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Personal Details
Full Names
Phone Number
Email
Do you have a Will?
Yes
No
Not Sure
Cover Details
Do you have a Death Benefit? Lump sum to settle debt and provide income to your dependents?
Yes
No
Not Sure
Do you have a Disability cover? When you are temporarily or permanently unable to earn an income.
Yes
No
Not Sure
Critical Illness? When you are diagnosed with a severe illness (e.g. cancer)
Yes
No
Not sure
Funeral cover? To assist with your funeral expenses.
Yes
No
Not Sure
Accidental death? When the unexpected happens.
Yes
No
Not Sure
Cover Details final step
Are you sure you are saving enough for retirement?
Yes
No
Not Sure
Can we assist you with investments and savings options?
Yes
No
Not Sure
Do you have short-term insurance (e.g. household content, vehicle etc.)?
Yes
No
Not Sure
If yes, can we assist you in saving on your monthly premium by doing a comparative free quote?
Yes
No
Not Sure
Are you a member of a medical aid scheme?
Yes
No
Not Sure
Name of your Medical Aid
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