We now offer Personal, Domestic and Motor Insurance, exclusive to Cyclesure clients only.
 Complete the Questionnaire for a free quotation 
 

 

                      

 

  
Insurance application for Change a life tour
  • Cyclesure is generously sponsoring all insurance for your bikes, for the duration of this cycle challenge. 

  • It is an All Risks cover to bikes and accessories such as shoes, helmets, pumps etc.

  • There is also an additional personal cover of R20 000 for death and permanent disability and R10 000 medical expenses for any accidents whilst riding your bike during the challenge.

 

To ensure that you have this cover, you will need to fill in an insurance form prior to your departure.

Fields Marked with a *  are mandatory.

Personal Details

* Name:
*E-mail Address:
*Cellular No:

 
*Tell No:  
Fax No:  
     

Cycle Details

   
*Make & model of frame:  
*Group Set:  
*Wheel Set:  
* Total replacement value: R  
     

Accessories

    
Heart Rate Monitor: R
Cycle Computer: R
Helmet Name: R
Glasses Name: R
Shoes Name: R
Clothing: R
Pump Name: R

How would you like us to contact you? 

 

I hereby declare that the information in this application and statement of values is, to the best of my knowledge and belief, true and accurate in every respect and that no fact, circumstance or hazard that could effect the acceptance of my application has been withheld. I confirm that this application and declaration shall be the basis if the contract between Hollard and myself.

* Date:

Please ensure your details are entered correctly to facilitate a speedy response.

* Details are correct

 
Cyclesure FSP Number 3262