No 2 The Colosseum Building
Century City Boulevard
Century City
PO Box 90 Century City 7446
Tel: (27) (21) 529 7800
Fax: 0865 202 355
E-mail: insure@aib.co.za
Personnal
Details
Name
Surname
Address
Telephone
Fax
E-mail
Dwelling
Please complete another form if you have more than one dwelling
with contents to be insured.
Type of home
If other, please supply details
How long have you lived at your home
address?
Years Months
If your house has a thatch roof, is it
protected by a SABS-approved lightning conductor?
Yes
No
High
Security Living Decleration
Please complete another form if you have more than one dwelling
with contents to be insured.
The proposer/policyholder
lives in the following premises where all major building constrction has
been completed:
High
Security Development Complex
Includes:
Controlled access to the
develpment
Perimeter wall of at least 1,8m
in height which surrounds the whole complex
Detached
Houses/Cottages (other than in security developments)
Includes:
Response alarm fitted to both
the private residence and outbuildings and will be kept in
full working order
Perimeter wall of at least 1,8m
in height which surrounds the whole complex
Electronically operated gates
control access to the property
All opening windows (including
louvres) are burglar barred and external sliding doors are
fitted with security gates
It is not opposite to or
adjoining a park, sports field, golf course, vacant stand,
school or shopping centre.
It is not situated on a plot,
farm or small holding and is not isolated
Flats/Apartment
Blocks
Includes:
Controlled access to the grounds
or at the main entrance
Response alarm is fitted to the
private residence and will be kept in full working order or
all windows are burglar barred and all entrance doors are
fitted with security gates
Surrounded by a perimeter wall
of at least 1,8m in height
Flats/Apartment
Blocks (other than above)
Includes:
Premises are situated above the
second floor (i.e. 3rd floor and above)
No controlled access to the
grounds or at the main entrance
All passage windows are burglar
barred
All entrance doors are fitted
with security gates
None
of the above (Not a high security premises)
Location
details
Ignore this section if proposer qualifies for High Security
Living.
Is your home a holiday home?
Yes
No
Is your home in an established built-up
area?
Yes
No
Is your home on a small holding or farm?
Yes
No
Is your home near or adjoining public
property e.g. vacant stand, park, sports field, golf course, school or
shopping centre?
Yes
No
Security
details
Ignore this section if proposer qualifies for High Security
Living.
All opening ground floor windows are
burglar barred?
Yes
No
Your home has an alarm system?
Yes
No
If yes, is it serviced at least once a
year?
Yes
No
Does the alarm have radio communication
with a security organisation?
Yes
No
Is there full-time security guards on the
property?
Yes
No
Does your home have external sliding
doors?
Yes
No
If yes, are they fitted with a
frame-mounted, key-operated locking bolt or a security gate?
Yes
No
Security gates are fitted to all other
external doors of your home?
Yes
No
Your home is usually occupied during
normal working hours?
Yes
No
If yes, by you or a member of your family?
Yes
No
Insurance
details
This cover replaces existing insurance for
household goods?
Yes
No
Have you or any member of your household
suffered any burglary/theft losses during the last 24 months, at your
present address?
Yes
No
If yes:
Number of times
Costs of losses R
What steps have you taken to prevent
further losses?
Are you entitled to a No Claim Bonus?
(Please supply documentary evidence from you previous insurer of number
of years claim free)
Yes
No
Inventory
Please complete the inventory
which will assist you to establish your Sum Insured. Fill in just the
amount without spaces, commas or currency symbols e.g 600 or 600.00
