Please enable JavaScript in your browser to complete this form.Do you give Finkor consent to share your personal information, in order to prepare insurance quotations for you? *YESSurname, Brith names & Title: *ID nr *Celphonen Nr: *EMAIL *Occupation: *Pensioner *YESNOMarital status: *With whom are you currently insured with? *Your current premium? *Address: * Area Kode: *Did you experience any losses in the last 7 years? *YESNOIf so, please specify below1: Date1: Section1: Circumstances1: Amount2: Date 2: Section 2: Circumstances 2: Amount 3: Date 3: Section3: Circumstances3: Amount Unspecified: Items that are taken from the home with a value below R 1 000 and are not included in specified items, e.g. handbag, purse, etcYESNOIf YES, Please specify the AmountSpecified: items, e.g. mobile phones, laptops, cameras, etc. Items with value and serial number:YESNOItem 1:Item 1: ValueItem 1: Serial / IMEI number:Item 2: Item 2: Value Item 2: Serial / IMEI number: Item 3: Item 3: Value Item 3: Serial / IMEI number:Item 4: Item 4: Value Item 4: Serial / IMEI number: Item 5: Item 5: Value Item 5: Serial / IMEI number: Item 6:Item 6: ValueItem 6: Serial / IMEI number:Item 7:Item 7: Value Item Serial Item 7: Serial / IMEI number:Item 8: Item 8: ValueItem 8: Serial / IMEI number:Item 9: Item 9: Value Item 9: Serial / IMEI number: Item 10: Item 10: ValueItem 10: Serial / IMEI number:Submit53102