Get Covered In Minutes.

Select “Yes” to whichever items you would like to be covered for and fill in the required info.

- Step 1 of 2

Client Details

Legal Name of Company *

Company Registration Number *

VAT Number *

Company Physical Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Postal is the same as physical *

Are You Currently, or Have In The Past Been Insured? *

Name of Insurer: *

Policy Number *

Detailed 3 Years Claim History *

Company Postal Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Trading Name of Company *

Type of Business (CC/PTY/ Sole Prop / Trust) *

Contact person *

Tel (W) *

Fax

Website / URL

Description of Premises (Office, Factory, Retail ,etc.) *

Security Measures in place (burglar bars on all opening windows, security gates on all opening doors to the outside, alarm system connected to 24 hour security company, electric fence, etc)? *

Please explain *

Business type (what does your business do?) *

When was the business established?: *

Is the building left unoccupied? *

How long and reason for unoccupancy? *

Do you have hose reels? *

Please indicate last date of service *

Do you have fire extinguishers? *

Please indicate last date of service *

Do you have sprinklers? *

Please indicate last date of service *

How often was waste removed from the premises? *

How many people have keys to the premises? *

How many people have the alarm pin code? *

How many days in a week operation? *

Capacity (role in company) *

Cellphone Number *

Email *

Operating Hours

Start *

Finish *

Member / Director Details

Name of Member or Director *

Name of Member or Director

ID Number of Member or Director *

ID Number of Member or Director

Risk Details

Business Description (full details required) *

Business Activities (what do you do?) *

Occupation of Premises *

Construction of Buildings? (Brick, Tile, Thatch etc.) *

Hazardous Process *

Other tenants occupying the premises? *

Please give more detail *

Estimated Annual Turnover *

Previous Insure’s Details and Claims History

Have you previously been insured? *

Company *

Policy No: *

Type of claim/loss: *

Type of claim/loss: (copy)

Type of claim/loss: (copy) (copy)

Year: *

Year: (copy)

Year: (copy) (copy)

Year: (copy) (copy) (copy)

Amount *

Amount (copy)

Amount (copy) (copy)

Amount (copy) (copy) (copy)

Insurer *

Insurer (copy)

Insurer (copy) (copy)

Insurer (copy) (copy) (copy)

COVER REQUIRED

Select what cover you are looking for and the amount required. For each section you select "yes" to, there will be a more detailed section on further down.

1. Fire *

Sum Insured *

2. Buildings Combined *

Sum Insured *

3. Office Contents *

Sum Insured *

4. Business Interruption *

Sum Insured *

5. Accounts Receivable *

Sum Insured *

6. Theft *

Sum Insured *

7. Money *

Sum Insured *

8. Glass *

Sum Insured *

9. Fidelity Guarantee *

Sum Insured *

10. Goods In Transit *

Sum Insured *

11. Business All Risks *

Sum Insured *

12. Accidental Damage *

Sum Insured *

13. Public Liability *

Sum Insured *

14. Employers Liability *

Sum Insured *

15. Stated Benefits *

Sum Insured *

16. Group Personal Accident *

Sum Insured *

17. Motor including Motor Traders *

Sum Insured *

18. Electronic Equipment *

Sum Insured *

19. Machinery Breakdown *

Sum Insured *

20. Machinery Breakdown L.O.P. *

Sum Insured (copy) *

Details Per Class Of Insurance

SECTION 1. FIRE

Covers you for loss or damage to your business caused by fire. Also covers power surges, includes an architects’ fees clause, a fi re extinguishing clause and more.

Item no. details / Address sum insured *

List the item with the insured amount required

Buildings *

Rent (Receivable/Payable) *

Plant, Machinery, Landlord’s Fixtures and Fittings and all other contents *

Stock and Materials in Trade *

Miscellaneous as described and tenants’ improvements *

Additional Claims Preparation Costs *

ADDITIONAL PERILS TO BE INCLUDED (Please tick the appropriate block)

Earthquake *

Special Perils (Storm, wind, water, hail) *

Malicious Damage (This is not SASRIA) *

Leakage – Limit Required *

Amount Required *

Subsidence and Landslip (Subject to Engineer’s Report) *

Riot and Strike (Outside RSA and Namibia) *

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Stock Declaration Conditions (Annual Policies Only) *

Disposal of Salvage *

Escalation *

Specify percentage *

SECTION 2. BUILDINGS COMBINED

Comprehensive cover for damage caused by fire, explosions and other hazards that may impact your business building.

Item no. details / Address sum insured *

List the item with the insured amount required

Additional Claims Preparation Costs *

Total *

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Subsidence and Landslip (Subject to Engineer’s Report) *

Riot and Strike (Outside RSA and Namibia) *

Escalation *

Specify percentage *

Prevention of Access *

SECTION 3. OFFICE CONTENTS

Safeguards the everyday operational assets of your place of business, from stationery and furniture to your staff ’s personal effects and even the loss of rent.

Item no. details / Address sum insured

Contents *

Documents *

Liability for Documents *

Additional Claims Preparation Costs *

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Riot and Strike (Outside RSA and Namibia) *

Theft by Forcible and Violent Entry or Exit *

First Amount Payable *

Theft *

First Amount Payable *

Do you require power surge cover? *

Required Sum Insure *

SECTION 4. BUSINESS INTERRUPTION

Protect against the possible loss of income resulting from a loss under a material damage section that interrupts normal business operations.

Item no. details / Address sum insured

1. Gross Profit (Difference Basis) *

2. Gross Profit (Additions Basis) *

3. Revenue *

4. Additional Increase in Cost of Working *

5. Wages (Number of Weeks Basis) Number of Weeks *

6. Fines and Penalties *

Other *

8. Additional Claims Preparation Costs *

Indemnity Period (Please specify the number of months) *

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Suppliers/Subcontractors (specified) *

% of the sums insured by items 1 to 5 *

Suppliers/Subcontractors (unspecified) *

% of the sums insured by items 1 to 5 *

Prevention of access – Extended cover *

Customers (specified) *

% of the sums insured by items 1 to 5 (copy) *

Public Utilities – Insured Perils *

Public Telecommunications – Insured Perils *

Public Utilities – Extended Cover *

Public Telecommunications – Extended Cover *

Accidental Damage *

(subject to a combined Business Interruption/ Accidental Damage limit as specified in the Accidental Damage Section

SECTION 5. ACCOUNTS RECEIVABLE

Item no. details / Address sum insured

Outstanding Debit Balances *

Additional Claims Preparation Costs *

Total *

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Transit Extension *

Riot and Strike (Outside RSA and Namibia) *

SECTION 6. THEFT

Loss or damage to all contents, as a result of theft (visible violent entry or exit), including extensions such as damage to buildings, locks and keys, etc.

ITEM (Premises to be specified) FIRST LOSS *

List the item and at which premises with the required insured amount

Additional Claims Preparation Costs *

Total *

Total Item First Loss + Additional Prep Costs

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Damage to Buildings – as a result of attempted Theft – increased limits *

Limit *

SECTION 7. MONEY

Cover against the loss of money, both in transit and on the premises.

ITEM (Premises to be specified) MAJOR LIMIT *

List the item and at which premises with the required insured amount

Total *

Limit required during any other specified period: *

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Receptacles *

Additional Claims Preparation Costs *

Riot and Strike (Outside RSA and Namibia) *

Limit *

Personal Accident Assault *

No of Persons *

Capital Sum *

Weekly Sum *

Medicals *

SECTION 8. GLASS

Cover for the expense of glass, from windows to signage.

ITEM (Premises to be specified) SUM INSURED *

List the item and at which premises with the required insured amount

Additional Claims Preparation Costs *

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Special Reinstatement *

Riot and Strike (Outside RSA and Namibia) *

Sum Insured *

SECTION 9. FIDELITY GUARANTEE

Covers the loss of money and/or property due to theft or fraudulent behaviour on the part of an insured employee.

Name or Position Basis SUM INSURED *

List the insured employee name/position with the required insured amount

Total *

Blanket Basis

Number of Employees *

Total *

Additional Claims Preparation Costs (Either Basis) *

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Retroactive Cover *

Superseded Policy *

Voluntary First Amount Payable *

Years *

Amount *

Reinstatement of Sum Insured *

Cost of Recovery Limit *

Limit *

Computer Losses *

Extension for losses discovered more than 24 months after being committed but not more than 36 months thereafter *

Extension granted on receipt of satisfactory systems audit in respect of losses discovered more than 24 months after being committed *

SECTION 10. GOODS IN TRANSIT

Cover against damage to, or the loss of goods-in-transit, as a result of accidents or misfortune.

Estimated Annual Carry of Goods in Transit: *

What goods do you transport? Please provide full details *

Specified Vehicle (Load Limit) Basis SUM INSURED *

List the vehicle & load limit basis with the required insured amount

Total *

All Goods usual to the Insured’s Business (Annual Carry) Basis

Annual Carry *

Limit per Conveyance *

Means of Conveyance *

Additional Claims Preparation Costs (Either Basis) *

SPECIFY THE TYPE OF COVER REQUIRED (Please tick the appropriate block)

All Risks *

Fire, Explosion, Collision, Derailment and Overturning Limitation *

SECTION 11. BUSINESS ALL RISKS

This section gives cover for items belonging to your business that you have specified. The items you specify will be insured against theft or damage, whether they are on your business premises or not.

Make *

Make (copy) *

Make (copy) (copy) *

Make (copy) (copy) (copy) *

Make (copy) (copy) (copy) (copy) *

Make (copy) (copy) (copy) (copy) (copy) *

Make (copy) (copy) (copy) (copy) (copy) (copy) *

Make (copy) (copy) (copy) (copy) (copy) (copy) (copy) *

Make (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) *

Make (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) *

MODEL/SERIES/RANGE *

MODEL/SERIES/RANGE (copy) *

MODEL/SERIES/RANGE (copy) (copy) *

MODEL/SERIES/RANGE (copy) (copy) (copy) *

SERIAL NUMBER *

SERIAL NUMBER (copy) *

SERIAL NUMBER (copy) (copy) *

SERIAL NUMBER (copy) (copy) (copy) *

SERIAL NUMBER (copy) (copy) (copy) (copy) *

SERIAL NUMBER (copy) (copy) (copy) (copy) (copy) *

SERIAL NUMBER (copy) (copy) (copy) (copy) (copy) (copy) *

SERIAL NUMBER (copy) (copy) (copy) (copy) (copy) (copy) (copy) *

SERIAL NUMBER (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) *

SERIAL NUMBER (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) *

REPLACEMENT VALUE *

REPLACEMENT VALUE (copy) *

REPLACEMENT VALUE (copy) (copy) *

REPLACEMENT VALUE (copy) (copy) (copy) *

REPLACEMENT VALUE (copy) (copy) (copy) (copy) *

REPLACEMENT VALUE (copy) (copy) (copy) (copy) (copy) *

REPLACEMENT VALUE (copy) (copy) (copy) (copy) (copy) (copy) *

REPLACEMENT VALUE (copy) (copy) (copy) (copy) (copy) (copy) (copy) *

REPLACEMENT VALUE (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) *

REPLACEMENT VALUE (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) (copy) *

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Replacement Value Conditions *

Riot and Strike (Outside RSA and Namibia) *

Increase In Cost of Working *

Additional Claims Preparation Costs *

Sum Insured *

SECTION 12. ACCIDENTAL DAMAGE

Cover against damage or loss incurred as a result of mishaps or acts of negligence engaged in by you, or your employees.

ITEM NO. DETAILS SUM INSURED

Please select your preferred insured option *

All property as defined in the section *Total Value*
First Loss

Value *

Premises *

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Leakage of Oils/Chemicals/Fumes *

Additional Claims Preparation Costs *

Sum Insured

SECTION 13. PUBLIC LIABILITY (Basis of Cover)

Cover against liability in the event of third-party death, illness or damaged property for which your business is held responsible.

Claims Made *

Occurrence *

State Retroactive Date *

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Products Liability *

Defective Workmanship *

Limit *

Legal Defence Costs/Wrongful Arrest/Defamation *

EEC Liability *

Products Liability

Selected Value: 1000000

Please select between R1million and R5million

Defective Workmanship *

EEC Liability *

Other *

SECTION 14. EMPLOYERS LIABILITY (Claims Made Basis only)

Employer's liability covers you for damages that you or any member, partner, director, principal or employee of your business may be held legally liable to pay following an incident in the course of or in connection with the persons employment with you. Safeguards businesses against legal and compensation expenses from employee claims.

LIMIT OF INDEMNITY

Retroactive Date *

Amount *

SECTION 15. STATED BENEFITS

Defined events. Bodily injury caused by accidental, violent, external and visible means to any principal, partner, director or employee of the Insured (hereinafter in this section referred to as such person) specified in the schedule.

ITEM NO. STAFF’S NAME, DESCRIPTION AND OCCUPATION, ID NO, SALARY *

**Up to 4 (Employee, principal, director, partner)

Please fill in values according to each circumstance category as per each item number (Item No refers to the employee/s as listed above)

Death Cover

Do you require Employee Death Cover? *

Item No. 1 (Employee, principal, director, partner) *

Times annual earnings

Item No. 2 (Employee, principal, director, partner)

Times annual earnings

Item No. 3 (Employee, principal, director, partner)

Times annual earnings

Item No. 4 Employee, principal, director, partner)

Times annual earnings

Permanent Disablement Cover

Do you require Employee Permanent Disablement Cover? *

Permanent Disablement - the specified percentage of:

Item No. 1 (Employee, principal, director, partner) *

Times annual earnings of average weekly earnings

Item No. 2 (Employee, principal, director, partner)

Times annual earnings of average weekly earnings

Item No. 3 (Employee, principal, director, partner)

Times annual earnings of average weekly earnings

Item No. 4 (Employee, principal, director, partner)

Times annual earnings of average weekly earnings

Temporary Disablement Cover

Do you require Employee Temporary Disablement Cover? *

Item No. 1 (Employee, principal, director, partner) *

Temporary Disablement Total

Item No. 2 (Employee, principal, director, partner)

Temporary Disablement Total

Item No. 3 (Employee, principal, director, partner)

Temporary Disablement Total

Item No. 4 (Employee, principal, director, partner)

Temporary Disablement Total

for a period longer than ... week(s) but not longer than ... weeks

Item No. 1 (Employee, principal, director, partner) *

for a period longer than ... week(s)

Item No. 1 (copy) *

but not longer than ... weeks

Item No. 2 (Employee, principal, director, partner)

for a period longer than ... week(s)

Item No. 2 (copy)

but not longer than ... weeks

Item No. 3 (Employee, principal, director, partner)

for a period longer than ... week(s)

Item No. 3 (copy)

but not longer than ... weeks

Item No. 4 (Employee, principal, director, partner)

for a period longer than ... week(s)

Item No. 4 (copy)

but not longer than ... weeks

Medical Expenses Cover

Do you require Employee Medical Expenses Cover? *

Item No. 1 (Employee, principal, director, partner) *

Item No. 2 (Employee, principal, director, partner)

Item No. 3 (Employee, principal, director, partner)

Item No. 4 (Employee, principal, director, partner)

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Burns Disfigurement Extension *

Business Hours Limitation *

Passive War Risks *

SECTION 16. GROUP PERSONAL ACCIDENT

Personal accident insurance is designed to provide financial help if you have become disabled, hospitalised, injured or in the event of your death from an accident. The amount paid is set out in the policy document and depends on the length of hospitalisation, the severity of the disablement or your death.

ITEM NO. STAFF’S NAME, DESCRIPTION AND OCCUPATION, ID NO, SALARY *

**Up to 4 (Employee, principal, director, partner)

Death Cover

Do you require Group Death Cover? *

Please fill in values according to each circumstance category as per each item number (Item No refers to the employee/s as listed above)

Item No. 1 (Employee, principal, director, partner) *

Times annual earnings

Item No. 2 (Employee, principal, director, partner)

Times annual earnings

Item No. 3 (Employee, principal, director, partner)

Times annual earnings

Item No. 4 (Employee, principal, director, partner)

Times annual earnings

Permanent Disablement

Permanent Disablement Cover

Do you require Group Permanent Disablement cover? *

Permanent Disablement – the specified percentage of:

Item No. 1 (Employee, principal, director, partner) *

Item No. 2 (Employee, principal, director, partner)

Item No. 3 (Employee, principal, director, partner)

Item No. 4 (Employee, principal, director, partner)

Temporary Disablement Cover

Do you require Group Temporary Disablement? *

Item No. 1 (Employee, principal, director, partner) *

Temporary Disablement Total

Item No. 2 (Employee, principal, director, partner)

Temporary Disablement Total

Item No. 3 (Employee, principal, director, partner)

Temporary Disablement Total

Item No. 4 (Employee, principal, director, partner)

Temporary Disablement Total

for a period longer than ... week(s) but not longer than ... weeks

Item No. 1 (Employee, principal, director, partner) *

for a period longer than ... week(s)

Item No. 1 (copy) (copy) *

but not longer than ... weeks

Item No. 2 (Employee, principal, director, partner)

for a period longer than ... week(s)

Item No. 2 (copy) (copy)

but not longer than ... weeks

Item No. 3 (Employee, principal, director, partner)

for a period longer than ... week(s)

Item No. 3 (copy) (copy)

but not longer than ... weeks

Item No. 4 (Employee, principal, director, partner)

for a period longer than ... week(s)

Item No. 4 (copy) (copy)

but not longer than ... weeks

Medical Expenses Cover

Do you require Group Medical Expenses Cover? *

Item No. 1 (Employee, principal, director, partner) *

Item No. 2 (Employee, principal, director, partner)

Item No. 3 (Employee, principal, director, partner)

Item No. 4 (Employee, principal, director, partner)

EXTENSIONS TO BE INCLUDED (Please tick the appropriate block)

Burns Disfigurement Extension *

Business Hours Limitation *

Passive War Risks *

Get Covered In Minutes.

Client Details

Member / Director Details

Risk Details

Previous Insure’s Details and Claims History

Details Per Class Of Insurance

SECTION 1. FIRE

SECTION 2. BUILDINGS COMBINED

SECTION 3. OFFICE CONTENTS

SECTION 4. BUSINESS INTERRUPTION

SECTION 5. ACCOUNTS RECEIVABLE

SECTION 6. THEFT

SECTION 7. MONEY

SECTION 8. GLASS

SECTION 9. FIDELITY GUARANTEE

SECTION 10. GOODS IN TRANSIT

SECTION 11. BUSINESS ALL RISKS

SECTION 12. ACCIDENTAL DAMAGE

SECTION 13. PUBLIC LIABILITY (Basis of Cover)

SECTION 14. EMPLOYERS LIABILITY (Claims Made Basis only)

SECTION 15. STATED BENEFITS

Death Cover

Permanent Disablement Cover

Temporary Disablement Cover

Medical Expenses Cover

SECTION 16. GROUP PERSONAL ACCIDENT

Death Cover

Permanent Disablement Cover

Temporary Disablement Cover

Medical Expenses Cover

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Legislation Requirements