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Home
About Us
Outreach Projects
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Our Solutions
Wealth Management
Local & Global Investments
Retirement Plan
Trusts
Estate Planning
Wills
Education Plans
Preservation Funds
Risk Management
Life Cover
Severe Illness Cover
Disability Cover
Income Protection
Educator Protection
Car, home & buildings
Personal Effects
Pleasure Craft
Art & Private Client Cover
SME Solutions
Medical Aid
Retirement/Pension/Provident
Death/Disability/Severe Illness
Keyman Cover
Buy and Sell Agreements
Trusts
Employee Benefits
Personal Financial Planning
Corporate Solutions
Buy & Sell Agreements
Succession Planning
Employee Benefits
Professional Indemnity & Liability
Speciality & Niche Commercial Short Term Insurance
Key Man Insurance
Trusts
Group Medical Aid
Commercial Insurance
Health & Wellness
Medical Aid
Gap Cover
Vitality
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Quote Requests
Car & Household Insurance Quote
Medical Aid Quote
Commercial & Business Insurance Quote
Life, Disability & Dread Disease Quote
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Special Offers
Discovery Capital 200 | 300 +
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The R14.90/$ Dollar Life Plan Offer
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Commercial and Business Insurance Quote
First Name
Last Name
Valid SA ID Number
Contact Number
Mobile Number
Email
Gender
Male
Female
Marital Status
Single
Co-habiting
Married
Separated
Divorced
Widowed
Company Name
Type of company
Close Corporation
Private Pty Ltd
Public Ltd
Sole Proprietor
Business Type
Number of employees
1-10
10-50
50+
Street Address
City
Province
Eastern Cape
Free State
Gauteng
KwaZulu Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
ZIP/ Postal Code
Country
Is the postal address the same as the physical address?
Yes
No
Any current insurer? Please specify
Terms and Conditions
By clicking this checkbox you acknowledge that you have read and understood the
privacy policy
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Medical Aid Quote Request
First Name
Last Name
Valid SA ID Number
Contact Number
Mobile Number
Email
Gender
Male
Female
Date of Birth
Marital Status
Single
Co-habiting
Married
Separated
Divorced
Widowed
Province
Eastern Cape
Free State
Gauteng
KwaZulu Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
Physical Address
City
Country
Postal Code
Are you currently covered by Medical Aid ?
Type of Medical Aid you are Interested in?
Full Cover
Hospital Plan
Hospital & Benefits
Do you receive Medical Aid subsidy from your employer?
Yes
No
Do you require cover for day to day expenses?
Yes
No
Principal Member
Yes
No
Spouse/ Partner
Yes
No
Dependants over the age of 20
Yes
No
Financially dependant on principal member?
Yes
No
Children under the age of 21
Yes
No
How many?
Terms and Conditions
By clicking this checkbox you acknowledge that you have read and understood the
privacy policy
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Car and Household Insurance Quote Request
First Name
Last Name
Valid SA ID Number
Contact Number
Mobile Number
Email
Gender
Male
Female
Date of Birth
Marital Status
Single
Co-habiting
Married
Separated
Divorced
Widowed
Province
Eastern Cape
Free State
Gauteng
KwaZulu Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
Street Address
City
Postal Code
Country
The Vehicle Owner is the Primary Driver
Yes
No
Licence Type of Principle Driver
RSA Drivers License
RSA Learners License
International Drivers License
Date Licence Obtained
Vehicle Year
Vehicle Make
Vehicle Model
Regular Driver
Owner
Other
Sound System
Factory Fitted Special
Standard
Other
Driver's Claim-free Years
0 Years Claim-free Uninterrupted Comprehensive Insurance
1 Year Claim-free Uninterrupted Comprehensive Insurance
2 Years Claim-free Uninterrupted Comprehensive Insurance
3 Years Claim-free Uninterrupted Comprehensive Insurance
4 Years Claim-free Uninterrupted Comprehensive Insurance
5 Years Claim-free Uninterrupted Comprehensive Insurance
More than 5 Years Claim-free Uninterrupted Comprehensive Insurance
Type of Cover
Comprehensive
Third Party Theft and Fire
Third Party Only
Overnight Parking
On Street / Pavement
In Locked Garage
In Yard, No Locked Gates
In Open Parking Lot
In Basement - Electronic Access
In Basement - No Electronic Access
Access Controlled Area
Value of Home Contents
When did you move into this home?
Have you had a burglary at this address?
Yes
No
Do you have a fitted alarm in working order?
Yes
No
Do you want to include geyser cover?
Yes
No
Do you have anything else you would like to cover such as valuables, watercraft or additional cars?
Yes
No
List extra valuables to cover
Current Building Value
Years at current address?
In the last 5 years have you or anyone covered in terms of this policy had any claims, losses or incidents?
Yes
No
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
Send
Life Cover Quote Request
First Name
Last Name
Valid SA ID Number
Contact Number
Mobile Number
Email
Gender
Male
Female
Date of Birth
Marital Status
Single
Co-habiting
Married
Separated
Divorced
Widowed
Province
Eastern Cape
Free State
Gauteng
KwaZulu Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
Qualification
No Matric
Matric
Diploma
Undergraduate Degree
Postgraduate Degree
Doctorate
Occupation
Type of Cover Required
Life Cover
Disability Cover
Dread Disease
Amount to Insure
R100 000
R200 000
R300 000
R400 000
R500 000
R1 000 000
R2 000 000
R3 000 000
Smoker Status
Smoker
Non-smoker
Height (cm)
Weight (kg)
Terms and Conditions
By clicking this checkbox you acknowledge that you have read and understood the
privacy policy
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