Request a quote Life Cover Quote RequestFirst Name*Last Name*Valid SA ID Number*Contact Number*Cellphone Number*Email Address*Gender*MaleFemaleDate of birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Marital StatusSingleCo-habitingMarriedSeparatedDivorcedWidowedProvince*Eastern CapeFree StateGautengKwaZulu-NatalLimpopoMpumalangaNorthern CapeNorth WestWestern Cape.Additional InformationQualification*No MatricMatricDiplomaUndergraduate DegreePostgraduate DegreeDoctorateOccupation*Type of cover required*Life CoverDisability CoverDreaded DiseaseAmount to Insure*SelectR100 000R200 000R300 000R400 000R500 000R1 000 000 +R2 000 000 +R3 000 000 +Severe Illness Benefit*SelectR100 000R200 000R300 000R400 000R500 000R1 000 000 +R2 000 000 +R3 000 000 +Disability*SelectR100 000R200 000R300 000R400 000R500 000R1 000 000 +R2 000 000 +R3 000 000 +Income Continuation Benefit*Salary*Smoker Status*SmokerNon-SmokerHeight (cm)*Weight (kg)*Terms and Conditions By clicking this checkbox you acknowledge that you have read and understood the privacy policy