request-a-quote-2 | Afken Global Wealth

Life Cover Quote Request

Car and Household Insurance Quote Request

Personal Details
First Name*
Surname*
ID Number*
Contact Number*
Cell Number*
Email Address*
Gender*
- Male
- Female
Marital Status*
Date of Birth*
Physical Address*
Street Address City Province ZIP / Postal Code Country
Vehicle Details
The Vehicle Owner is the Primary Driver*
Licence Type of Principle Driver*
Please Specify Country of Issue*
Date Licence Obtained*
Vehicle Year*
Vehicle Make*
Vehicle Model (Description)*
Regular Driver*
Other Driver*
First Name Surname
Other Driver Date of Birth*

DD
MM
YYYY
Other Driver Relationship*
Driver's Claim Free Years*
Sound System*
Sound System Value*
Type of Cover*
Overnight Parking*
Home Content
Value of Home Contents*
When did you move into this home?*
Have you suffered a burglary at this address?*
When last did you have a burglary?*
Do you have a fitted alarm in working order?*
Do you want to include geyser cover?*
Do you have anything else you would like to cover such as valuables, watercraft or additional cars ?*
List extra valuables to cover*
Building
Current Building Value*
Years at Current Address*
Rating Factors
In the last 5 years have you or anyone covered in terms of this policy had any claims, losses or incidents?*
Please indicate how many times you had a claim, loss or incident in the last 12 months*
Please indicate how many times you had a claim, loss or incident in the last 13 to 24 months**
Please indicate how many times you had a claim, loss or incident in the last 25 to 36 months
Please indicate the date that you had the last incident
Any other cover you require, please specify
Terms and Conditions*
- By clicking this checkbox you acknowledge that you have read and understood the privacy policy

Medical Aid Quote Request

Personal Details
First Name*
Surname*
ID Number*
Contact Number*
Cell Number*
Email Address*
Gender*
Marital Status*
Date of Birth*
Physical Address*
Street Address City Province ZIP / Postal Code Country
Medical Aid
Are you currently covered by Medical Aid ?*
Type of Medical Aid you are Interested in?*
Do you receive Medical Aid subsidy from your employer?*
Do you require cover for day to day expenses?*
Additional Details
Principal Member*
Spouse / Partner*
Dependants over the age of 20*
Financially dependant on principal member?*
Children under the age of 21*
How many?*
Terms and Conditions*
- By clicking this checkbox you acknowledge that you have read and understood the privacy policy

Commercial & Business Insurance Quote Request

Personal Details
First Name*
Surname*
ID Number*
Contact Number*
Cell Number*
Email Address*
Gender
Marital Status*
Company Details
Company Name*
Type of Company*
Business Type*
Number of Employees*
Physical Address*
Street Address City Province ZIP / Postal Code Country
Is the postal address same as the physical address?*
Postal Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Current Insurer*
Terms & Conditions*
- By clicking this checkbox you acknowledge that you have read and understood the privacy policy

Request a quote

Life Cover Quote Request

Car and Household Insurance Quote Request

Personal Details

Vehicle Details

Home Content

Building

Rating Factors

Medical Aid Quote Request

Personal Details

Medical Aid

Additional Details

Commercial & Business Insurance Quote Request

Personal Details

Company Details