Murray Clan - Insurance Brokers - domestic quote form

Domestic Quote Form

Name:

ID:

Tel:

Fax:

e-mail:

Adress:

Construction:

Walls

Brick

Wooden

Asbestos

Roofs

Tiles	Wooden	Thatch	Asebstos

Security


Burglar bars	Security gates


Alarm systems	Armed response

Value of household contents

Value of building

All risks general for wearing apparel and personal effects - normally R5000

All risks specified:

Cell Phones, Sunglasses, Spectacles, Car Radios, Fire Arms, Leather Jackets, etc. needs to be specified.

Item to be insured

Value of item:

Item to be insured

Value of item:

Motor:

How Many cars would you like to insure:

Previously insured?

Copy of previous policy would assist.

Currently paying?:

Refer to Murray Clan for Caravans, Trailers, Motorcycles & Boat Quotes

Reset the form:

Submit the form:

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