Name of insured:
In who's name is the house registered?
ID number of insured:
Policy Number:
Is this a second building you want to add or is it replacing an existing building on the policy.
Is this a main building, holiday home or other building?
From which date do you require cover?
Please complete Captcha Code
Please take note that this is just a request to add the building to the policy and your consultant will contact you shortly to discuss all the details that we will need before the building will be on cover.
Name of Company
Contact Person
Title
Email
Contact Telephone number
Cellphone number
When would it be convenient for us to contact you?
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