Short term insurance for

all your personal and commercial needs.

We have over 30 years of experience providing expert short-term insurance advice for both businesses and individuals.

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100

HAPPY CLIENTS

YEARS OF EXPERIENCE

What you can gain with us

COMMERCIAL INSURANCE

BUSINESS INSURANCE

CYBER INSURANCE

CONTRACTORS ALL RISK INSURANCE

PERSONAL MOTOR & HOME INSURANCE

AGRICULTURAL INSURANCE

PROFESSIONAL INDEMNITY

PUBLIC LIABILITY INSURANCE

Contact us. Feel free to call or write anytime

BERNHARD HEESEN

073 599 4971

CONTACT ME VIA E-MAIL

info@bestadvice.co.za

Application Form

Personal Short Term Quote

Please select the applicable sections that will be relevant to the quote: *

Buildings
Household Contents
All Risk - Unspecified
All Risk - Specified
Personal Liability
Motor
Trailer / Caravan
Personal Accident
SASRIA

The options already selected, are automatically included in the policy!

Personal Information

Title *

First Names *

Surname *

ID/Passport Number *

Marital Status *

Physical Address

Unit / Stand / Street Name and No *

Suburb *

City *

Postal Code *

Postal Address

Same as above

PO Box / P Bag *

Suburb / City *

Postal Code *

Contact Details

Home no.

Office no.

Mobile no. *

Fax no.

Email *

HOMEOWNERS COVER (Building cover)

How many properties do you want to insure?

Risk Address 1 (Main Residence)

Unit / Stand / Street Name and No *

Suburb *

City *

Postal Code *

Sum Insured? *

Roof Construction *

Wall Construction *

Accidental Damage *

Within 100m of River/Sea/Dam? *

Rented Out? *

Solar Geyser? *

Finance / Bond Institute *

Household Contents

Risk Address 1 (Household Contents)

Unit / Stand / Street Name and No *

Suburb *

City *

Postal Code *

Building Type *

Sum Insured? *

Security Questionnaire (Yes/NO)

Do you have interleading doors from main house to garage/outbuildings? *

Does your home have an alarm linked to an armed response organisation? *

Is your home on a small holding or farm? *

Is your home normally occupied during office hours? *

Do you have external sliding doors? *

Will you be going on holiday in the next 30 days? *

Do you have Pin Locks or security gates fitted to the sliding doors? *

Are security gates fitted to all external doors of your home? *

Are burglar bars fitted to ALL opening windows? *

Is any part of your home still under construction? *

Does your home have a thatched roof/timber walls? *

Will the residence be unoccupied for more than 60 day in any year? *

Perimeter Walled/Fenced off *

24 Hour Access Control for security complex? *

Accidental Damage *

Power Surge *

Risk Address 2

Unit / Stand / Street Name and No *

Suburb *

City *

Postal Code *

Sum Insured? *

Roof Construction *

Wall Construction *

Accidental Damage *

Within 100m of River/Sea/Dam? *

Rented Out? *

Solar Geyser? *

Finance / Bond Institute *

Risk Address 3

Unit / Stand / Street Name and No *

Suburb *

City *

Postal Code *

Sum Insured? *

Roof Construction *

Wall Construction *

Accidental Damage *

Within 100m of River/Sea/Dam? *

Rented Out? *

Solar Geyser? *

Finance / Bond Institute *

Risk Address 4

Unit / Stand / Street Name and No *

Suburb *

City *

Postal Code *

Sum Insured? *

Roof Construction *

Wall Construction *

Accidental Damage *

Within 100m of River/Sea/Dam? *

Rented Out? *

Solar Geyser? *

Finance / Bond Institute *

Risk Address 2 (Household Contents)

Unit / Stand / Street Name and No *

Suburb *

City *

Postal Code *

Building Type *

Sum Insured? *

Security Questionnaire (Yes/NO)

Do you have interleading doors from main house to garage/outbuildings? *

Does your home have an alarm linked to an armed response organisation? *

Is your home on a small holding or farm? *

Is your home normally occupied during office hours? *

Do you have external sliding doors? *

Will you be going on holiday in the next 30 days? *

Do you have Pin Locks or security gates fitted to the sliding doors? *

Are security gates fitted to all external doors of your home? *

Are burglar bars fitted to ALL opening windows? *

Is any part of your home still under construction? *

Does your home have a thatched roof/timber walls? *

Will the residence be unoccupied for more than 60 day in any year? *

Perimeter wall/fence Type *

24 Hour Access Control for security complex? *

Accidental Damage *

Power Surge *

Risk Address 3

Unit / Stand / Street Name and No *

Suburb *

City *

Postal Code *

Building Type *

Sum Insured? *

Security Questionnaire (Yes/NO)

Do you have interleading doors from main house to garage/outbuildings? *

Does your home have an alarm linked to an armed response organisation? *

Is your home on a small holding or farm? *

Is your home normally occupied during office hours? *

Do you have external sliding doors? *

Will you be going on holiday in the next 30 days? *

Do you have Pin Locks or security gates fitted to the sliding doors? *

Are security gates fitted to all external doors of your home? *

Are burglar bars fitted to ALL opening windows? *

Is any part of your home still under construction? *

Does your home have a thatched roof/timber walls? *

Will the residence be unoccupied for more than 60 day in any year? *

Perimeter wall/fence Type *

24 Hour Access Control for security complex? *

Accidental Damage *

Power Surge *

Risk Address 4

Unit / Stand / Street Name and No *

Suburb *

City *

Postal Code *

Building Type *

Sum Insured? *

Security Questionnaire (Yes/NO)

Do you have interleading doors from main house to garage/outbuildings? *

Does your home have an alarm linked to an armed response organisation? *

Is your home on a small holding or farm? *

Is your home normally occupied during office hours? *

Do you have external sliding doors? *

Will you be going on holiday in the next 30 days? *

Do you have Pin Locks or security gates fitted to the sliding doors? *

Are security gates fitted to all external doors of your home? *

Are burglar bars fitted to ALL opening windows? *

Is any part of your home still under construction? *

Does your home have a thatched roof/timber walls? *

Will the residence be unoccupied for more than 60 day in any year? *

Perimeter wall/fence Type *

24 Hour Access Control for security complex? *

Accidental Damage *

Power Surge *

All Risk Items (Min = R5 000)

Unspecified All Risks *

Specified All Risks

Specified Item (Description)

Make & Model

Serial Numbers

Sum Insured

Specified Item 2

Make & Model 2

Serial Numbers 2

Sum Insured 2

Specified Item 3

Make & Model 3

Serial Numbers 3

Sum Insured 3

Specified Item 4

Make & Model 4

Serial Numbers 4

Sum Insured 4

Specified Item 5

Make & Model 5

Serial Numbers 5

Sum Insured 5

Specified Item 6

Make & Model 6

Serial Numbers 6

Sum Insured 6

Make *

Model (eg: 1.6 GLS) *

Vehicle Colour *

Registration No.

VIN No.

Engine No.

Overnight Vehicle Address *

Vehicle 4

Year *

Make *

Model (eg: 1.6 GLS) *

Vehicle Colour *

Registration No.

VIN No.

Engine No.

Overnight Vehicle Address *

Vehicle Accessories & Price

Vehicle 1

Extra Accessories (Description)

Value

Extra Accessories (Description) 2

Value 2

Extra Accessories (Description) 3

Value 3

Extra Accessories (Description) 4

Value 4

Vehicle Info

Alarm / VSS Immobilizer *

VSS Approved Gearlock *

Tracking Device Installed *

Vehicle a Rebuild (Code 3) *

Credit Shortfall for Financed *

Value *

Excess Waiver *

Overnight Parking *

Locked Garage
Behind Locked Gates
Street

Vehicle a Soft Top *

Car Hire *

30 Days
60 Days

Any Drivers, Physical Defect - Vision or Hearing *

Any Drivers, Convicted / License Endorsed *

Type of Use *

Private
Business

Vehicle 2

Extra Accessories (Description) *

Value *

Extra Accessories (Description) 2 *

Value 2 *

Extra Accessories (Description) 3 *

Value 3 *

Extra Accessories (Description) 4 *

Value 4 *

Vehicle Info

Alarm / VSS Immobilizer *

VSS Approved Gearlock *

Tracking Device Installed *

Vehicle a Rebuild (Code 3) *

Credit Shortfall for Financed *

Value *

Excess Waiver *

Overnight Parking *

Locked Garage
Behind Locked Gates
Street

Vehicle a Soft Top *

Car Hire *

30 Days
60 Days

Any Drivers, Physical Defect - Vision or Hearing *

Any Drivers, Convicted / License Endorsed *

Type of Use *

Private
Business

Vehicle 3

Extra Accessories (Description) *

Value *

Extra Accessories (Description) 2 *

Value 2 *

Extra Accessories (Description) 3 *

Value 3 *

Extra Accessories (Description) 4 *

Value 4 *

Vehicle Info

Alarm / VSS Immobilizer *

VSS Approved Gearlock *

Tracking Device Installed *

Vehicle a Rebuild (Code 3) *

Credit Shortfall for Financed *

Value *

Excess Waiver *

Overnight Parking *

Locked Garage
Behind Locked Gates
Street

Vehicle a Soft Top *

Car Hire *

30 Days
60 Days

Any Drivers, Physical Defect - Vision or Hearing *

Any Drivers, Convicted / License Endorsed *

Type of Use *

Private
Business

Vehicle 4

Extra Accessories (Description) *

Value *

Extra Accessories (Description) 2 *

Value 2 *

Extra Accessories (Description) 3 *

Value 3 *

Extra Accessories (Description) 4 *

Value 4 *

Vehicle Info

Alarm / VSS Immobilizer *

VSS Approved Gearlock *

Tracking Device Installed *

Vehicle a Rebuild (Code 3) *

Credit Shortfall for Financed *

Value *

Excess Waiver *

Overnight Parking *

Locked Garage
Behind Locked Gates
Street

Vehicle a Soft Top *

Car Hire *

30 Days
60 Days

Any Drivers, Physical Defect - Vision or Hearing *

Any Drivers, Convicted / License Endorsed *

Type of Use *

Private
Business

Trailer 4

R5000 000.00

Insurance History (for the past 3 years)

Insurer *

Period with Insurer *

Insurer 2

Period with Insurer 2

Insurer 3

Period with Insurer 3

Insurer 4

Period with Insurer 4

Insurer 5

Period with Insurer 5

Claims History (for the past 3 years)

Year of Incident *

Description of Incident *

Estimated Value of Claim *

Year of Incident 2

Description of Incident 2

Estimated Value of Claim 2

Year of Incident 3

Description of Incident 3

Estimated Value of Claim 3

Year of Incident 4

Description of Incident 4

Estimated Value of Claim 4

Year of Incident 5

Description of Incident 5

Estimated Value of Claim 5

General Underwriting

Has any insurer ever declined to accept, refused to renew, or imposed special terms for any insurance for which this quote is being made? *

If answer yes, please supply details below:

Click Here to Accept our Terms & Conditions *

I Accept

By clicking "I Accept" you confirm that you have read our Privacy Policies and agree to our Terms & Conditions.

Further more, you confirm that the information provided is true & accurate. Should any material information provided be incorrect, any quotes given will be subject to change.
Quotes given are estimates untill final underwriting takes place.

Short term insurance for

all your personal and commercial needs.

What you can gain with us

Contact us. Feel free to call or write anytime

BERNHARD HEESEN

CONTACT ME VIA E-MAIL

Application Form

Personal Short Term Quote

Personal Information

Physical Address

Postal Address

Contact Details

HOMEOWNERS COVER (Building cover)

Risk Address 1 (Main Residence)

Household Contents

Risk Address 1 (Household Contents)

Security Questionnaire (Yes/NO)

Risk Address 2

Risk Address 3

Risk Address 4

Risk Address 2 (Household Contents)

Security Questionnaire (Yes/NO)

Risk Address 3

Security Questionnaire (Yes/NO)

Risk Address 4

Security Questionnaire (Yes/NO)

All Risk Items (Min = R5 000)

Specified All Risks

Vehicle Details

Vehicle 1

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle Accessories & Price

Vehicle 1

Vehicle Info

Vehicle 2

Vehicle Info

Vehicle 3

Vehicle Info

Vehicle 4

Vehicle Info

Principle Driver / Registered Owner

Regular Driver (Vehicle 1)

Regular Driver (Vehicle 2)

Regular Driver (Vehicle 3)

Regular Driver (Vehicle 4)

Trailer / Caravan Details

Trailer 1

Trailer 2

Trailer 3

Trailer 4

Trailer / Caravan Accessories & Price

Trailer / Caravan 1

Trailer / Caravan 2

Trailer / Caravan 3

Trailer / Caravan 4

Personal Liability

Insurance History (for the past 3 years)

Claims History (for the past 3 years)

General Underwriting

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