PROPOSAL/SCHEDULE FOR MOBILE DEVICE INSURANCE
Insurer: Constantia Insurance Company Ltd – Reg. No. 1952/001514/06– VAT No. 4920108935 – FSP No. 31111
Underwriting Manager: Administration Plus (Pty) Ltd – Reg. No. 2004/023852/07 – VAT No. 4190243008 – FSP No. 36841
Your Broker is Majestic Financial Services An Approved Financial Services Provider
Broker: Majestic Financial Services CC. – Reg. No. CK1997/019890/23 – VAT No. 4780169043 – FSP No. 10035 The broker acts as your agent in all respects regarding this product.
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** Laptop ONLY
You've selected Laptop-only insurance option
** Cellphone ONLY
You've selected Cellphone-only insurance option
● I declare that I have applied for insurance cover on my cellular handset.
● I understand that cover on the handset is only when used with the sim card listed.
● I am aware of the first amount payable in the event of a claim. ● I confirm that I am in possession of the above handsets.
● I have been advised of the premium payable and that the premium will be deducted by monthly debit order by Constantia Insurance Comapny Ltd.
● I understand that failure to pay the monthly premium will result in cover lapsing ● I understand that this declaration forms part of the policy of insurance
● I have read and understood the policy wording and disclosure document accompanying this policy
THIS SCHEDULE BECOMES A TAX INVOICE WHEN THE AMOUNT REQUESTED HAS BEEN PAID
Administration Plus (Pty) Ltd-Directors: Mark Clark (M.D) (British)
Address: PO Box 6044, Roggebaai, Cape Town 8012-Telephone no: 086 111 8765-Fax: 0865056721
E-mail:helpdesk@adminplus.co.za
Please Print your COMPLETED FORM before hitting 'Finish and Send Order' - these are important documents & should be kept for reference purposes. When clicking 'Print Form' these documents will be printed: 1. Schedule Info Entered onscreen 2. Policy Wording 3. Disclosure Document