Household Quotation Form




Personal Details

Title:

Gender:

Marital status:

Pensioner:

Language:

Residence Details


(Rand)

(Rand)

Residence Type?:

Is the property a holiday home? :

Is the property a commune? :

Is the property let or sublet?:

Is the property security access controlled? :

Does the complex have security? :

Is there an alarm? :

Is the alarm radio linked?:

Is there a fi re retardant?:

Is the property used for business? :

Wall construction:

Perimieter wall construction

Do you have fence:

Wire fence:

Brick wall more than 180 cm tall:

Brick wall less than 180 cm tall:

Precast wall less than 180 cm tallBrick wall less than 180 cm tall:

Precast wall more than 180 cm tallBrick wall less than 180 cm tall:

Pallisade wall less than 180 cm tall:

Wood fence less than 180 cm tall:

Wood fence more than 180 cm tall:

Brick wall more than 180 cm tall with electric fencing:

Other

Is the structure greater than 15% of the main building? :

Roof construction:

Is there a thatch roof within 5 metres? :

Is there a lightning conductor?:

Is the property near open ground? :

Burglar bars? :

Spanish burglar bars? :

How many years at the previous insurer :

Additional options

Comprehensive subsidence and landslip :

Accidental damage:

Risk address

On plot/farm/small holding :

Is the building next to the open field?: