QUOTE APPLICATION FORM: Building

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

YES

Surname, Brith names & Title: *

ID nr *

Celphone Number: *

Email *

Occupation *

Pensioner *

YES
NO

Marital Status: *

Total years of house owners insurance and with whom? *

Total years of house contents insurance and with whom? *

With whom are you currently insured with? *

Your current premium? *

Address *

Area Code: *

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

Ja
Nee

Indien JA spesifiseer datum, afdeling, omstandighede en bedrag:

you? swimming you

1: Date

1: Section

1: Circumstances

1: Amount

2: Date

2: Section

2: Circumstances

2: Amount

3: Date

3: Section

3: Circumstances

3: Amount

Has any insurer ever refused any proposal of yours, cancelled any policy (or section thereof), refused to renew any policy (or section thereof), or imposed any special conditions? (Tick yes, even if only one part of the question applies)

YES
NO

If “Yes”, supply full details:

Type of Residence:

Main House
Cottage
Security Complex
Appartment

Insured Amount:

Neighbours all around

YES
NO

Fence Hight:

Meters

Fence Type:

Does any of the following border your property :

Open field
Business
Shoping centre
High way
Golf course
Informal settlement
None of the above

Linked alarm:

YES
NO

If YES, please specify, Name of Security company:

Security Gates

YES
NO

24h Guards

YES
NO

Burglar Bars on all Windows

YES
NO

Include Accidental damage?

YES
NO

If YES, please specify the amount

Include Power Surge cover?

YES
NO

If YES, please specify the amount

Do you have a thatch lapa 10 meters from the building?

YES
NO

Is the lapa treated?

YES
NO

Do you have a lightning conductor?

YES
NO

Do you have a fire extinguisher?

YES
NO

Does the roof of the lapa consist of a material other than grass?

YES
NO

If YES, please specify the material

Is there a swimming pool or pond on the property?

YES
NO

Is there is any water source within a radius of 500m from the premises?

YES
NO

Do you have a solar system?

YES
NO

If YES, please specify the amount

How many geysers do you have?

What type of geysers do you have?

Gas
Electric
Solar

Include water pipe cover?

YES
NO

If YES, please specify the amount

Finkor

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