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Home
About Us
Company Overview
Management
Our Purpose
Contact Us
Personal Insurance
Home Combined
Motor Insurance
Student Insurance
Business Insurance
Short-term Insurance
Employee Benefits
Risk Management
Payments
Claims
Forms
Claims
Underwriting
Employee Benefits
Help Desk
Feedback
FAQs
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Claims Forms
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Step
1
of 5
PRIVATE MOTOR PROPOSAL FORM
SURNAME
*
FIRST NAME(S): Mr /Mrs/Dr
*
DATE OF BIRTH
OCCUPATION:
HOBBIES
SPORT
ID NUMBER
Email
*
Next
TELEPHONE: HOME
TELEPHONE: WORK
CELL
POSTAL ADDRESS
RESIDENTIAL ADDRESS
BANK DETAILS
BANK ACCOUNT NO
PERIOD OF INSURANCE
From
To
Next
Are you fully licenced for this class of vehicle
Yes
No
Date when licenced
Have you ever been denied or have insurance policy cancelled?
Yes
No
STATE THE REASON
Name of previous insurer
State any loss suffered for the past 3 years and their monetary value
Next
Do You Have Another Vehicle?
No
Yes
Make/Model
Engine & Chassis No:
Make/Model
Engine & Chassis No:
Year of make
Reg No:
Year of make
Reg No:
Type of cover
Value To be insured(incl.accessories)
Type of cover
Value To be insured(incl.accessories)
Next
Make of audio equipment
Market value to be insured (audio equipment)
What is the vehicle used for
WARNING: INSURANCE FRAUD IS A CRIME
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