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Getting Cover
> Gap Cover
Gap Cover
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Contact Number
*
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*
I am a member of a medical aid
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Yes
No
Unfortunately, you have to be a member of a South African medical aid to qualify for our Gap Cover product. If you are interested in medical aid, simply email
healthmax@zestlife.co.za
.
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Dental Cover
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I am a member of a medical aid
*
Yes
No
Comments
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> Cancer Cover
Cancer Cover
Name & Surname
*
Contact Number
*
E-mail Address
*
I am a member of a medical aid
*
Yes
No
Unfortunately, you have to be a member of a South African medical aid to qualify for our Cancer Cover product. If you are interested in medical aid, simply email
healthmax@zestlife.co.za
.
Phone
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Assetlife
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Medical Aid
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Other
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Cover required:
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Medical Premium Waiver
Road Accident Cover
Group Life Policy
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General Queries and Complaints
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Admin / Claims
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Policy or Claim Number (if applicable)
Query / Complaint
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Name
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Zestlife Health Products Referral
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Zestlife Health Products Referral
View the status of your leads submitted
"
*
" indicates required fields
Please confirm the following:
*
The client consented to the transfer of his/her personal information to Zestlife and requested to be contacted regarding Zestlife Health Products.
Client name
*
Contact number:
*
Email address
*
Additional comments
Broker Name
*
Broker Cellphone Number
*
Broker's SA ID number
*
Does client have Medical Aid?
*
Yes
No
Products
Gap Cover
Dental Cover
Medical Aid Broker Services
Products
New Medical Aid Services
Dental Cover
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