"*" indicates required fields YOUR DETAILSYour name*Email address* Phone number*Time you'd prefer us to contact you: Morning Midday Evening TELL US ABOUT YOUR FUR BABYWould you be interested in Comprehensive Plan, Smart Plan, or Accident Plan?* Smart Plan Comprehensive Accident 10 Accident 20 Pack Plan Due to your pet's age, accident only cover is recommended.Is your baby a:* Cat Dog Pet name*Age*< 1 year1 year2 years3 years4 years5 years6 years7 years8 years or olderDog breed*Crossbreed 0-10kgCrossbreed 10-25kgCrossbreed > 25kgAberdeen TerrierAbyssinian Sand TerrierAffenpinscherAfghan HoundAfricanisAiredale TerrierAkitaAlaskan KleekaiAlaskan MalamuteAlsatianAmerican BulldogAmerican BullyAmerican Cocker SpanielAmerican Indian DogAmerican SpitzAmerican Water SpanielAmstaffAnatolian Karabash DogAnatolian Shepherd DogAppenzeller SennenhundAustralian Cattle DogAustralian Kelpie SheepdogAustralian Shepherd DogAustralian Silky TerrierAustralian TerrierAzawakhBasenjiBassadorBasser Bleu De GascogneBasset Fauve De BretagneBasset Griffon VendeenBasset HoundBavarian Mountain HoundBeagleBearded CollieBeaucheronBedlington TerrierBelgian Laekenois Shepherd DogBelgian Shepherd DogBergamasco Shepherd DogBerger de PicardBernese Mountain DogBichon FriseBiewer TerrierBlack & Tan CoonhoundBlack LabradorBlack RussianBloodhoundBlue Merle Welsh CollieBoerBoelBologneseBorder CollieBorder TerrierBorzoiBoston TerrierBouvier Des FlandresBoxerBraccoBriardBrittany SpanielBrussels GriffonBull TerrierBulldogBullmastiffCaine Corso (Italian Mastiff)Cairn TerrierCanaanCardigan CorgiCatalan SheepdogCavalier King Charles SpanielCesky TerrierChesapeake Bay RetrieverChihuahuaChinese CrestedChocolate LabradorChow ChowClumber SpanielCockapooCocker SpanielCollieContinental LandseerCoonhoundCorgiCoton De TulearCurly Coated RetrieverDachshundDalmatianDandie Dinmont TerrierDeerhoundDobermannDobermann PinscherDogue de BordeauxDorgieDorset Old Tyme BulldogDutch Partridge DogDutch SheepdogDutch ShepherdElkhoundEnglish BulldogEnglish PointerEnglish SetterEnglish Springer SpanielEnglish Toy TerrierEskimo DogEstrela Mountain DogEurasierFell TerrierField SpanielFila BrasileiroFinnish LapphundFinnish SpitzFlat Coated RetrieverFox HoundFox TerrierFrench BulldogFrench MastiffFrenchtonGalgo CodeGazelle HoundGerman PointerGerman ShepherdGerman SpitzGiant SchnauzerGlen Of Imaal TerrierGolden LabradorGolden RetrieverGoldendoodleGordon SetterGrand Bleu De GascoigneGreat DaneGreenland DogGreyhoundGriffon BrabanconGriffon BruxelloisGroenendaelHamiltonstovareHarrier HoundHavaneseHeelerHovawartHungarian KuvaszHungarian PuliHungarian VizslaHungarian Wirehaired VizslaHuskyIbizan HoundInuitIrish Red & White SetterIrish SetterIrish TerrierIrish Water SpanielIrish WolfhoundItalian GreyhoundJack Russell TerrierJapanese AkitaJapanese ChinJapanese Shiba InuJapanese SpitzKeeshondKerry Blue TerrierKing Charles SpanielKomondorKooikerhondjeKorean JindoKorthals GriffonLabradoodleLabradorLabrador RetrieverLakeland TerrierLancashire HeelerLarge MunsterlanderLemon PointerLeonbergerLhasa ApsoLibyan Desert DogLogotto RomagnoloLowchen (Little Lion Dog)Lucas TerrierLurcherMalamuteMalinoisMalteseManchester TerrierMaremmaMastiffMexican HairlessMiniature Bull TerrierMiniature DachshundMiniature PinscherMiniature PoodleMiniature SchnauzerNeapolitan MastiffNew Zealand HuntawayNewfoundlandNorfolk LabradorNorfolk TerrierNorsk LundehundNorthern InuitNorwegian BuhundNorwegian ElkhoundNorwegian LundehundNorwich TerrierNovascotia Duck Tolling RetOld English MastiffOld English SheepdogOtterhoundPapillonParson Jack Russell TerrierPatterdale TerrierPekingesePembroke CorgiPetit Basset Griffon VendeenPharaoh HoundPicardy SheepdogPinscherPit BullPointerPolish Lowland SheepdogPomeranianPoodlePortugese Water DogPortuguese PodengoPugPyrenean Mountain DogPyrenean SheepdogRed SetterRetrieverRhodesian RidgebackRottweilerRough CollieRussian Black TerrierSalukiSamoyedSchipperkeSchnauzerScottish TerrierSealyham TerrierSegugio ItalianoSetterShar-PeiSheltieShetland SheepdogShiba InuShih TzuSiberian HuskySilken WindhoundSkye TerrierSloughisSmall MunsterlanderSmooth CollieSoft Coated Wheaten TerrierSpanielSpanish Water DogSpinoneSpitz MittelSpringer SpanielSt BernardSt Johns WaterdogStaffordshire Bull TerrierStandard PoodleSussex SpanielSwedish LapphundSwedish VallhundSwiss AppenzeloisSwiss ShepardTerrierTervuerenTibetan MastiffTibetan SpanielTibetan TerrierToy Manchester TerrierToy PoodleTrailhoundUtonaganVictorian BulldogVolpino ItalianoWeimaranerWelsh Border CollieWelsh CorgiWelsh SheepdogWelsh Springer SpanielWelsh TerrierWest Highland White TerrierWheaten TerrierWhippetWirehaired DachshundWirehaired Pointing GriffonWirehaired TerrierWorking SheepdogYellow LabradorYoodleYorkshire TerrierYugoslavian SarplaniniacCat breed*AbyssinianAmerican BobtailAmerican CurlAmerican ShorthairAmerican WirehairAngoraBalineseBengalBirmanBombayBritish BlueBritish ShorthairBurmese CatCalifornia Spangled CatCaracalChartreuxChinchillaColorpoint ShorthairCornish RexCrossbreedCymricDevon RexDomestic Long HairDomestic Short HairDwelfEgyptian MauEuropean BurmeseExotic ShorthairHavana BrownHimalayanJapanese BobtailJavaneseKhao ManeeKoratLapermMaine CoonManx CatMinskinMunchkinNebelungNorwegian Forest CatOcicatOrientalOtherPersianRagdollRexRussian BlueScottish FoldSelkirk RexSiameseSiberianSiberian Forest CatSingapuraSnowshoeSomaliSphynxTiffanyTonkineseTurkish AngoraTurkish VanYork ChocolateHow long have you had this pet?Select your preferred excess option* Gold: 15% of claim, min. R500, Additional MRI/CT Scans carry an excess of R1000 Platinum: 15% of claim, min. R250, All Gastro-Intestinal related conditions excess – 15% or min. R500 per claim Silver: Flat R1000 per claim, Additional MRI/CT-Scan excess of R1000 per scan This field is hidden when viewing the formSelect your preferred excess option*PlatinumGoldSilverStandard Excess – 15%, minimum R250 per claim. Condition Specific Excess – 20% of claim min R500. 50% co-insurance is applicable to specific procedures within the first 6 monthsStandard Excess – 15%, minimum R500 per claim. Condition Specific Excess – 20% of claim min R500. Additional excess: MRI/CT Scan claims – 15% min R1000 per scan. 50% co-insurance is applicable to specific procedures within the first 6 months.Standard Excess – R1000 per claim. Additional excess: MRI/CT Scan – R1000 per scan. 50% co-insurance is applicable to specific procedures within the first 6 monthsEnable TAME add-on* Yes No Enable Lifestyle Benefit add-on* Yes No Your estimated monthly premium for ##petname## is ##premium## per month.PhoneThis field is for validation purposes and should be left unchanged. T’s & C’s apply. For more information on policy wording, click here.
