I would like to
Comapany name (if applicable):
First Name:
Last Name:
ID no:
Home Tel:
Work Tel:
Cell phone:
Alternative Tel:
e-Mail:
Preferred means of communication:
Preferred time of communication:
Please select the product(s) you're interrested in:
Commercial Insurance
Commercial Insurance


Please select the sections you're interrested in
Fire
Buildings combined
Office Contents
Business Interruption (Loss of Income)
Accounts receivable
Theft
Money
Glass
Fidelity
Goods In Transit
Business All Risks (Specified Items)
Accidental Damage
Public Liability
Group Personal Accident
Vehicle
Electronic Equipment
Motor Traders Internal Risks
Motor Traders External Risks
Machinery Breakdown
Machinery Breakdown – Business Interruption
Deterioration of stock


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Contractors All Risk
Contractors All risks


Please select the sections you're interrested in
Plant All Risks
Contractors All Risks: Specified
Contractors All Risks: Non-Specified


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Farmers Insurance
Farmers Insurance


Please select the sections you're interrested in

Farming related
Fire
Theft
Money
Glass
Fidelity
Goods In Transit
Business All Risks (Specified Items)
Accidental Damage
Public Liability
Group Personal Accident
Vehicle (Motor, LDV, Trucks, Trailers, Motorcycle, Quad)
Caravan & Trailer
Electronic Equipment
Machinery Breakdown
Machinery Breakdown – Business Interruption
Deterioration of stock

Personal related
Household Contents
Buildings
Personal All Risks
Personal Legal Liability
Extended Personal Legal Liability
Motorcycle & Quad


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Haulage Contractors Insurance
Haulage Contractors


Please select the sections you're interrested in
Fire
Office Contents
Business Interruption (Loss of Income)
Accounts receivable
Theft
Money
Glass
Fidelity
Goods In Transit
Business All Risks (Specified Items)
Accidental Damage
Public Liability
Group Personal Accident
Vehicle - (Motor, LDV, Trucks, Trailers, Motorcycle, Quad)
Electronic Equipment
Machinery Breakdown
Machinery Breakdown – Business Interruption
Deterioration of stock


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Personal Insurance
Personal Insurance


Please select the sections you're interrested in
Household Contents
Buildings
All Risks
Motor
Caravan & Trailer
Personal Legal Liability
Extended Personal Legal Liability
Watercraft & Jetski
Motorcycle & Quad
Personal Accident
Death Benefit Plan
Hospital Plan


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Message:
Our Contact Details


Address:

9 Fougat Road
Impala Park
BOKSBURG
1459


FSP License no: 29738


Tel: +27 11 918 4664
Fax: +27 866 196 663
Cell: +27 83 462 4452
e-Mail: info@ateasebroking.co.za

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