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Forms and Applications

Fax                    086 649 4861    

Fax                    086 649 4861    

OWN DAMAGE & DAMAGE INVOLVING THIRD PARTY

  • Accident report

  • Pictures (if available)

  • Copy of license and ID of driver at the time of incident

  • Quote of damage (if vehicle is driveable)

  • Towing invoice (if applicable)

  • Brief description of the incident

THIRD PARTY CLAIM
(not claiming from your insurance )

  • Accident report

  • Pictures of damage

  • Copy of license & id of driver/ claimant at the time of incident

  • 3 quotes from 3 reputable panel beaters

  • No claims letter from your insurance

  • Affidavit confirming why you say the other party / our insured is in the wrong

  • Proof of ownership of the vehicle

CELLPHONE CLAIM

  • ITC number (reference after you block the phone)

  • Quote of the phone

  • Affidavit or police report of the incident

BUILDING CLAIM

  • Police report

  • Pictures of the damage

  • Quotation of the damage

HOUSE CONTENT CLAIM

  • Damage report

  • affidavit

  • Pictures of the damage

  • (if burglary) proof of forcible entry

  • List of items affected and their values

  • Quote of each item

AMENDMENTS

  • Policy number and/or ID number

  • Policy holders name

  • Contact number (email and cell phone)

  • Clear instruction of required changes

COMPLAINTS PROCEDURE

GENERAL DISCLOSURE

New Quotes / Personal Lines &  Commercial Insurance

PERSONAL INFORMATION

MARITAL STATUS

RESIDENTIAL ADDRESS

FREE-STANDING (YES/NO)
BURGLAR PROOF SECURITY GATES?
ALARM & IS IT LINKED TO ARMED RESPONSE?
FENCE OR WALL AROUND?
ELECTRIC FENCE/ RAZOR WIRE/ BARB WIRE?
CLOSE TO RIVER/DAM/LAGOON?
OCCUPIED DURING THE DAY?

INSURANCE HISTORY

DATE JOINED
Year
Month
Day
DATE ENDED
Year
Month
Day
PREVIOUS ACCIDENTC/CLAIMS (DATE)
Year
Month
Day

VEHICLE

USE (PRIVATE OR BUSINESS)
TRACKER?
NIGHT TIME PARKING (LOCKED GATE/GARAGE/ACCESS CONTROL)
DAY TIME PARKING (LOCKED GATE/GARAGE/ACCESS CONTROL)
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