MJD Risk Insurance Brokers

Short Term Insurance and Risk Management Consultants

“Partners in your Risk”

Quote Me

MJD Domestic Quote form

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Page 1


General 






Provide your age at next birthday
We have a special discounted product for pensioners. Please contact us for details






Insert Box number or street name & number plus suburb & postal code



This question must be answered irrespective whether you were insured ot not

This is the total amount (Rand value) of all your claims in the past 3 years

Tick more than one if applicable
Select the sections that you require cover for

A minimum of R75 000 contents cover is compulsory in order to qualify for any of the other sections. therefore you must select contents first and then any of the others.

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Contents







Minimum value is R75 000. This is the total replacement value of all the contents in your home. Please remember that average applies if you are under-insured


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Standard = Brick walls under IBR,Tile or zinc roof Non - Standard = other than above

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If more than R25 000 is required then contact the office for a quote

If more than R25 000 is required then contact the office for a quote


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Buildings



Standard = Brick walls under IBR,Tile or zinc roof Non - Standard = other than above

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If more than R20 000 is required then contact the office for a quote

If more than R20 000 is required then contact the office for a quote


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Page 3

 
All Risks Section

On clothing and personal efffects
any one item not exceeding R1000

Specified Items




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Personal Liability Section


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Personal Accident Section





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Small Craft Section


KPH
Max speed to insure is 75 KPH



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Page 4

Motor Section


e.g. Volkswagen, Mercedes Benz, Nissan etc

e.g. Polo Vivo 1.4 Trendline manual





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This is the person who will driver the vehicle more than 50% of the time


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Info

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Page 5

Trailers & Caravans




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General


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