Join Now | Legal iQ

Join now for instant legal protection

For as little as R145 per month you get cover of R270 000 per case.

To protect those who matter most to you, simply fill out the form below.

*Subject to Legal iQ terms and conditions.

Step 1: Personal Details
Electronic debit order agreement
Name*
Surname*
ID Number*
Cell Number*
Email Address*
Address*
Street Address Address Line 2 City Province ZIP / Postal Code Country

Step 2: Family Details
Please provide your immediate family details.
Spouse / Partner
ID Number
Date of Birth
Child 1
ID Number
Date of Birth
Child 2
ID Number
Date of Birth
Child 3
ID Number
Date of Birth
Child 4
ID Number
Date of Birth
Child 5
ID Number
Date of Birth

Step 3: Bank Account Details
Please provide your bank account information.
Account Holder*
Bank Name*
Branch Code*
Account Number*
Account Type
Agreement
Contract Amount*
I/we agree that the first payment instruction will be issued and delivered on:
Start Date*
MM slash DD slash YYYY
Debit Day
I hereby request and authorise Insuresense Consultants (Pty) Ltd or its agent/s to draw against my bank account as indicated herein each month / year and to debit my account with the amount equivalent to the service and administration fee due by me to Insuresense Consultants (Pty) Ltd for membership of Insuresense Consultants (Pty) Ltd, until cancelled by me in writing. In the event of an increase of service fees, Insuresense Consultants (Pty) Ltd or its agent/s have my authority to deduct from my account all such fees in payment as indicated herein. All such debits against my account shall be treated as though I have signed and done them personally. If, in the event of payment from my bank account, such payment day falls on a Sunday or recognized South African public holiday, the payment day will automatically be the preceding or following ordinary business day. I further authorize that, if there are insufficient funds in my nominated bank account, the debit order system tracks my account and re-present the instruction for payment as soon as sufficient funds are available in my account.
- Agree
I, the undersigned hereby apply for a policy in accordance with all applicable terms and conditions. The application form is completed in my presence and signed by me. I acknowledge that payment of premiums on the due dates is my responsibility. I warrant that all information given in this application form whether in my handwriting or not is true and complete. I understand and accept the implications of this application and I accept that this application together with the applicable terms and conditions represent the agreement between myself and GENRIC Insurance Company Limted.
- Agree
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Email
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Get in touch

info@legaliq.co.za | 0861 114 171

766 Ruby Drive, Mooikloof Heights, Pretoria.

Legal iQ is a comprehensive legal expense insurance policy underwritten by GENRIC Insurance Company Limited, a registered non-life Insurer (FSP 43638), and administered by Insuresense Consultants (Pty) Ltd (FSB 47115). GENRIC and Insuresense Consultants are authorised financial services providers.

Terms and Conditions

Join now for instant legal protection

For as little as R145 per month you get cover of R270 000 per case.

To protect those who matter most to you, simply fill out the form below.

*Subject to Legal iQ terms and conditions.

Step 1: Personal Details

Step 2: Family Details

Step 3: Bank Account Details

Agreement

Get in touch

info@legaliq.co.za | 0861 114 171

Legal iQ is a comprehensive legal expense insurance policy underwritten by GENRIC Insurance Company Limited, a registered non-life Insurer (FSP 43638), and administered by Insuresense Consultants (Pty) Ltd (FSB 47115). GENRIC and Insuresense Consultants are authorised financial services providers.