Apply Online
Use our handy online application form for the quickest, easiest way to get Gapwise cover. First though, let's look at some important housekeeping notes:
What You Need to Have Ready
To avoid a stop-start process with the online application form, please be sure to have the following information on hand:
Cover Detail
- Option selection (Comprehensive or Ultra);
- Desired cover start date (this month, next month or the month after);
Principal Insured and Dependants
- RSA ID or passport number;
- Date of birth, if passport no. is used;
- Title (Principal only), first name & surname;
- Relationship of Dependant to Principal;
- Email address and cell number (Principal only);
- Physical and postal address (Principal only);
- Medical aid name and number (in the case of Dependant, only if different to that of Principal);
- If currently on gap cover, name of the provider and from & to dates (in the case of Dependant, only if different to that of Principal);
- Whether diagnosed, medical advice, care or treatment received for any condition in the past 12 months, and, if Yes:
- whether admitted to hospital in the last 4 months (provide details);
- whether expecting a hospital admission or aware of any conditions or Illness that would require treatment in the next 12 months (provide details with date);
- whether admitted to hospital in the last 4 months (provide details).
- whether currently pregnant (provide due date);
- whether currently taking or taken chronic medication in the past 24 months (provide details).
Beneficiary (for Accidental Death Benefit)
- First name & surname;
- RSA ID or passport number;
- Email address and cell number;
- Relationship to Principal.
Payment Details
- Personal details of Payer;
- Bank account details.
