Step 1 of 5 20% Apply for insurance cover. Apply here within the first 60 days of your purchase to get insurance for your new Apple and iStore Pre-owned products, with inSure by iStore.This insurance is only available for items purchased from an authorised network retailer. Devices can not be more than 60 days old in order to qualify for this insurance product.Your name* MrMsMrsDoctorReverendHonorableProfessor Title First Name Surname Email* Phone number*Please select either:* New device iStore Pre-Owned Date of Purchase* YYYY dash MM dash DD Please select either:* Cellular Contract Cash Purchase Device type* iPhone Apple Watch Mac iPad Other Condition*GoodBetterBestUnknownProduct*Select device typeCapacity*Select productColour*Select modelModel*Purchase Price*As your device is not on our list, one of our underwriting staff will contact you to obtain further details & finalise your application.Applying online or in-store? Online In-store Store*Select storeiStore BallitoiStore BrooklyniStore Canal WalkiStore Cape Gate iStore Cape Gate Pre-OwnediStore CavendishiStore CenturioniStore ClearwateriStore Constantia Pre-OwnediStore CrestaiStore East RandiStore EastgateiStore FourwaysiStore Garden RouteiStore GatewayiStore HighveldiStore IlangaiStore Kolonnade iStore Loch LoganiStore Mall of AfricaiStore Mall of the NorthiStore MaponyaiStore MenlyniStore MidlandsiStore PavilioniStore Queens HoteliStore Sandton CityiStore Sandton DriveiStore SomersetiStore StellenboschiStore Table BayiStore The GleniStore TygervalleyiStore Vaal MalliStore Walmer ParkiStore WaterfrontiStore WoodlandsiStore iStore Pre-Owned RosebankiStore iStore RosebankOtherPlace of Purchase*Please state where it was purchased and email your proof of purchase to underwriting@istoreinsure.co.za. This is a mandatory part of the application process if your device was not purchased from iStore.Sales Consultant IDPolicy wording is available for download here: Policy wording (PDF) Bank Details & Debit AuthorityIMEI Number*To obtain your IMEI, dial *#06# on your device's keypadIMEI Not Available or device is GPS-only (please select this if IMEI does not apply to this device) IMEI is not yet available IMEI Not Available or device is GPS-only (please select this if IMEI does not apply to this device or ONLY a serial number is applicable)Serial Number*For non-cellular devices please fill in the device serial numbers.Postal Address* Street Address Street Address Line 2 City Province Postal Code Type of identification* South African ID number Passport Number ID Number*Passport numberPlease supply passport number if you do not have a RSA ID NumberBank*ABSA BANKCAPITEC BANKFIRST NATIONAL BANKNEDBANK LIMITEDSTANDARD BANKAFRICAN BANKALBARAKA BANKBNP PARIBASBANK ZEROBIDVEST BANKCITIBANKDISCOVERY BANKFINBOND MUTUAL BANKFINBOND EPEGROBANK LTDGRINDRODBANKHBZ BANKHSBC BANKHABIB OVERSEAS BANKINVESTEC BANKITHALAJP MORGAN CHASEMERCANTILE BANKRAND MERCHANT BANKOLYMPUS MOBILEPEOPLES BANK LTD INC NBSPOSTBANKS.A. RESERVE BANKSASFIN BANKSOCIETE GENERALSTANDARD CHARTERED BANKSTATE BANK OF INDIATYMEBANKUBANK LIMITEDUNIBANKVBS MUTUAL BANKBranch Code*Account Type*SavingsCurrentChequeBank Account Holder's Name*Account Number*Debit Date*1st15th25th27th Your monthly premium amount is: I authorise Old Mutual Alternative Risk Transfer Insure Limited to draw against the above account, the amount necessary for payment of the monthly premium every month until this arrangement is cancelled in writing by either party. I accept that if the debit date falls on a weekend or public holiday, we will be debited on the following working day. I am the authorised signatory on the above banking account and am authorised to apply for insurance on behalf of the company. I declare that I have applied for insurance cover on our mobile devices. I am aware of the first amount payable in the event of a claim. I am aware of the premium payable and that the premium will be deducted in the cover month via monthly debit order by Old Mutual Alternative Risk Transfer Insure Limited. I understand that failure to pay the monthly premium will result in cover lapsing. I confirm that I am in possession of the mobile devices stated in the schedule. I understand that this declaration forms part of the policy of insurance. YOUR MONTHLY BANK DEBIT ORDER REFERENCE WILL CONTAIN 'ISTOREMFRF' Document UploadDefer documents upload I'll upload these required documents later * Please note, if you have opted to upload your documents later, you will not be on cover until we have received these required documents.Proof of identity (ID, drivers license, or passport)*Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 1 GB.Proof of purchase (invoice)*Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 1 GB.Proof of bank account*Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 1 GB.NB : Please ensure banking details completed above matches the correspondence attached. Accept T&CsClient Signature*Agreement* I have read and understood the policy wording and disclosure document accompanying this policy.We confirm your device is covered. One of our consultants will be in contact with you within 72 hours (Monday-Friday) to confirm the cover and will forward your policy documents to you. Just a few Terms and Conditions that you need to be aware of: I declare that I have applied for insurance cover on my mobile device(s). This insurance is only available for items purchased from an authorised network retailer and my device is currently free from damage and in my possession. Insurance Regulations require that we have on file a copy of your ID document and a copy of your proof of purchase. If we do not have this, you agree to provide it to us upon request. All premiums must be successfully collected into Insurers bank account in order that your policy remains valid and that a claim can be entertained. I am aware of the first amount payable in the event of a claim and that any claim submitted within the first sixty days (60) of cover, is subject to an additional excess of 10% of the claim. Any failure to disclose material fact or any false disclosure could result in us not accepting your risk and/or Insurers voiding your Policy. I understand that this declaration forms part of the policy of insurance. Administration Plus (Pty) Ltd does not and will not sell or provide personal information to third parties for independent use. We may, however, share personal information with our business partners if that information is required to provide the product, or service you have requested and where relevant recruitment purposes. However, our business partners will adhere to using your information only as directed by Administration Plus (Pty) Ltd. YOUR MONTHLY BANK DEBIT ORDER REFERENCE WILL CONTAIN ISTOREMFRF.Keep me informed about other iStore products and services* Yes No thanks Almost doneThank you for taking the time to fill in this application. If you've elected to take up cover and completed your application in full, once you hit 'Submit' below, we'll be in touch to finalise & confirm your policy has been accepted or rejected. We will send you further correspondence related to your insurance cover within 72 hours (Monday - Friday)This field is hidden when viewing the formClient referenceThis field is hidden when viewing the formItem referenceThis field is hidden when viewing the formPolicy referencePhoneThis field is for validation purposes and should be left unchanged.
