Classic Car Insurance.
Get a quote now!

CAR INSURANCE QUOTE

This quote is valid for 30 days from date of issue

Full name of Proposer / Legal Entity*
ID or Passport No. / Registration No.*
Responsible Person (Legal Entity)
Date of Birth*
Date Format: MM slash DD slash YYYY
Physical address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Postal address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Tel.
Mobile Tel.*
Number of Drivers*
Driver information*
Prefix First Last
Driver information*
Prefix First Last
ID / Passport*
ID / Passport*
Date of Birth*
Date Format: MM slash DD slash YYYY
Date of Birth*
Date Format: MM slash DD slash YYYY
Policy number (If existing client)
Policy number (If existing client)
Mobile Tel.*
Mobile Tel.*
Gender*
Gender*
Marital status*
Marital status*
Driver’s licence code (i.e. B, EB, C1 etc.)*
Driver’s licence code (i.e. B, EB, C1 etc.)*
Date of first issue of licence:*
Date Format: MM slash DD slash YYYY
Date of first issue of licence:*
Date Format: MM slash DD slash YYYY
Driver CFG ( Claim free group )*
How many years claim-free?
Vehicle value (excl. accessories)*
Model Year*
Make/Model*
Accessories value
Existing security*
Vehicle use Cover*
Cover type*
Usual daytime parking*
Overnight parking*
Drive*
Please select one of the following mileage options:*
Optional benefits
- None
- Credit shortfall
- For Executive Policy
- Depreciation Protection Cover
- Roadside assistance
Vehicle Claims history (Please provide details of any vehicle losses in the last 5 years)
Date of Event
Description of Event
Amount Claimed
Has any insurer ever refused, cancelled or declined to renew any policy held by you or any individual who will be covered by this policy?*
- Yes
- No
If ‘Yes’, please provide details:
Current Insurers
Renewal Date*
Date Format: MM slash DD slash YYYY
Are you interested in the following seperate quotes?
General
- Vehicles must be registered in the Republic of South Africa.
- This quotation is inclusive of VAT and SASRIA, but excludes broker fees.
- This quotation is subject to the terms, exceptions, conditions, limits of indemnity/sum insured and standard excesses of the company’s standard motor policy.
Information Sharing Declaration

It is necessary for insurance companies to share information in order to underwrite (assess and price the risks) policies fairly and lower the number of fraudulent claims.

In view of the above, I/we (and any person representing me) declare by the submission and/or signing of this document to:
- accept that it is in the public interest for insurers to share insurance information (including credit information);
- consent to my policy, claims or credit information being verified or shared with third parties in the ordinary course of business;
- accept that any information provided to the insurer may be stored in a shared database;
- consent to such information being given to any other insurance company and/or reinsurance company or its agent should there be a legitimate business reason for doing so;
- accept that this information may be checked against other legal sources or databases;
- and confirm that all information provided is true, correct and complete.
Consent*
Check here to indicate that you have read and agree to the terms of the Vintage Motors customer agreement.

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Then keep it classic like our cars and complete the form and sent it to us at: insurance@vintagemotors.co.za

Classic Car Insurance. Get a quote now!

CAR INSURANCE QUOTE

This quote is valid for 30 days from date of issue

General

Information Sharing Declaration

Please refesh your browser if the form fails to submit

Online form not your style?

Classic Car Insurance.
Get a quote now!