Specific Items Insurance

Capture your details and we’ll get an expert to respond with some options and guidance for you.

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 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?

For how many years have you been insured?

Your insurance company prior to current (if any)?

Personal Details

Insured First Name

Insured Surname

Gender

Nationality

ID Number

Occupation

Residential Address

Postal Address

Cellphone Number

Email Address

Marital Status

Are you co-insured? (i.e. another person with an interest in insuring this asset)

Co-Insured Name & Surname

Co-Insured Gender

Co-Insured ID Number

Co-Insured Occupation

Has an insurance company ever cancelled your entire policy or part of a policy?

Has special conditions ever been attached to your Insurance?

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

Have you had another claim in the last 5 years?

Date of Claim

Type of Claim (Vehicle, Home, Assets, etc)

Description

Amount Paid

Have you had another claim in the last 5 years?

Date of Claim

Type of Claim (Vehicle, Home, Assets, etc)

Description

Amount Paid

ALL RISK - Specific items you'd like to insure

What asset would you like to insure?

Sum Insured

Make

Model