Authorised Financial Services Provider No. 14000

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Authorised FSP No. 14000

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ZULULAND INSURANCE BROKERS (PTY) LTD

Quote Form

Fill in the form below and we will get back to you with a comprehensive quote.
Title
Initials
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ID Number *
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Contact Number *
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    Marital Status
    Single
    Married
    Home Address *
    Are You Currently Insured?
    Yes
    No
    Through whom?
    Any Claims For The Last 3 Years
    Yes
    No
    Please Provide Amounts
    Description of Claim
    HOUSEHOLD CONTENTS QUOTE REQUIRED
    Yes
    No
    Sum Insured For Contents
    Construction of Building, Brick Walls/Tile Roof/Any Thatch Please Advise
    Security At The Premises
    Yes
    No
    Security Doors In Front Of All Opening Doors Including Sliding Doors
    Yes
    No
    Burglar Bars In Front Of All Opening
    Yes
    No
    Linked Alarm With 24HR Armed Response 
    Yes
    No
    Is The Property Surrounded With Wall/Fence
    Yes
    No
    Does The Property Have An Electric Fence Right Round
    Yes
    No
    BUILDING INSURANCE QUOTE REQUIRED
    Yes
    No
    Sum Insured For Building
    Construction Of Building, Brick Walls/Tile Roof/Any Thatch Please Advise
    ALL RISKS QUOTE REQUIRED  (FOR GOODS TAKEN OUT OF THE HOME)
    Yes
    No
    Want To Insure Unspecified Items/Cellphones/Laptops/Tablets Etc Please List With Values
    MOTOR INSURANCE QUOTE REQUIRED
    Yes
    No

    1.Vehicle/Motor/Motorcycle/Caravan/Trailer Details

    Year
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    Model
    DESCRIPTION (Example 1.4 SX) Full Description Required Please
    Mileage
    Regular Driver ID Number
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    Early Warning Tracking Device
    Yes
    No

    2.Vehicle/Motor/Motorcycle/Caravan/Trailer Details

    Year
    0 (Max. 4 Characters)
    Model
    DESCRIPTION (Example 1.4 SX) Full Description Required Please
    Mileage
    Regular Driver ID Number
    0 (Max. 13 Characters)
    Early Warning Tracking Device
    Yes
    No

    3.Vehicle/Motor/Motorcycle/Caravan/Trailer Details

    Year
    0 (Max. 4 Characters)
    Model
    DESCRIPTION (Example 1.4 SX) Full Description Required Please
    Mileage
    Regular Driver ID Number
    0 (Max. 13 Characters)
    Early Warning Tracking Device
    Yes
    No
    Submit

    Please feel free to contact us if you need help with any quote.