Auto Form

Indicate the country of citizenship

Anything to declare? Use the block above.

Please provide a description of the loss, the year in which it occurred, The Rand value of the loss, and the insurance company involved (if applicable). If the allocated space is too small please send an email with this detail to info at insurancefundi.co.za

For how many months or years have you been insured with your current insurance company?

If you have not enjoyed continuous and uninterrupted cover please indicate the period in months or years where you did not have insurance cover.

This is the risk address of the building you intend covering.

Indicate whether any business activities take place at the premises.

You may select more than one option here.

Please indicate the size of the lapa in square metres (Length x breadth).

You may select more than one option here.

If other is selected under the security measures section, please provide more detail regarding this.

Insert the replacement value - not the market value! Example: If the building is 100 square meters large and the building costs are R10, 000 per square meter, you insure for R1 million. Remember to factor in the cost of boundary walls, swimming pools, garages, and outbuildings.

What is the approximate age of the building in years?

Please indicate whether there are any additional features on the premises such as tennis courts, swimming pools, or windmills. Remember to include the replacement value of these features in the replacement value block above!

What is the approximate size of the building in square metres (length x breadth)?

Indicate the number of bedrooms on the premises

Will the dwelling be unoccupied for more than 60 days in any one year? An example would be a holiday home.

This extension provides cover where the damage is caused by the sinking or slipping of the building. There are conditions placed on this type of cover. Examples of these conditions would include faulty design of the building, building alterations taking place, and excavations taking place above or below the insured property.

This is the risk address of the building you intend covering.

Indicate whether any business activities take place at the premises.

You may select more than one option here.

Please indicate the size of the lapa in square metres (Length x breadth).

You may select more than one option here.

If other is selected under the security measures section, please provide more detail regarding this.

Insert the replacement value - not the market value! Example: If the building is 100 square meters large and the building costs are R10, 000 per square meter, you insure for R1 million. Remember to factor in the cost of boundary walls, swimming pools, garages, and outbuildings.

What is the approximate age of the building in years?

Please indicate whether there are any additional features on the premises such as tennis courts, swimming pools, or windmills. Remember to include the replacement value of these features in the replacement value block above!

What is the approximate size of the building in square metres (length x breadth)?

Indicate the number of bedrooms on the premises

Will the dwelling be unoccupied for more than 60 days in any one year? An example would be a holiday home.

This extension provides cover where the damage is caused by the sinking or slipping of the building. There are conditions placed on this type of cover. Examples of these conditions would include faulty design of the building, building alterations taking place, and excavations taking place above or below the insured property.

This is the risk address where your household goods are kept

Indicate whether any business activities take place at the premises.

You may select more than one option here.

Please indicate the size of the lapa in square metres (Length x breadth).

You may select more than one option here.

If other is selected under the security measures section, please provide more detail regarding this.

Will the dwelling be unoccupied for more than 60 days in any one year? An example would be a holiday home.

Will the residence be unoccupied for more than 4 consecutive days within the next 60 days?

Is the residence occupied by anyone other than you or your direct family?

This extension provides cover where the damage is caused by the sinking or slipping of the building. There are conditions placed on this type of cover. Examples of these conditions would include faulty design of the building, building alterations taking place, and excavations taking place above or below the insured property.

What is the replacement value of your household goods on the 'new for old' basis. Remember to include the value of your jewellery here as well!

What is the replacement value of all jewellery which has been included in the replacement value block above, e.g. R500, 000 is the value of all contents. R100, 000 is the value of the jewellery which forms part of the R500, 000. Remember to exclude all jewellery insured under the 'all risks' section!

Do you have any garden patio furniture worth more than R5, 000 which needs to be specified under this section?

This is the risk address where your household goods are kept

Indicate whether any business activities take place at the premises.

You may select more than one option here.

Please indicate the size of the lapa in square metres (Length x breadth).

You may select more than one option here.

If other is selected under the security measures section, please provide more detail regarding this.

Will the dwelling be unoccupied for more than 60 days in any one year? An example would be a holiday home.

Will the residence be unoccupied for more than 4 consecutive days within the next 60 days?

Is the residence occupied by anyone other than you or your direct family?

This extension provides cover where the damage is caused by the sinking or slipping of the building. There are conditions placed on this type of cover. Examples of these conditions would include faulty design of the building, building alterations taking place, and excavations taking place above or below the insured property.

What is the replacement value of your household goods on the 'new for old' basis. Remember to include the value of your jewellery here as well!

What is the replacement value of all jewellery which has been included in the replacement value block above, e.g. R500, 000 is the value of all contents. R100, 000 is the value of the jewellery which forms part of the R500, 000. Remember to exclude all jewellery insured under the 'all risks' section!

Do you have any garden patio furniture worth more than R5, 000 which needs to be specified under this section?

Do you require an unspecified amount of all risk cover which could cover a variety of items that are out and about with you? Example Handbag, Sunglasses.

How much unspecified cover would you like (R5, 000 to R10, 000 is usually adequate)?

Please list specific items with (rand) amount replacement values you intend covering. Example: 1) HP Laptop R10 000. 2) IPod Nano 8Gig R3000. 3) Trek mountain bike R10, 000.

Insert name of the owner of the vehicle if it does not belong to you

If the vehicle is not registered in RSA. Please provide the name of the country the vehicle was registered in

Indicate year, make, and model (such as 1996 Toyota GLS sprinter, 2001 VW golf GTI DSG gearbox) and indicate whether automatic, manual, direct shift gearbox, etc

Some insurers require the car colour.

Comprehensive covers all risks. Third party covers damage to the other party only. Third party, fire, and theft covers damage to the other party, loss of your vehicle through fire or theft only.

Partial business use would be 8 or less business trips per month

Market value is the difference between trade-in value and retail value as per the Mead and McGrouther handbook.

Describe the optional extra's added and their Rand value (Tow bars, Mag Wheels are optional extra's) Remember to include non standard sound equipment here.

Have there been any modifications or conversions to the vehicle or engine?

If any modifications or conversions have been made provide detail and the Rand value of these modifications.

You may select more than one option.

Indicate the daytime suburb where the vehicle will be parked. If vehicle is used for business use and is in no specific area then indicate 'various'.

This is the physical risk address where the vehicle is kept overnight

This section pays the difference between the value of the vehicle and the amount still owing to the finance company.

This provides for roadside assistance in the event of your vehicle breaking down alongside the road.

Do you require cover for visits to neighbouring countries?

Who willl drive the vehicle most often? This does not mean that the vehicle is not insured when someone else drives the vehicle; but rather that the insurer wants to base their risk exposure on the profile of the person most often using the vehicle.

Provide firstname and surname of regular driver.

Indicate what type of license the regular driver has by clicking on the relevant button above.

Indicate the day, month, and year in which the license was first obtained.

Does the regular driver have any endorsements or limitations on their drivers license?

Please describe any incidents/accidents that the regular driver has been involved in during the past 3 years regardless of whether a claim was submitted or not (and even if it was not the regular driver's fault). Include the Rand amount of any loss that was suffered per incident.

Insert name of the owner of the vehicle if it does not belong to you

If the vehicle is not registered in RSA. Please provide the name of the country the vehicle was registered in

Indicate year, make, and model (such as 1996 Toyota GLS sprinter, 2001 VW golf GTI DSG gearbox) and indicate whether automatic, manual, direct shift gearbox, etc

Some insurers require the car colour.

Comprehensive covers all risks. Third party covers damage to the other party only. Third party, fire, and theft covers damage to the other party, loss of your vehicle through fire or theft only.

Partial business use would be 8 or less business trips per month

Market value is the difference between trade-in value and retail value as per the Mead and McGrouther handbook.

Describe the optional extra's added and their Rand value (Tow bars, Mag Wheels are optional extra's) Remember to include non standard sound equipment here.

Have there been any modifications or conversions to the vehicle or engine?

If any modifications or conversions have been made provide detail and the Rand value of these modifications.

You may select more than one option.

Indicate the daytime suburb where the vehicle will be parked. If used for business and in no specific area then simply indicate 'various'!

This is the physical risk address where the vehicle is kept overnight

This section pays the difference between the value of the vehicle and the amount still owing to the finance company.

This provides for roadside assistance in the event of your vehicle breaking down alongside the road.

Do you require cover for visits to neighbouring countries?

Who willl drive the vehicle most often? This does not mean that the vehicle is not insured when someone else drives the vehicle; but rather that the insurer wants to base their risk exposure on the profile of the person most often using the vehicle.

Provide firstname and surname of regular driver.

Indicate what type of license the regular driver has by clicking on the relevant button above.

Indicate the day, month, and year in which the license was first obtained.

Does the regular driver have any endorsements or limitations on their drivers license?

Please describe any incidents/accidents that the regular driver has been involved in during the past 3 years regardless of whether a claim was submitted or not (and even if it was not the regular driver's fault). Include the Rand amount of any loss that was suffered per incident.

Insert name of the owner of the vehicle if it does not belong to you

If the vehicle is not registered in RSA. Please provide the name of the country the vehicle was registered in

Some insurers require the car colour.

Indicate year, make, and model (such as 1996 Toyota GLS sprinter, 2001 VW golf GTI DSG gearbox) and indicate whether automatic, manual, direct shift gearbox, etc

Comprehensive covers all risks. Third party covers damage to the other party only. Third party, fire, and theft covers damage to the other party, loss of your vehicle through fire or theft only.

Partial business use would be 8 or less business trips per month

Market value is the difference between trade-in value and retail value as per the Mead and McGrouther handbook.

Describe the optional extra's added and their Rand value (Tow bars, Mag Wheels are optional extra's) Remember to include non standard sound equipment here.

Have there been any modifications or conversions to the vehicle or engine?

If any modifications or conversions have been made provide detail and the Rand value of these modifications.

You may select more than one option.

Indicate the daytime suburb where the vehicle will be parked. If used for business and in no specific area then simply indicate 'various'!

This is the physical risk address where the vehicle is kept overnight

This section pays the difference between the value of the vehicle and the amount still owing to the finance company.

This provides for roadside assistance in the event of your vehicle breaking down alongside the road.

Do you require cover for visits to neighbouring countries?

Who willl drive the vehicle most often? This does not mean that the vehicle is not insured when someone else drives the vehicle; but rather that the insurer wants to base their risk exposure on the profile of the person most often using the vehicle.

Provide firstname and surname of regular driver.

Indicate what type of license the regular driver has by clicking on the relevant button above.

Indicate the day, month, and year in which the license was first obtained.

Does the regular driver have any endorsements or limitations on their drivers license?

Please describe any incidents/accidents that the regular driver has been involved in during the past 3 years regardless of whether a claim was submitted or not (and even if it was not the regular driver's fault). Include the Rand amount of any loss that was suffered per incident.

Insert name of the owner of the vehicle if it does not belong to you

If the vehicle is not registered in RSA. Please provide the name of the country the vehicle was registered in

Indicate year, make, and model (such as 1996 Toyota GLS sprinter, 2001 VW golf GTI DSG gearbox) and indicate whether automatic, manual, direct shift gearbox, etc

Some insurers require the car colour.

Comprehensive covers all risks. Third party covers damage to the other party only. Third party, fire, and theft covers damage to the other party, loss of your vehicle through fire or theft only.

Partial business use would be 8 or less business trips per month

Market value is the difference between trade-in value and retail value as per the Mead and McGrouther handbook.

Describe the optional extra's added and their Rand value (Tow bars, Mag Wheels are optional extra's) Remember to include non standard sound equipment here.

Have there been any modifications or conversions to the vehicle or engine?

If any modifications or conversions have been made provide detail and the Rand value of these modifications.

You may select more than one option.

Indicate the daytime suburb where the vehicle will be parked. If used for business and in no specific area then simply indicate 'various'!

This is the physical risk address where the vehicle is kept overnight

This section pays the difference between the value of the vehicle and the amount still owing to the finance company.

This provides for roadside assistance in the event of your vehicle breaking down alongside the road.

Do you require cover for visits to neighbouring countries?

Who willl drive the vehicle most often? This does not mean that the vehicle is not insured when someone else drives the vehicle; but rather that the insurer wants to base their risk exposure on the profile of the person most often using the vehicle.

Provide firstname and surname of regular driver.

Indicate what type of license the regular driver has by clicking on the relevant button above.

Indicate the day, month, and year in which the license was first obtained.

Does the regular driver have any endorsements or limitations on their drivers license?

Please describe any incidents/accidents that the regular driver has been involved in during the past 3 years regardless of whether a claim was submitted or not (and even if it was not the regular driver's fault). Include the Rand amount of any loss that was suffered per incident.