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Close Cover Type

Comprehensive Cover

R599.99pm

excess of R

your cover

Pro rata amount

RXXX.XX

Once-off inception fee

RXXX.XX

Your monthly premium

RXXX.XX

Inception date

XX/XX/XXXX

Preferred Debit Order Date

By completing this information I authorise you to deliver payment instructions to your banker for collection against my account. Please note your account will be debited on the debit order date you select each month.

VIRGIN MONEY INSURANCE IS UNDERWRITTEN BY

AIG South Africa Limited is a licensed Financial Services Provider FSP No. 15805 Reg. No. 1962/003192/06

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