GET A NO OBLIGATION QUOTE NOW PERSONAL INFORMATION MOTORCYCLE INFORMATION NON-STANDARD EXTRAS Are there any non-standard extras on your bike? Description Make Value (Add more rows as needed) RIDING GEAR INSURANCE Do you want to insure your riding gear? Item Make Value Helmet Jacket Boots Gloves (Add more rows as needed) OTHER ALL-RISK ITEMS (GPS, ETC.) Do you have any other all-risk items you wish to insure? Description Make Value (Add more rows as needed) ADDITIONAL INFORMATION SECURITY AT ADDRESS: Locked garageBehind locked gatesOther MARITAL STATUS: SingleMarriedDivorcedWidowed LICENSE INFORMATION LearnersFull INSURANCE INFORMATION ARE YOU CURRENTLY INSURED? YesNo WHO ARE YOU INSURED WITH? POLICY NUMBER FOR HOW LONG HAVE YOU HAD UNINTERRUPTED COVER? Have you suffered any motorcycle related losses (whether claimed for or not) in the past 5 years? YESNO Description Date Value COVERAGE OPTIONS Comprehensive Comprehensive Own damage, Third party damage and theft cover Balance of Third Party, Fire and Theft Balance of Third Party, Fire and Theft Third party damage and Theft cover only Balance of Third Party Only Balance of Third Party Only Third party damage only ADDITIONAL COVERAGE PERSONAL ACCIDENT IRON GUARD PERSONAL ACCIDENT IRON GUARD • Death cover – R 50 000 • Permanent Disability – Up to R 60 000 • Temporary Disability – Up to R 60 000 • Medical Expenses – Up to R 20 000 • Helicopter transportation – Up to R 350 000 BASIC EXCESS WAIVER BASIC EXCESS WAIVER Removes the basic excess from any claim (excludes penalty excesses) ADDITIONAL EXCESS WAIVER ADDITIONAL EXCESS WAIVER Removes basic excess AND all penalty excesses from any claim TYRE & RIM COVER TYRE & RIM COVER • Tyres: R 5 000 – R 10 000 (max 2 tyres & 2 claims per year) • Rims: R 2 000 (max 2 rims & 2 claims per year) ROADSIDE ASSISTANCE IRON AID ROADSIDE ASSISTANCE IRON AID • Flat tyre assistance – Max R 1 500 • Battery assistance – Max R 1 500 • Run out of fuel – 5 litres delivered • Towing – Max R 1 500 • Car hire (>100km from home) – Max R 500 • Overnight accommodation – Max R 500 TOP UP / CREDIT SHORTFALL TOP UP / CREDIT SHORTFALL Covers the difference when your bike’s retail value is less than the amount owed to the bank ADDITIONAL QUESTIONS DO YOU REQUIRE TRACK DAY COVER YESNO What do you use the motorcycle for: Private, social and domestic useBusiness useCommercial use – delivery bike LEGAL AGREEMENTS (Required) I accept and understand the POPI Consent Policy View Policy I accept and understand the Disclosure Consent View Policy I accept and understand the Privacy Policy View Policy
