysers
Do you have solar geysers?
Please select…
Yes
No
Value of solar system
Is there a motorised electric gate?
Yes
No
Is there a pool pump
Yes
No
Subsidence & landslip cover required
Yes
No
Please advise security in place eg burglar bars, security gates, linked alarm
Terms and Conditions
By ticking, you are confirming that you have read, understood and agree to
Life Current terms and conditions.
Submit