Get a Quote - Cyclesure

Personal Details of Policy Holder

Please enter the policy holder information below

Title

First Name

Last Name

ID Number

Email Address

Phone Number

PPA Member

Membership Number

3 Year Claim History

Bicycle Details

Please enter the bicycle information below

Ownership Status

Was bicycle frame repaired?

Please describe the previous damage on the frame and who repaired your frame *

Make and Model

Bicycle Type

Other bicycle type

Notice: Please note downhill bicycles are unfortunately not insurable.

Year model

Older year model

Replacement Value

ZAR

Purchased Price

ZAR

Do you have more than one Bicycle?Add another Bicycle

2nd Bicycle Details

Please enter the bicycle information below

Ownership Status

Was bicycle frame repaired?

Please describe the previous damage on the frame and who repaired your frame *

Make and Model

Bicycle Type

Other bicycle type

Notice: Please note downhill bicycles are unfortunately not insurable.

Year model

Older year model

Replacement Value

ZAR

Purchased Price

ZAR

Do you have more than one Bicycle?Add another Bicycle

3rd Bicycle Details

Please enter the bicycle information below

Ownership Status

Was bicycle frame repaired?

Please describe the previous damage on the frame and who repaired your frame *

Make and Model

Bicycle Type

Other bicycle type

Notice: Please note downhill bicycles are unfortunately not insurable.

Year model

Older year model

Replacement Value

ZAR

Purchased Price

ZAR

Personal Details of Cyclist

Please enter the cyclist information

Same as Policy HolderYesNo

Title

First Name

Last Name

Date of Birth

Type of Rider

1.Joy RiderYou enjoy cycling – the exercise, socializing, pure pleasure. You occasionally participate in races. Commuting to work

2.Cycle AddictYou train like an addict. Participating in as many races as possible. You like mountain biking just as much as road cycling. You ride in all types of conditions.

3.Speed FreakActive, competitive and speed focuses. A Pro-rider. Train as much as you can and participate in most races. You and your bicycle travel often.

How do you transport your bicycle/s?

Please specify transport type

Accessories

1.Second set of wheels

Insured Value

ZAR

Please Specify Make And Model

2.Power meter (only add if not included in bicycle value)

Insured Value

ZAR

Please Specify Make And Model

3.GPS

Insured Value

ZAR

Please Specify Make And Model

4.Heart rate monitor

Insured Value

ZAR

Please Specify Make And Model

5.Helmet

Insured Value

ZAR

Please Specify Make And Model

6.Glasses

Insured Value

ZAR

Please Specify Make And Model

7.Cycling shoes

Insured Value

ZAR

Please Specify Make And Model

8.Bottle cages

Insured Value

ZAR

Please Specify Make And Model

9.Wetsuit (Triathlon)

Insured Value

ZAR

Please Specify Make And Model

10.Indoor trainer

Insured Value

ZAR

Please Specify Make And Model

11.Bicycle Carrier

Insured Value

ZAR

Please Specify Make And Model

12.Other (specify)

Insured Value

ZAR

Please Specify Make And Model

Personal Liability cover

Accidental loss or damage to third party property as well as accidental death, bodily injury or illness sustained by third party

R 1 000 000 cover automatically included

Increase cover toR 3 000 000 ( R 3.00 per month)R 5 000 000 ( R 5.00 per month)

Personal Accident Cover

For cycling related accident

Cover automatically included:

Death and Permanent Disability R 20 000
Medical expenses R 2 000
Trauma counselling cost up to R 2 000 as result of a violent act of theft, hold-up, hijacking or armed robbery
Bereavement benefit of R 10 000

Increase Cover

Extend Personal Accident cover - Optional Cover:

Personal Accident Cover (Select Optional cover)

ER24 SweatSafe

Options available:

ER24 SweatSafe (Select Optional cover)

Contact ConsentI agree for Cyclesure to process my personal information for the purpose of this quote and to be contacted by a Cyclesure representative for the purpose of processing my quote request.To proceed with this quotation request you have to accept our contact and data processing consent.