Step 1 of 5 20% Apply for insurance coverThis 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.Date of Purchase* YYYY dash MM dash DD Please select either:* New device As new iStore Pre-Owned Your name* MrMsMrsDoctorReverendHonorableProfessor Title First Name Surname Applying on behalf of another individual I'm applying on behalf of another individual Insured name* MrMsMrsDoctorReverendHonorableProfessor Title First Name Surname Email* Phone number*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 Company Registration number ID Number*Passport number*Please supply passport number if you do not have a RSA ID NumberCompany Registration number*VAT 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: YOUR MONTHLY BANK DEBIT ORDER REFERENCE WILL INCLUDE YOUR POLICY NUMBER AND ISTOREINS. The premium amount may vary due to annual increases, costs incurred where debit orders are returned unpaid, or other additional amounts due on an ad hoc basis, allowed or specified in the insurance contract (referred to as "the Agreement"). I acknowledge that a pro-rata premium may be debited based on or within 48(forty-eight) hours from the inception date of coverage, and this amount will be confirmed via an SMS sent to the mobile number provided in my application. 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 the agreement 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 authorised to apply for insurance on behalf of the company. I declare that I have applied for device insurance cover. 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 device/s stated in the schedule. I acknowledge that cancelling this payment authorisation does not constitute the cancellation of the agreement unless explicitly stated otherwise in the agreement. I acknowledge and consent that this authority may be ceded or assigned to a third party if the agreement is also ceded or assigned to that third party and I am notified accordingly. I understand that this declaration forms part of the policy of insurance. 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 referenceEmailThis field is for validation purposes and should be left unchanged.
