CONTACT DETAILS
 
PHYSICAL ADDRESS
28 Du Plessisstraat
Schweizer-Reneke
2780
 
CONTACT NUMBERS
053-963-2845
053-963-2846
 
FAX NUMBER
053-963-2860
 
BROKERS: INSURANCE/INVESTMENTS
Jan de Villiers
Contact Number
082-524-8733
devilliersmakelaars@telkomsa.net
BROKERS:MEDICAL SCHEMES/FUNERAL PLANS
Marinda de Villiers
Contact number
082-524-8744
marindadevilliers@telkomsa.net
 
MEDICAL CLAIMS DEPARTMENT
Contact Person
Anne Koorts
Contact Number
053-963-2845
devilliersmakelaars@telkomsa.net
 
CUSTOMER SUPPORT
Contact Person
Marinda de Villiers
Contact Number
082-524-8744
devilliersmakelaars@telkomsa.net
 
APPOINTMENT OF BROKER
 
PERMISSION TO OBTAIN PERSONAL INFORMATION
 
 
I hereby authorize you to provide full information of my policies with you to De Villiers Makelaars (De Villiers & Hoffman Makelaars bk h/a ck99/66082/23) and appoint them as my broker.
 
   
Full Name & Surname
   
Identification Number
   
Date of Birth
   
Address:
   
Street Name
   
Suburb
   
Town
   
Province
   
Contact Number (work)
   
Contact number (home)
   
Cell Number
   
Email Address
   
Companies & Policy Numbers
   
Additional Information or Remarks