QUOTE APPLICATION FORM: ALL RISK

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Do you give Finkor consent to share your personal information, in order to prepare insurance quotations for you? *

Surname, Brith names & Title: *

ID nr *

Celphonen Nr: *

EMAIL *

Occupation: *

Pensioner *

Marital status: *

With whom are you currently insured with? *

Your current premium? *

Address: *

Area Kode: *

Did you experience any losses in the last 7 years? *

If so, please specify below

1: Date

1: Section

1: Circumstances

1: Amount

2: Date

2: Section

2: Circumstances

2: Amount

3: Date

3: Section

3: Circumstances

3: 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, etc

If YES, Please specify the Amount

Specified: items, e.g. mobile phones, laptops, cameras, etc. Items with value and serial number:

1: you insurance

Item 1:

Item 1: Value

Item 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: Value

Item 6: Serial / IMEI number:

Item 7:

Item 7: Value

Item 7: Serial / IMEI number:

Item 8:

Item 8: Value

Item 8: Serial / IMEI number:

Item 9:

Item 9: Value

Item 9: Serial / IMEI number:

Item 10:

Item 10: Value

Item 10: Serial / IMEI number: