Life Cover Quote Request Step 1 of 3 33% Fill in your personal details below to receive a customized life cover quotation. Your information is secure and will only be used for this purpose.Title(Required)DrProfMrMrsMsMissRevName(Required) Name Surname Email(Required) Cellphone Number(Required)WhatsApp Contact Number (If applicable)Date of birth(Required) DD slash MM slash YYYY Preferred Language(Required) English Afrikaans Gender(Required) Male Female Gross monthly income (before deductions)(Required)Are you married?(Required) Yes No Gross monthly gross income (before deductions)Highest qualification(Required)No matricMatric3 year diploma or Degree4 year diploma or DegreeOccupation(Required)Describe the type of work you do(Required)Please state the total hours spent each day doing each of these types of work (this should add up to a total of 8 hours):Administrative / Duties(Required)012345678Light Physical Work(Required)012345678Travel(Required)012345678Hard Labour (Shovelling / Building etc.)(Required)012345678Smoker(Required) Yes No Do you have any pre-existing conditions that have displayed in the last 5 years?(Required) None Cancer Heart Attack Stroke Coronary Artery Bypass Graft Life Cover(Required) Yes No Life cover amountR150 000R250 000R500 000R1 000 000R1 500 000R2 000 000R3 000 000R4 000 000R5 000 000R6 000 000R7 000 000R8 000 000Core Dreaded Disease(Required)Payable for cancer, heart attack, stroke or coronary artery bypass graft. Yes No Core dreaded disease amountR50 000R150 000R250 000R500 000R1 000 000R1 500 000R2 000 000R3 000 000R4 000 000Funeral cover for yourself(Required) Yes No Funeral cover amountR10 000R30 000R40 000R50 000R60 000 Would you like to add funeral benefits for other family members?(Required) Yes No For children, the following maximums however apply: R15 000 for children younger than 6 years R30 000 for children aged 6 years and older but younger than 14 years Other family member Name of family member Date of birth of family member Relationship to you Cover amount for family member Actions Edit Delete There are no family members. Add family member Maximum number of family members reached.
