Personal Insurance Checklist

This form is intended to ensure your Daberistic's Short-term Insurance Broker covers all the necessary areas of your personal insurance, when onboarding you as a client as well as when annually renewing your insurance policy.

This form should be completed by your Broker together with you, telephonically. Once completed and submitted, a copy of this record is automatically emailed to you for your review and safekeeping. If you find the record to be factually incorrect, please email office@daberistic.com with your changes.

A copy of this record is automatically kept in our system for legal compliance purpose.

Your (Client's) Name*

First NameLast Name

Client email*

example@example.com

Client Phone Number*

Area CodePhone Number

Broker's name*

Date of discussion*

Date

Did you broker discuss the following areas of importance with you:

1. Car insurance*

YesNoPartiallyNot applicable

2. Car security requirements*

YesNoNot applicable

3. Car hire options*

YesNoPartiallyNot applicable

4. Roadside assistance benefits*

YesNoPartiallyNot applicable

5. Car insurance exclusions (e.g. drunken driving, breaking the law)*

YesNoPartiallyNot applicable

6. Household contents insurance*

YesNoNot applicable

7. Building insurance*

YesNoNot applicable

8. Home Assistance benefits*

YesNoPartiallyNot applicable

9. Building security requirements (e.g. construction standard, 24-hour security, alarm, security gate, burglar bars)*

YesNoPartiallyNot applicable

10. Insurance for electronic devices (cellphones, computers, game consoles) inside and outside the house*

YesNoPartiallyNot applicable

11. Insurance for bags and wallets and contents therein outside the house*

YesNoPartiallyNot applicable

12. Insurance for jewellery, paintings, rare coins, expensive artifacts*

YesNoPartiallyNot applicable

13. Personal/legal liability cover (R5m and additional)*

YesNoPartiallyNot applicable

14. Unique benefits related to your policy (e.g. cashback, fuel payback, instant accident alert, free car tracking online)*

YesNoPartiallyNot applicable

Additional comment*

If nothing to add, type N/A