• Language / Taalkeuse

KWOTASIE:

TIPE DEKKING:

  • Beskrywing van Kwotasie:

  • Versekerde Naam:

  • Risiko Adres: (Plaas Naam & Distrik)
  • DEKKING BYVOEGING:
  • Versekering Dekking Opsies:

  • Spesifiseer Tipe Dekking:

  • Spesifiseer Dier Spesie:

  • Indien nie Gelys:

  • Foto's van die betrokke bok/dier:

  • Hoeveelheid Diere:

  • Spesifiseer die ouderdom:

  • Geslag van Dier:

  • Enige Dragtige diere:

  • Watter fase?

  • Verskaf besonderhede:

  • Mikroskyfie / Tag No:

  • Foto van Tag / Microchip No.

  • Aankoops Waarde: (Faktuur Waarde)

  • Versekerde Waarde: (BTW ingesluit)

  • Bevestiging - Hoe die waarde bepaal is:

  • Voorsiene Vervoer Datum:

  • Afskrif vam Permitte:

  • Distansie van Vervoer:

  • Van Waar? (Naaste Dorp)

  • Tot Waar? (Naaste Dorp)

  • Transport Informasie:

  • Selfoon No:

  • E-mail adres:

  • Veearts Informasie:

  • Selfoon No:

  • E-mail Adres:

QUOTE:

TYPE OF COVER:

  • Description of Quote:

  • Insurer Naam:

  • Risk Address: (Farm Name & District)
  • ADD COVER
  • Insurance Cover Options:

  • Specify Type of Cover:

  • Specify each animal individually:

  • If not included in the above mentioned list:

  • Photo of animal:

  • Quantity of animal(s):

  • Specify Age of Animal(s):

  • Male or Female

  • Is the animal pregnant?

  • Which period?

  • Microchip / Tag No:

  • Photo of Tag/Microchip no:

  • Purchase Price: (VAT include)

  • Sum Insured: (VAT included)

  • Invoice Available?

  • Transport Date:

  • Distance Travelling:

  • From where to where?

  • Transport Information:

  • Cellphone No:

  • E-mail Adress:

  • VET Info:

  • Cellphone No:

  • E-mail Adress:

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