Get a Quote Quote Request Client Name ID number Tel Email Physical Address Marital Status —Please choose an option—MarriedDivorcedWidowedSingleOther Household Section Type of Dwelling —Please choose an option—HouseFlat on ground floorFlat above ground floorPlotFarmOther Sum Insured Period of Address Roof Construction —Please choose an option—TileZinc Wall Construction —Please choose an option—BrickWoodZinc Thatched Lapa YesNo Dwelling Classification —Please choose an option—Residential SuburbIndustrial Suburb Burglar Alarm YesNo If yes is the alarm linked YesNo If yes with what company —Please choose an option—ADTSOSOther Burglar bars in front of windows/louvers/fanlights YesNo Occupied during work hours YesNo Unoccupied 45 days a year YesNo Motor Vehicle Section Year Make Model Retail Value Risk Address Security Registered Owner Regular Driver Date of Birth Car Hire Sound equipment to be covered YesNo Sound equipment value Overnight parking Sound equipment factory fitted YesNo Vehicle Type —Please choose an option—Motor VehicleLDV4x42x2 All Risk Section Unspecified items & values Specified items & values
