SWL Vehicle Quotation

Vehicle Quotation

Please fill the form accurately for better assistance
Full Name & Surname / Company Name
E-mail Address:
Phone Number:
ID Number / Company Registration Number (Required to Quote)
Current Insurer:
Policy number with current Insurer:
ITC Consent (Required To Quote):
Have you had any claims in the past 3-5 years?
If "Yes" (you had claims in the past 3-5 years) provide details:
Vehicle Details

We require some information about your vehicle to do an accurate quote.
Inception date
Make of Vehicle
Model of Vehicle
Year of Vehicle Model
M&M Code
VIN Number
Engine number
Vehicle Registration Number
Colour of Vehicle
Is The Vehicle Modified?
Cover required?
Is your Vehicle used for
Security in Vehicle
Do you require car hire?
Basic/Standard excess waiver required?
Outstanding Amount Owed on Vehicle?
Is the Vehicle Financed?
If “yes” – with which Finance Company?
Was a Deposit Amount Paid?
If Yes, What Deposit Amount?
Credit shortfall required?
Current Outstanding Amount at Financial Institution?
Do you need to insure extras?
Please add what extras you would like to insure, with the replacement value.
Is a vehicle being replaced?
Any existing damages to vehicle
Registered Owner Details

We require information about regular driver, class of use, finance house, cover etc, to do an accurate quote.
Registered Owner Full Name & Surname / Company Name
Registered Owner ID Number / Company Registration Number
Regular Driver Details

We require information about regular driver, class of use, finance house, cover etc, to do an accurate quote.
Regular Driver Full Name & Surname:
Regular Driver ID Number:
License Code:
Date License was 1st Issued
Any Restrictions on Drivers License?
If “yes” please provide details:
Regular Driver Primary Occupation:
Regular Driver Secondary Occupation (if applicable)
Vehicle used for carrying goods?
If "Yes" please provide detail and the amounts
Daytime & Night Time Risk Address & Security Details
Where is your vehicle usually parked during the day (Full Risk Address):
Tick if True
Where is your vehicle usually parked during the night (Full Risk Address):
Tick if True
SIGNATURE OF CLIENT
Date of Signature:
SWL FINANCIAL SERVICES – Licensed Financial Services Provider in terms of Section 8 of the Financial Advisory and Intermediary Services Act, 2002. (Act No 37 OF 2002) (Licence Number 34914)
Should be Empty:

Vehicle Quotation

Vehicle Details

Registered Owner Details

Regular Driver Details

Daytime & Night Time Risk Address & Security Details