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First Name
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Last Name
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Identity Number
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Email Address
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Contact Number
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Which insurance would you like
Domestic
Commercial
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Hidden
Domestic
Are you currently insured
*
Yes
No
Have you claimed in the last 3 years
*
Yes
No
How much was the claim amount
*
Current Insurance Policy (upload)
Accepted file types: doc, docx, pdf, Max. file size: 128 MB.
How long have you had uninterrupted insurance
*
Buildings
Risk Address
Roof Type
if thatch you should have a lighting conductor
Wall Type
Security
Burglar bars infront of all windows
Security gates in front of all opening doors to the outside
Alarm system
24 hour armed response
Perimeter around your property
Perimeter
Electric Fence
1.8m Wall
Sum Insured
Still Financed
Yes
No
Financed House
ABSA
Nedbank
First National Bank
Standard Bank
SA Home Loans
Other
Contents
Risk Address
Roof Type
if thatch you should have a lighting conductor
Wall Type
Security
Burglar bars infront of all windows
Security gates in front of all opening doors to the outside
Perimeter around your property
Alarm system
24 hour armed response
Sum Insured
All Risks
1
General
Sum Insured
2
Artificial limb(s) and replacements
Sum Insured
Description
3
Baby prams & car seats / baby accessories
Sum Insured
Description
4
Car sound equipment
Sum Insured
5
Caravan unspecified contents
Sum Insured
6
Caravan specified contents
Sum Insured
Description
7
LP's, CD's and DVD collection
Sum Insured
8
Cellular phones / Pager / Car phones
Sum Insured
Make & Model
IMEI Number / Serial Number
Box Sticker
Accepted file types: jpg, jpeg, png, bmp, Max. file size: 128 MB.
9
Collectables/ Antiques / Works of Art
Sum Insured
Certificate
Accepted file types: jpg, jpeg, png, bmp, pdf, Max. file size: 128 MB.
10
Contact Lenses / Spectacles
Sum Insured
11
Drones
Sum Insured
Make & Model
Serial Number
12
Essential Medical Equipment
Sum Insured
Description
13
Firearms
Sum Insured
Is it in a safe
Yes
No
14
Jewellery / Wristwatches
Sum Insured
Certificate
Accepted file types: jpg, jpeg, png, bmp, pdf, Max. file size: 128 MB.
15
Musical Instruments
Sum Insured
Discription
16
Pedal Cycles
Sum Insured
Description
17
Photographic / Video Equipment
Sum Insured
Description
18
Portable / Handheld Electronic Items
Sum Insured
Make & Model
Serial Number
19
Specified Clothing / Personal Effects
Sum Insured
20
Sport / Recreational Equipment
Sum Insured
Description
21
Tools / Hand Tools
Sum Insured
22
Wheelchair / Lawnmower / Motorized items
Sum Insured
23
Zippy Nippys / Kiddies Cycles
Sum Insured
Motor
Registered Owner
First name
Surname
Regular Driver
First name
Surname
if it differs from the registered owner
Drivers License (upload)
Accepted file types: jpg, jpeg, png, bmp, pdf, Max. file size: 128 MB.
Risk Address
where the vehicle will be parked at night
Security
Behind locked gates
Garage
Other
Year
Make
Model
If a new purchase, upload OTP / Invoice from dealership
Accepted file types: jpg, jpeg, png, bmp, pdf, Max. file size: 128 MB.
Type of insurance required
Comprehensive
Third party / Fire / Theft
Car Hire
Yes
No
Car hire term
30 Days
45 Days
60 Days
Tracking Device
Yes
No
Tracking Company
ACM Group
Afritelematics
Altrack
Autotracker
Autotrak
Bandit / Bidtrack
Baytrac (Pty) Ltd
Bonema Technologies (Pty) Ltd
Capital Air
Cartrack (Pty) Ltd
Cellsecure Holdings (Pty) Ltd
Cellstop South Africa (Pty) Ltd
Celtrac Management Services (Pty) Ltd
Chase Intelligent Tracking
Cobra Telematics SA
Ctrack
Digicell 23 CC
EWC Communications (Pty) Ltd
Fidelity ADT (Pty)Ltd
Fleetcam (Pty) Ltd
Globaltrack
GPS Tracking Solutions (Pty) Ltd
GRM Technology CC
Innovid Asset Management Solutions (Pty) Ltd
Intellidrive Tracking (Pty) Ltd
iTrack Live
Lamtrack
Landmark Tracking
Mix Telematics (Pty) Ltd
MLT Tech CC
MPI Holdings (Pty) Ltd
Mtrack
My Tracer (Pty) Ltd
Mzantsi Smarttracker
Nav Track
Neo-Track South Africa (Pty) Ltd
Netstar (Pty) Ltd
Next
No Jack Vehicle and Asset Tracking
PFK Electronics (Pty) Ltd
Pinpoint (Pty) Ltd
Point Track
Pointer SA (Pty) Ltd
Pro Track
Protection Through Innovation
Raptor Vehicle Tracking (Pty) Ltd
Resource Tracking (Pty) Ltd
Route Management Services
SA Electronic Tracking Systems Ltd
Safesky Africa
Securetrac
Selftrack
Smart Track
SmartSurv Wireless (Pty) Ltd
Soltrack
Star Trac Technologies
Teltonika
The Tracker
Tracetec
Track Corp
Tracker Network (Pty) Ltd
Tracking Africa (Atrack Technology Inc.)
Trackmatic Solutions (Pty) Ltd
Tracontime CalAmp
Tract Group (Pty) Ltd
Utrack IT
Vodacom
Volptec - GPS Tracking Solutions
We Track 24/7
24
Add a 2nd car
Regular Driver
First name
Surname
if it differs from the registered owner
Risk Address
where the vehicle will be parked at night
Security
Behind locked gates
Garage
Other
Make
Model
Year
If a new purchase, upload OTP / Invoice from dealership
Accepted file types: jpg, jpeg, png, bmp, pdf, Max. file size: 128 MB.
Type of insurance required
Comprehensive
Third party / Fire / Theft
Car Hire
Yes
No
Car hire term
30 Days
45 Days
60 Days
Tracking Device
Yes
No
Tracking Company
ACM Group
Afritelematics
Altrack
Autotracker
Autotrak
Bandit / Bidtrack
Baytrac (Pty) Ltd
Bonema Technologies (Pty) Ltd
Capital Air
Cartrack (Pty) Ltd
Cellsecure Holdings (Pty) Ltd
Cellstop South Africa (Pty) Ltd
Celtrac Management Services (Pty) Ltd
Chase Intelligent Tracking
Cobra Telematics SA
Ctrack
Digicell 23 CC
EWC Communications (Pty) Ltd
Fidelity ADT (Pty)Ltd
Fleetcam (Pty) Ltd
Globaltrack
GPS Tracking Solutions (Pty) Ltd
GRM Technology CC
Innovid Asset Management Solutions (Pty) Ltd
Intellidrive Tracking (Pty) Ltd
iTrack Live
Lamtrack
Landmark Tracking
Mix Telematics (Pty) Ltd
MLT Tech CC
MPI Holdings (Pty) Ltd
Mtrack
My Tracer (Pty) Ltd
Mzantsi Smarttracker
Nav Track
Neo-Track South Africa (Pty) Ltd
Netstar (Pty) Ltd
Next
No Jack Vehicle and Asset Tracking
PFK Electronics (Pty) Ltd
Pinpoint (Pty) Ltd
Point Track
Pointer SA (Pty) Ltd
Pro Track
Protection Through Innovation
Raptor Vehicle Tracking (Pty) Ltd
Resource Tracking (Pty) Ltd
Route Management Services
SA Electronic Tracking Systems Ltd
Safesky Africa
Securetrac
Selftrack
Smart Track
SmartSurv Wireless (Pty) Ltd
Soltrack
Star Trac Technologies
Teltonika
The Tracker
Tracetec
Track Corp
Tracker Network (Pty) Ltd
Tracking Africa (Atrack Technology Inc.)
Trackmatic Solutions (Pty) Ltd
Tracontime CalAmp
Tract Group (Pty) Ltd
Utrack IT
Vodacom
Volptec - GPS Tracking Solutions
We Track 24/7
Motor Cycle
Registered Owner
First Name
Surname
Regular Driver
First Name
Surname
if it differs from the regular driver
Drivers License (upload)
Accepted file types: jpg, jpeg, png, bmp, pdf, Max. file size: 128 MB.
Risk Address
where the vehicle will be parked at night
Year
Make
Model
Security
Behind locked gates
Garage
Other
If a new purchase, upload OTP / Invoice from dealership
Accepted file types: jpg, jpeg, png, bmp, pdf, Max. file size: 128 MB.
Type of insurance required
Comprehensive
Third party / Fire / Theft
Trailer
Description
Sum Insured
Registration Document (upload)
Accepted file types: jpg, jpeg, png, bmp, pdf, Max. file size: 128 MB.
Caravan
Description
Sum Insured
Registration Document (upload)
Accepted file types: jpg, jpeg, png, bmp, pdf, Max. file size: 128 MB.
Pleasure Craft
Description
Sum Insured
Registration Document (upload)
Accepted file types: jpg, jpeg, png, bmp, pdf, Max. file size: 128 MB.
Where did you hear about us?
Google
Social Media
Friend
Other
Hidden
Commercial
No business is too big or too small
Are you currently insured
Yes
No
Policy schedule (upload)
Accepted file types: jpg, jpeg, png, bmp, pdf, doc, docx, Max. file size: 128 MB.
Any Claims in the last 3 years
Yes
No
Claim Amount
Describe claim
Insurance required for
Commercial
Marine
Agri
Contractors All Risk
Engineering
PI Cover (Professional Indemnity)
PI Cover (Professional Indemnity) cover description
Option Cover
R 1 000 000,00
R 5 000 000,00
R 10 000 000,00
Other type of cover
Where did you hear about us?
Google
Social Media
From a friend
Other
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