Vehicle Quote Request

Motor Vehicle, Motorcycle, Trailer, Caravan, Watercraft

Please note that the personal information section is compulsory as we will not be able to quote withouth this information provided to us.

Full Name & Surname (Mr / Mrs / Miss / Dr / Prof)
Email
Contact Number
Full physical address where insured items are kept
* Note: If there is more than one address, then we will issue separate policies. Please specify which vehicle is parked at which address. We are VERY strict with this!
ID Number
Marital Status
Employment Status (Employed, Retired, Student, Civil Servant)
* Note: If Retired: Regular driver (must be over 50) and spouse (must be over 40) and both must not be gainfully employed
Drivers License Period
Consent from client to do ITC Scoring: Yes / No

Full description of vehicle: Make, Model, Year etc
Regular driver of vehicle (We are VERY strict with this!)
Regular driver insurance history / claims history (NCB) (We are VERY strict with this! We work on true claims free years. If there was a claim, we want to know who made the accident)
ID number of Regular driver (we cannot do quote without this info)
Marital status of Regular driver
License period of Regular driver
Use of the vehicle (private / occupational business or full business) Note: We are VERY strict with this!
License period of Regular driver
Parking over night (Locked garage / behind locked gates etc.)
Has the engine of the vehicle been upgraded to increase the performance?
Market / Retail / Trade Value
Financed or fully paid
Do you require additional cover, at additional cost? (If you do not select any of these, you will not have cover.
Do you currently have a tracking device fitted or security device fitted?
If not, are you willing to install a tracking device?
Do you want to increase excess to reduce premium? Yes No

Full description of vehicle: Make, Model, Year etc
Regular driver of vehicle (We are VERY strict with this!)
Regular driver insurance history / claims history (NCB) (We are VERY strict with this! We work on true claims free years. If there was a claim, we want to know who made the accident)
ID number of Regular driver (we cannot do quote without this info)
Marital status of Regular driver
License period of Regular driver
Use of the vehicle (private / occupational business or full business) Note: We are VERY strict with this!
License period of Regular driver
Parking over night (Locked garage / behind locked gates etc.)
Has the engine of the vehicle been upgraded to increase the performance?
Market / Retail / Trade Value
Financed or fully paid
Do you require additional cover, at additional cost? (If you do not select any of these, you will not have cover.
Do you currently have a tracking device fitted or security device fitted?
If not, are you willing to install a tracking device?
Do you want to increase excess to reduce premium? Yes No

Full description of vehicle: Make, Model, Year etc
Regular driver of vehicle (We are VERY strict with this!)
Regular driver insurance history / claims history (NCB) (We are VERY strict with this! We work on true claims free years. If there was a claim, we want to know who made the accident)
ID number of Regular driver (we cannot do quote without this info)
Marital status of Regular driver
License period of Regular driver
Use of the vehicle (private / occupational business or full business) Note: We are VERY strict with this!
License period of Regular driver
Parking over night (Locked garage / behind locked gates etc.)
Has the engine of the vehicle been upgraded to increase the performance?
Market / Retail / Trade Value
Financed or fully paid
Do you require additional cover, at additional cost? (If you do not select any of these, you will not have cover.
Do you currently have a tracking device fitted or security device fitted?
If not, are you willing to install a tracking device?
Do you want to increase excess to reduce premium? Yes No

Full description of vehicle: Make, Model, Year etc
Regular driver of vehicle (We are VERY strict with this!)
Regular driver insurance history / claims history (NCB) (We are VERY strict with this! We work on true claims free years. If there was a claim, we want to know who made the accident)
ID number of Regular driver (we cannot do quote without this info)
Marital status of Regular driver
License period of Regular driver
Use of the vehicle (private / occupational business or full business) Note: We are VERY strict with this!
License period of Regular driver
Parking over night (Locked garage / behind locked gates etc.)
Has the engine of the vehicle been upgraded to increase the performance?
Market / Retail / Trade Value
Financed or fully paid
Do you require additional cover, at additional cost? (If you do not select any of these, you will not have cover.
Do you currently have a tracking device fitted or security device fitted?
If not, are you willing to install a tracking device?
Do you want to increase excess to reduce premium? Yes No

Full description of vehicle: Make, Model, Year etc
Regular driver of vehicle (We are VERY strict with this!)
Regular driver insurance history / claims history (NCB) (We are VERY strict with this! We work on true claims free years. If there was a claim, we want to know who made the accident)
ID number of Regular driver (we cannot do quote without this info)
Marital status of Regular driver
License period of Regular driver
Use of the vehicle (private / occupational business or full business) Note: We are VERY strict with this!
License period of Regular driver
Parking over night (Locked garage / behind locked gates etc.)
Has the engine of the vehicle been upgraded to increase the performance?
Market / Retail / Trade Value
Financed or fully paid
Do you require additional cover, at additional cost? (If you do not select any of these, you will not have cover.
Do you currently have a tracking device fitted or security device fitted?
If not, are you willing to install a tracking device?
Do you want to increase excess to reduce premium? Yes No
Client Comments