* * REFER A FRIEND * *

 

 

Complete the form below to get a quote from a Santam Broker:

 

Title
First Name
Surname
ID Number
Date of Birth
Tel no & code
E-mail
Occupation
Residential Suburb
Postal Code
Marital status
Previous insurer(s)
How long in total?
Amount of claims
Value of claims
Current Premium
GENERAL DETAILS 

Has an insurer ever refused any proposal of yours,  cancelled any policy (or section thereof), refused to renew any policy (or section thereof) or imposed any special conditions?

 

YES  NO  (If YES, supply details below)
House Contents 
Type of residence 
Value of contents 
Date you moved in 
Thatched Roof? 

Yes 

No 
Any burglaries?

Yes 

No 

 If yes, date:  
Security measures 

Burglar bars at all openable windows

Gates at all doors leading outside

Linked alarm (Monitoring)

Linked alarm (Armed response)

Electric fencing

Complex with controlled access

24-hour security guards 
Claim-free years 
BUILDING
Used as 
Residential suburb
Postal code 
Insured amount 
ALL RISKS (UNSPECIFIED)
Insured amount
ALL RISKS (SPECIFIED)
Item 1 description Value:
Item 2 description Value:
Item 3 description Value:
Item 4 description Value:
Item 5 description Value:

VEHICLE 1
Year, make & model
Value
Overnight parking
Vehicle cover
Radio cover   value
Vehicle security Alarm/Immobiliser Gearlock
Anti-hijack Tracking device
Details of driver
License Obtained  (indicate year)
Claim-free years (of regular driver)

VEHICLE 2
Year, make & model
Value
Overnight parking
Vehicle cover
Radio cover   value
Vehicle security Alarm/Immobiliser Gearlock
Anti-hijack Tracking device
Details of driver
License Obtained  (indicate year)
Claim-free years (of regular driver)
OTHER ITEMS 
Description & value
 

 

Click here for more car insurance quotes.