QUICK QUOTE (MORE THAN 1 BIKE) - Motorcycle Underwriting Room

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Motorcycle Underwriting Room

BikesureAssist 24 Hour Accident or Emergency Call 086 1777 228

BikesureAssist 24 Hour Accident or Emergency Call
086 1777 228

Home
About Us
What We Cover
Basket of Care
Quick Quote
Contact

Home
About Us
What We Cover
Basket of Care
Quick Quote
Contact

Home
About Us
What We Cover
Basket of Care
Quick Quote
Contact

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QUICK APPLICATION FORM

FILL OUT THE FORM BELOW

Name *

First

Last

Contact Number *

Email *

Do you have a preferred broker? *

Yes
No

If yes, please provide the following:

First

Last

Contact Number

Email

What type of riding do you do?

Road Only
Road and Track
Track Only
Touring-Road
Touring-Road and Gravel
Commute to and from Work
Motocross
Enduro
Cross-Country / Off-Road

Make of Bike 1 *

Model and Year of Bike 1 *

Value of Bike 1 *

Make of Bike 2

Model and Year of Bike 2

Value of Bike 2

Make of Bike 3

Model and Year of Bike 3

Value of Bike 3

Make of Bike 4

Model and Year of Bike 4

Value of Bike 4

Make of Bike 5

Model and Year of Bike 5

Value of Bike 5

Do you require cover for Bike Accessories? *

Yes
No

If yes, specify value to specify accessory type and value

Do you require cover for Riding Gear? *

Yes
No

If yes, specify value to specify item of gear and value

Would you like to add any of the following optional extensions:

Personal Accident - R15,000 cover limit
Legal Assistance - R100,000 per annum for traffic violations
Credit Shortfall

To qualify for a discounted premium, please answer the following - Do you currently have a training certificate? *

Yes
No

If Yes: Course Name and Highest Certificate Level

What is your current age?

Selected Value: 25

How many years bike riding experience do you have?

Selected Value: 25

Have you had any losses (Insured and uninsured) in the past 3 years *

Yes
No

If Yes: Number of incidents?

Total Value of losses?

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Bikesure Assist

QUICK LINKS

BikesureSA.co.za
Bikefinder.co.za
MyBikeQuotes.co.za
Quadsure.co.za
PedalsureSA.co.za

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24 HOUR
ACCIDENT OR EMERGENCY

Call +27 86 1777 228

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QUICK APPLICATION FORM

MENU

RESOURCES

Brochures

QUICK LINKS

24 HOURACCIDENT OR EMERGENCY

Call +27 86 1777 228

FOLLOW US

24 HOUR
ACCIDENT OR EMERGENCY