Contact Us

Get In Touch With Us!

At GovRisk, we pride ourselves on offering simple, reliable insurance solutions backed by responsive, client-focused service. Reach out to us using any of the methods below, and a friendly member of our team will get back to you as soon as possible.

Tel

087 701 4931

Email Address

insure@govrisk.co.za

069 911 0744

Postal Address

P O Box 31756, Superbia, 0759

Pretoria Branch

42 Tigris Avenue, Pretoria, 0022

Polokwane Branch

Library Gardens, 1st Floor, 63 Hans Van Rensburg Street, Polokwane, 0699

Full Name

Email Address *

Phone Number

Company Name

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Our Insurance Forms

To help you access the services you need quickly and efficiently, we’ve provided a selection of easy-to-use forms below. Whether you’re requesting a quote, reporting a claim, or applying for insurance, each form is designed to guide you through the process with ease.

Change request

Full Name

ID Number

Email Address *

Phone Number

Address

insurer

Policy Number

Details to be updated

Add or delete item

Item Description

Amount

Date from when the change is required

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Car & Home quote request

Prefix

First Name

Last Name

ID Number

Email Address *

Phone Number

Address

Marital Status

Insured *

Name of current insurer

Accidents or claims in the last 3 years *

Claim Details

Type of Claim

Claim Date

Claim Amount

Home

Building *

Construction of Walls

Construction of Roof

Building Value (amount)

Outbuilding Type

Outbuilding Construction of Walls

Outbuilding Construction of Roof

Contents *

Contents Value (amount)

Burglar bars in front of all opening windows ?

Security gates in front of all outside leading doors ?

Alarm system linked to armed response

All Risks

Clothing & Personal Items (amount)

Specified All Risks

Item 1:

Item 2:

Item 3:

Item 4:

I consent to an ITC check and to sharing my information with insurers/underwriters/service providers to source quotes.

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Report a Claim

Company Name

Prefix

First Name

Last Name

Phone

Address

Email Address

Name of Insurer

Policy / Client number

Date & time of claim

Place where claim occurred

Type of Claim

Item Description

Item Registration Number

SAPS / Traffic Ref number

Description of claim

Where is item?

3rd party Information

Additional Information

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Business Quote Request

Prefix

First Name

Last Name

ID Number

Email Address *

Phone Number

Address

Business Name

Type of business

Company Registration Number

Municipality

Insured

Name of current insurer

Do you provide consent for ITC check

Do you provide consent for your Personal Information to be shared with Insurers/Underwriters/Service Providers

Accidents or claims in the last 3 years

Claim 1

Claim 2

Claim 3

Claim 4

HTML

Buildings

Building Value (amount)

Construction of Walls

Construction of Roof

HTML

Fire Section

Contents Value

Machinery & Equipment Value

Stock & Materials in Trade Value

Miscellaneous Value

Goods in the open value

HTML

Office Contents

Contents Value

Documents Value

HTML

All Risks

Tools & Equipment Value

Cellphones, Tablets, iPads

Laptops

Other All risks

HTML

Theft

Theft Limit Required

Burglar Bars in front of all opening windows

Burglar Bars in front of all opening doors

Alarm System linked to Armed Response

HTML

Money

Money Limit Required

Seasonal Increase Limit Required

Value of Receptacle’s, Safes, etc

HTML

Liability

Liability Limit Required

Employers Liability Limit Required

HTML

Electronic Equipment

Computers Value

Printers & Scanners Value

Other Electronic Equipment Value

HTML

Vehicle 1

Year

Make & Model

Number of Seats

Registration

Value (amount)

Extras (amount)

Use

Tracking Device

Loss of Use Cover Required?

Finance

HTML

Vehicle 2

Year

Make & Model

Number of Seats

Registration

Value (amount)

Extras (amount)

Use

Tracking Device

Loss of Use Cover Required?

Finance

Completed By

Any other details to assist us make informed decision?

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Transporter Quote Request

Full Name

Email Address *

Phone Number

Company Name

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Request Forms

Full Name

Email Address *

Phone Number

Company Name

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Motor only Quote Request

Prefix

First Name

Last Name

ID Number

Email Address *

Phone Number

Address

Business Name

Type of business

Company Registration Number

Type of Transport Provided

Type of Goods Transported

Area of Operation

Cross Border Transport

Name of Countries other than RSA

Insured

Name of current insurer

Do you provide consent for ITC check

Do you provide consent for your Personal Information to be shared with Insurers/Underwriters/Service Providers

Accidents or claims in the last 3 years

Are Vehicles Fitted with Fleet Management systems ?

HTML

Vehicle 1

Year

Make & Model

Number of Seats

Registration

Value (amount)

Extras (amount)

Use

Tracking Device

Loss of Use Cover Required?

Finance

HTML

Vehicle 2

Year

Make & Model

Number of Seats

Registration

Value (amount)

Extras (amount)

Use

Tracking Device

Loss of Use Cover Required?

Finance

Completed By

Any other details to assist us make informed decision?

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Motor Only – Lead Form

Prefix

First Name *

Last Name *

ID Number

Email Address *

Phone Number

Address

Marital Status

Drivers Licence code

Drivers Licence date of issue

Insured *

Name of current insurer

Accidents or claims in the last 3 years *

Claim Information

Vehicle Year

Vehicle Make & Model

Vehicle Type

Value (amount)

Who is the Regular driver of your vehicle?

Use

Tracking Device *

Tracking Provider

“I consent to an ITC check and to sharing my information with service providers to source quotes (required for a quotation).

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Insurance Application

Title

First Name

Last Name

Email Address *

Phone Number

ID Number *0 / 13

Countries Visiting

Departure Date

Return Date

Number of Travelers

Reason for Travel0 / 180

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Contact Us

Get In Touch With Us!

Tel

Email Address

Whatsapp

Postal Address

Pretoria Branch

Polokwane Branch

Our Insurance Forms

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Twitter

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