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Please complete the details of the person taking out the policy (e.g. policyholder)

Title *

First Name *

Surname *

Age *

Contact Number *

Email Address *

Cover *

RSA ID Number *

Basic income per month *

Education Status *

Smoker *

Gender *

Cover Amount *

Min R 50 000 – Max R 1 000 000

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Get Life Cover with our Quick Claim Insurance option or Cancer Cover with A-surance Insurance. Prevention is better than Remedy and we know that you would want to be covered when the unforseen happens. Choose A-surance Today!

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Products underwritten by Old Mutual Alternative Risk Transfer Limited, a licensed Life Insurer.

An authorised Financial Services Provider