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Quotation form
Car Insurance Quotation form
Please fill the form accurately for better assistance
Personal Infomation
First Name
*
Middle Name
Last Name
*
Phone Number
Email Address
*
Are You South African Citizen ?
*
Yes
No
ID/Passport Number
*
Date Of Birth
*
d-m-y
Street Address
*
City
State/Province
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
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Australia
Austria
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Bouvet Island
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British Indian Ocean Territory
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Cook Islands
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Heard Island And Mcdonald Island
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Korea, Republic of
Kosovo
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Mayotte
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Netherlands Antilles
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Norway
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Panama
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Poland
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Stateless Persons
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Sudan, South
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Virgin Islands, U.S.
Wallis And Futuna Islands
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Vehicle Information
The Make Of The Car
*
The Model Of The Car
*
The Model Year Of The Car
*
Colour Of The Car
*
What's the car used for?
*
Private / Travelling to work
Private / Private Occasional Business
Private / Full Business
Is The Car Registered In South Africa?
*
Yes
No
Is The Car Financed ?
*
Yes
No
In your own words describe what the car is used for
*
Select your preferred cover type
*
Covers the loss of, or damage to your car due to accident – regardless of who’s at fault – theft, weather, malicious damage, fire and accidental damage your car causes to other people’s property.
Cover for damages to your car as a direct result of fire, explosions, lightning or theft, including damages you may cause to someone else’s car, for which you are legally liable.
You are covered for damages that your car caused to someone’s car or property, for which you are legally liable.
You are covered for hail damages, damages your car caused to other cars/property for which you are legally liable and if your car was written off.
You are covered for limited accident damage, hail damages, damages your car caused to other cars/property for which you are legally liable and if your car was written off.
Select your preferred insured value
*
In the event of a claim, your car will be covered for the average amount your car would sell for today.
We will pay you the price you would expect to pay for your car if you bought it from a motor dealer. This attracts a higher premium, but also means you will get a higher payout when you claim.
We will pay you the estimated amount the dealership would offer you for your car after inspecting it. This will provide you with the lowest possible premium, but also the lowest payout when you claim.
We will pay you the estimated amount the dealership would offer you for your car after inspecting it. This will provide you with the lowest possible premium, but also the lowest payout when you claim.
We will pay out for, or replace, your car with the same model that is one year newer than your insured car, in the event of a write off (this excludes theft related claims). If there’s no newer model of the car, we will pay out 15% more than your car’s retail value.
In which area or suburb is the car normally parked at night?
*
Night-time parking area / suburb
Where is the car normally parked at night?
Basement
Carport
Driveway/yard
Garage
Open parking lot
Pavement/street
What type of security do you have where the car is parked at night?
Security guarded access control
Electronic access control
Locked gate
None
In which area or suburb is the car normally parked during the day?
*
Night-time parking area / suburb
Where is the car normally parked during the day?
Basement
Carport
Driveway/yard
Garage
Open parking lot
Pavement/street
What type of security do you have where the car is parked during the day?
Security guarded access control
Electronic access control
Locked gate
None
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