Submit a claim

Tell us what happened and we'll take care of it so you don't have to

Name and surname *

First

Last

Policy Number *

ID number *

Phone *

Email *

Tell us what happened *

Date of the incident *

Date

Time

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Was there another party involved? *

The other party's name and surname

First

Last

The othe party's ID number (if you have it)

The other party's cell number (if you have it)

Please upload any relevant documents here eg. photo / invoice

Click or drag files to this area to upload. You can upload up to 20 files.

Please choose your office *

Choose your Bela Bela broker *

Choose your Brits broker *

Choose your Modimolle broker *

Choose your Phalaborwa broker *

Choose your Pretoria broker *

Choose your Tzaneen broker *

FSP: 17660