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Introduce Your Self*

First Surname

Tell us a bit about yourself and your business

Do you currently have insurance?*

Yes
No

Please upload your schedule from your current Insurer*

Max. file size: 20 MB.

Select Business Insurance Category

Select Business Insurance Category*

MOTOR
LIABILITY
BUSINESS ALL RISKS
PROPERTY
ACCIDENT

Motor

What type of Motor cover do you require?*

Just Motor Vehicle/ Fleet (your business use cars or personal cars used for business)
Motor Traders Internal (For your motor stock and client’s motors on your premises)
Motor Traders External (For your motor stock off premises)

Vehicle Detail*

Vehicle Model	Registration Number	Year of Manufacture

Would You Like Car Hire*

Yes
No

Motor Traders Internal

What is the Maximum Cover Required?

Motor Traders External

What is the Maximum Cover Required?

Hidden

Motor Traders External

Vehicle Model	Year	Registration number

Liability

Which Liability Cover do you require?

Public Liability
Employers Liability
Cyber Risk
Personal Accident

How much cover would you like to take out? (minimum R 2 million)

Would you like to add?

Defamation
Wrongful Arrest
Statutory Defense Costs

How Much Defamation would you like to be covered for?*

How Much Wrongful Arrest would you like to be covered for?*

How Much Statutory Defense would you like to be covered for?*

How much Employers Cover would you like to take out?*

How much cover would you like to take out for Cyber Risk? (Minimum R 50 000)*

How much cover would you like to take out for Group Personal Accident?*

Number of Employees (Please upload list when accepting quote, Max Age 75)	Death Benefit Amount

Business All Risks

All Portable devices taken off premises is selected: e.g laptops,cellphones,ebikes, cameras

List of items to be covers

Make (Manufacturer name)	Model	Serial No (Not compulsory for quote)	Value	Quantity

Property

Property Type*

Buildings
Office Contents
Business Interruption
Accounts Receivable
Stock

Is this another building apart from your stated office?*

Yes
No

Main Office Building Details Insurable Value*

Insurable Value

Second Building Details*

Address	Insurable Value

Would you like to Glass cover to your building?*

Yes
No

How much Glass cover would you like ?*

Would you like to add Fire cover?*

Yes
No

How much fire cover would you like?*

What is the value of your office contents?*

How much cover would you like to have?*

How much do your clients owe you?*

How much is your annual turnover?*

How much do you want to cover your debtors’ book for?*

How Much Stock Cover Do You Want?*

Tell us how much is your stock worth.

Accident

Type of Accident*

Theft
Electronic Equipment
Money
Fidelity Guarantee
Goods in transit cover

How much Goods in transit cover would you like

Does the property have an alarm system?*

Yes
No

How much theft cover would you like?*

Electronic Equipment Details

Make (Manufacturer name)	Model	Serial No (Not compulsory for quote)	Value	Quantity

Do you have a safe on the premises?

Yes
No

Do you have a contract with a cash services provider?*

Yes
No

How much money cover would you like?*

How many employees do you employ?*

How much cover would you like against employee dishonesty and fraud?*

Consent

Please be advised the Quote you will receive is based on the accuracy of the information you have given us, changes in the information supplied might affect your Quoted amount.

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