House & Contents Insurance Quotation Info 房屋和家庭用品保险问卷
Info about the insured 投保人资料
Full name as per ID 车主身份证上的英文姓名
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名 First Name
姓 Last Name
ID / Passport number 身份证或护照号码
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ID / Passport 身份证或护照号码
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Browse Files
Cancel
of
Date of birth 车主出生日期
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-
Year
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Month
Day
Date
Cell phone number 手机号码
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-
Email 电子邮件地址
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example@example.com
Profession 职业
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Marital status 婚姻状态
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已婚 Married
未婚 Single
其它 Other
Current insurer and premium 现在的保险公司和保费
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When do you want cover to start if you are satisfied with our proposal? 如果对我们提供的方案满意的话，请问您想几月几号投保呢？
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How long have you had uninterrupted motor/household insurance? 您在南非有没有在您自己的名义下买过汽车/房子保险？有的话，几年（在没有断过保的状况）？
First time insured 从来没买过
1 year 年
2 years 年
3 years 年
4 years 年
5 years 年
5 years or above 年以上
Has any insurers ever refused or rejected your insurance? 有没有保险公司曾经拒绝提供保险或取消您的保险呢？
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有 Yes
没有 No
Do you have any criminal and/or insolvent record? 有没有犯罪或破产记录？
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有 Yes
没有 No
Has any insurer ever impose special conditions, cancel your insurance or refuse to provide you with insurance? 有没有保险公司曾经给您特别条款、主动取消您的保险或是拒绝提供保险给您呢？
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有 Yes
没有 No
Any claims in the last 5 years? If yes, please provide date, brief description and values. 在过去5年内有任何索赔吗？如果是，请提供日期、简要说明和数值。
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Info about the house 房屋资料
Value of the House 房屋的价值
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Value of all Home Contents 家庭用品的价值
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* 家庭用品动产（例如：家具、电器、电子用品、珠宝首饰、衣服） Home contents refer to all movable contents inside the house (e.g. furniture, home appliances, electronics, jewellery, clothing items )
Value of Outdoor contents 室外用品的价值
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* 室外用品动产（例如：室外家具、花园用品、烧烤炉） Outdoor contents refer to all movable contents outside the house (e.g. Outdoor furniture, Gardening equipment, BBQ, )
Physical Address 住址
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号码/路名 Number
路名 Street name
区域 Area
城市 City
区域号码 Area code
Type of house 房屋类别
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Stand-alone house 独立式的房屋
Townhouse 联排别墅
Mansion豪宅
Other
SQM of the house 房屋平方米
*建筑物的面积（不包括地） The SQM of the actual structure (excluding the land/plot)
Number of storey 几层楼
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Number of rooms 几个房间
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Number of geysers outside of building 几个在外面的热水器
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Number of geysers inside of building 几个在里面的热水器
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Finance house 贷款公司
Additional information 任何额外设备 / 特点
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Special roof (E.g. Metal, wood, thatch) 特别的屋顶（例如铁皮，木头, 茅草屋顶）
Standard roof (E.g. Tile) 标准建筑屋顶（如瓷砖）
Special construction (E.g. Metal, wood) 特别的建筑材料 （例如铁皮、木材）
Standard construction (E.g. Brick, concrete) 标准结构（如砖、混凝土）
The building has been structurally altered 房屋结构有改建过
The building is being altered or renovated 房屋正在改建或装潢
Swimming pool 游泳池
Thatch/Lapas within 5 meters 五公尺内有茅草屋
Wendy house / cottage 后花园有小屋
Solar geyser 太阳能热水器
Solar energy system 太阳能发电系统
Water filters or water tanks 净水器、存水系统
Vacant land/park next to the house 隔壁是空地或公园
Construction site nearby 周遭还在建筑中
Other
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Info about occupancy & security 房屋用途和保安设备
Occupation 房屋用途
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Primary residence 主要住宅
Secondary residence 次要住宅
Let / Sublet 出租用
Business use 商业用途
Holiday home 渡假屋
Commune 公社用
Other
Is the house occupied during working hours? 白天工作时间时，房屋里会有人吗？
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Yes 有
No 没有
If Yes, by whom? 如果有的话，请问是谁呢？
Will the house be unoccupied for more than 60 consecutive days in a year? 该住址在一年内会有连续 60 天无人居住吗?
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Yes 是
No 否
If Yes, please provide reason 如果是的话，请提共原因
Security information 保安设备
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Alarm system 有警报系统
The alarm is linked to an armed response company 警报系统有连接到保安公司
Electric fence 电网
Every opening window has burglar bars 每个可以打开的窗户都有防盗栏
Each door leading to the outside has a security gate / door 每个可以到外面的门都有多加一个安全门或是铁门
Inside a complex with 24 hours security 有保安的小区
Inside a complex without 24 hours security 没有保安的小区里
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Declaration & signature 宣言和签名
I hereby declare the foregoing particular to be true in every aspect. If there are additional information that may have a material impact on the policy, I will inform my advisor and insurer as soon as possible. To enable the insurance companies to underwrite risk fairly and to combat insurance fraud, we need to have your consent to verify and share policy information with insurers and other institutions as well as to access credit information held by other institutions. By signing this form you give your consent. 我在此确认以上资料正确无误，如果还有其他对保障有影响的额外资料，我会尽快提供给我的保险顾问和公司。为使保险公司能够公平承保风险，打击保险欺诈，我们需要征得您的同意，与保险公司和其他机构核实和分享保单信息，并访问其他机构持有的信贷信息。你签署这张表格，你就同意了。.
Signature 签名
Submit 提交资料
Should be Empty: