Tyrelife Insure Application FormPRODUCT TYPEStep 1: Choose Your CoverWhat would you like to cover? Tyre Cover Tyre + Rim CoverPLAN SELECTIONStep 2: Choose Your Plan R3,000 — R110/month (Stand Alone) R5,000 — R170/month (Stand Alone) R7,500 — R250/month (Stand Alone) R10,000 — R400/month (Stand Alone) R15,000 — R550/month (Stand Alone) R20,000 — R690/month (Stand Alone) R3,000 — R80/month (Excess Waiver) R5,000 — R140/month (Excess Waiver) R7,500 — R220/month (Excess Waiver) R10,000 — R370/month (Excess Waiver) R15,000 — R520/month (Excess Waiver) R20,000 — R660/month (Stand Alone) R10,000 — R255/month (Stand Alone) R20,000 — R400/month (Stand Alone) R30,000 — R500/month (Stand Alone) R40,000 — R620/month (Stand Alone) R50,000 — R780/month (Stand Alone) R10,000 — R195/month (Excess Waiver) R20,000 — R350/month (Excess Waiver) R30,000 — R450/month (Excess Waiver) R40,000 — R570/month (Excess Waiver) R50,000 — R730/month (Excess Waiver)PERSONAL DETAILSStep 3: Your DetailsFirst NameLast NameEmailID NumberAddressAddress Line 1Address Line 2CityProvincePostal CodeBANK DETAILSStep 5: Payment DetailsAccount NameBank NameBranch CodeAccount NumberAccount TypeCONFIRMATIONFinal Step I confirm that the information provided is correct I accept the terms and conditionsGet Covered Now
