Triarc (PTY) LTD
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Life Insurance Quote Form

Complete the Quote form below or if you prefer a phone call, submit your contact details and we will call you right back.

HAVE A QUESTION? LET US CALL YOU BACK!

GET YOUR QUOTE WITH THE  QUOTE FORM BELOW

SECTION 1

INSURED LIFE

For you and your partner put together.
"A PEP generally presents a higher risk for potential involvement in bribery and corruption by virtue of their position and the influence that they may hold."
"Entity that owns an insurance policy and has the right to exercise all privileges under the contract of insurance, except where restricted by the rights of an assignee"

SECTION 2

POLICY OWNER

A. OCCUPATION

What kind of work do you do on a typical day?

TELL US WHAT YOU ARE INTERESTED IN

Choose one or more from the list below.

Choose the Cover you are interested in below.

DEATH COVER REQUIREMENTS

You have 2 options here, you can always pay the exact premium for the cover amount you have, called "Level premium" or you can choose to pay a reduced premium now to help your budget and increased premium in later years, called "5% Premium Pattern"
You have the option to fix your premium for 5 years, or allow us to increase it if necessary based on our risk experience. Fixing your premium for 5 years costs slightly more.

DISABILITY OR FUNCTIONAL IMPAIRMENT COVER REQUIREMENTS

You have 2 options here, you can always pay the exact premium for the cover amount you have, called "Level premium" or you can choose to pay a reduced premium now to help your budget and increased premium in later years, called "5% Premium Pattern"
You can choose to increase the Cover Amount by 3% or 6% annually, or leave it as it is now. (0%)
You have the option to fix your premium for 5 years, or allow us to increase it if necessary based on our risk experience. Fixing your premium for 5 years costs slightly more.
Choose "Stand Alone" if you want this cover to function independently of your Death Cover. Choose "Accelerated" if you want a cheaper gross premium, but keep in mind that claims against this policy will reduce your Death Cover by the same amount.
Example Age 65

DREAD DISEASE REQUIREMENT

You have 2 options here, you can always pay the exact premium for the cover amount you have, called "Level premium" or you can choose to pay a reduced premium now to help your budget and increased premium in later years, called "5% Premium Pattern"
You can choose to increase the Cover Amount by 3% or 6% annually, or leave it as it is now. (0%)
You have the option to fix your premium for 5 years, or allow us to increase it if necessary based on our risk experience. Fixing your premium for 5 years costs slightly more.
Choose "Stand Alone" if you want this cover to function independently of your Death Cover. Choose "Accelerated" if you want a cheaper gross premium, but keep in mind that claims against this policy will reduce your Death Cover by the same amount.
Example Age 65

INCOME PROTECTION REQUIREMENTS

You have 2 options here, you can always pay the exact premium for the cover amount you have, called "Level premium" or you can choose to pay a reduced premium now to help your budget and increased premium in later years, called "5% Premium Pattern"
You can choose to increase the Cover Amount by 3% or 6% annually, or leave it as it is now. (0%)
This is similar to the previous questaion, but relates to the cover increasing while you are getting Income Protection payouts due to a claim.
You have the option to fix your premium for 5 years, or allow us to increase it if necessary based on our risk experience. Fixing your premium for 5 years costs slightly more.
Example Age 65
This is the time you have to wait after you became unable to earn an income before you can put in a claim.
You have the option to fix your premium for 5 years, or allow us to increase it if necessary based on our risk experience. Fixing your premium for 5 years costs slightly more.

B. FOREIGN TRAVEL

C. AVOCATION

 

D. INSURANCE HISTORY

Please indicate Death cover, Critical Illness Cover, Disability and Income protector values

E. HABITS, MEASUREMENTS AND FAMILY HISTORY

1 unit = 1 bottle of beer, 1 glass of wine or 1 tot of spirits
 

F. DOCTORS/SPECIALISTS/HEALTHCARE PROVIDER(S)

If you don't have a regular doctor, please provide the details of a doctor whom we may send confidential correspondence to (if required)

G. YOUR MEDICAL HISTORY

Please include Condition, GP name, are you still on treatment, when last you had symptoms, are you recovered.

H. MEDICAL TESTS

SECTION 4

ADDITIONAL QUESTIONS FOR INCOME PROTECTION BENEFITS

SECTION 5

BENEFICIARY

If Yes, please also ensure that you supply Triarc with a copy of the Cession form

SECTION 6
PREMIUM

SECTION 7

STARTING DATE

Note: Policies can only start on the first of a month
I Declare and guarantee that the information is true, complete and precise.

About Us

TRIARC is an authorised financial services provider FSP45009. TRIARC insurance products underwritten by Guardrisk Life FSP76. Council of Medical Scheme
Number ORG 4040.

Contacts

087 231 0222
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