Bicycle Insurance - Insurance for cyclists arranged by cyclists

Quotation Form

Please Note: Downhill Bicycles Not Insurable

Fields marked with a * are mandatory

Cyclist Name:*
ID No:
E-mail Address:
Are you a Professional Cyclist?
Cellular No:	-
Tel No:*	-
Fax No:	-
Replacement Value of Bike:*	R
Type of Bicycle (e.g. Road):*
Value of Accesories:	R
Value of 2nd set of wheels:	R
	Accessory Breakdown
Accessory Name:

How would you like us to contact you with your quote?

Can we contact you to quote on the rest of your short term insurance portfolio?

Yes No

* I hereby declare that the information in this application and statement of values is, to the best of my knowledge and belief, true and accurate in every respect and that no fact, circumstance or hazard that could effect the acceptance of my application has been withheld. I confirm that this application and declaration shall be the basis if the contract between Zurich Insurance and myself.

Please ensure your details are entered correctly to facilitate a speedy response.