QUESTIONNAIRE Get Your Short Term Insurance Quote

Info to Quote Questionnaire

  • Personal Information
  • Household Contents
  • Motor Vehicle

Personal Information

Full Name

Email

Phone

ID Number

Gender

Marital Status

Educational Qualification

Occupation

Household Contents

Full Risk Address

Premises occupied for more than 60 days in a year?

Burglar bars on all opening windows?

Security gates on all external doors (including sliding doors)?

Alarm linked to a 24 hour control room?

Name of security company

Security enclosed area?

Full time guards on premises

Motor Vehicle Information

Vehicle Make

Model

Year of Manufacture

Colour

Suburb parked during the day

Day time security

Alarm

Tracking device

Tracking device name and company

Number of years of comprehensive insurance

Overnight Parking

In which year was your license obtained

Licence code

Vehicle Use

I give Rattan Risk & Investment Consultants consent to verify and share my policy information with other insurers and institutions as well as access my credit information held by other institutions.

I confirm that all information provided above is true and correct and I understand that incorrect information might negatively impact claims made in future.

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42 Aintree Ave, Savoy Estate, Johannesburg, 2090
011 440 9847
info@rattan.co.za

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