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
MEDICALCLAIMS 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
NO OBLIGATION QUOTATION FORM
FOR MEDICAL SCHEME FOR GROUPS
Kindly contact us about the medical scheme promotion by Liberty Life for groups, with no obligation, on the details supplied below:
Company Name
Company Registration
Number of adults
Number of children
Address:
Street Name
Suburb
Town
Province
Gauteng
Freestate
North West
Limpopo
Mpumulanga
Eastern Cape
Northern Cape
Western Cape
Kwa Zulu Natal
Select Province
Contact Person
Contact number
Cell Number
Email Address
Current Medical Scheme Membership Number, if applicable
Broker Code
Your Requirements, such as Full Medical/Hospital Plan/etc & other Remarks
By submitting this form I hereby request a quotation for a Medical Scheme, agree that De Villiers may contact me regarding the requested quote and understand that I am under no obligation to accept the quote. I also understand that the quote may change due to factors like change in health from date of quote to date of joining the scheme.