| Life Insurance in South Africa |
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(fields marked red are required) Your Contact Details
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Please note that we require a deposit of R 450 before we can obtain quotes for you. Obtaining and analysing the quotes is an extensive workload as we give you details on the guarantee periods involved, details on the cover, waiting periods and exclusions so that you can make an informed decision. The deposit will be refunded if you take out the policy via our office. Please find our banking details below.| Date of Birth | ||
| ID or passport no | ||
| Highest qualification | ||
| Occupation | ||
| Occupation details in % | % Administration | % Supervision |
| % Travel | % Manual work | |
| Income p.m. | ||
| Smoker | Yes No | |
Medical Questions
Have you ever had any operation, are you being treated for any medical condition at this stage, do you have any medical problems or a you aware of any treatment planned or expected in the future? If so, please give details of treatment, dates and name of doctor:
Do you use any chronic medication or are you under permanent treatment?
Product Choice
| Amount of life cover in Rand | ||
| Terms in years | life or years | |
| Payment method | monthly | quarterly |
| half-yearly | annually | |
| Inflation linked premium and cover | Yes No | |
| I would like | a pure risk product or a policy with cash values | |
| I further would like to insure myself against: | Disability | Sum insured Rand |
| Trauma (Heart attack, kidney failure etc.) | Sum insured Rand | |
| Please note that these amounts cannot exceed the amount of death cover. | ||
Other
If you need further information or if would you like to place any comments please use the box below.
Nedbank, Business Western Cape Branch, Branch code 12-32-09, Account 1232036382, account holder Swiss Financial Consulting.
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South African independent insurance quotes from Life insurer Discovery Life, Liberty Life, Momentum Life, Old Mutual, SA Eagle, Sanlam, Santam
South Africa, independent life insurance broker: Swiss Financial Consulting