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Personal Info Step 1 of 6

Personal Information

First Name *

Surname *

Date of Birth *

Format: dd/mm/yyyy

Nationality *

SA ID Number *

Phone Number *

Email Address *

Physical Address *

Suburb/City *

Postal Code *

Car Make *

Car Model *

Year of Manufacture *

Vehicle Value (Estimate) *

Colour *

Registration Number *

Primary Usage *

Personal

Business / E-Hailing

Personal Usage Type *

Province of Registration *

Main Driver is the same as the Insured (Page 1)

Cover Type *

Overnight Parking *

Secure your family's future with our affordable funeral benefit linked to your policy.

Yes, I want Funeral Cover

Ownership Type *

Transmission *

Engine Capacity (Litres) *

Enter in litres (e.g., 1.6, 2.0, 3.0)

Tracking Device Installed? *

I agree to the terms and conditions and authorize Mzansi Brokers to process my personal information for the purpose of obtaining an insurance quote.