Changes to your Policy Should you wish to make any changes / amendments to your policy, please complete the following form that applies. Change in Banking Details Please complete and sign attached debit order form and return to us via fax or email: Fax | 086 111 6642 Email | info@mrabrokers.co.za Debit Order Form | ENG | Debit Order Form | AFR | Change your Contact Details Name and Surname (required) Email Address (required) Policy Number ID Number Cellphone Number Changes to your policy | Motor amend | add or cancellation Name and Surname (required) Email Address (required) Policy Number (required) Is this an additional Vehicle "Yes" or "No"(required) If yes... Contact details of dealership/seller (required) If no... Details of vehicle to be cancelled (required) Changes to your Policy | Changes to house owners | building | Name and Surname (required) Email Address (required) Policy Number (required) New Address Changes to your Policy | Changes to house holders | content | Name and Surname (required) Email Address (required) Policy Number (required) New details of content to be changed/added General Enquires Name and Surname (required) Email Address (required) Policy Number (required) Details of enquiry Any other Changes not mentioned Name and Surname (required) Email Address (required) Policy Number (required) Nature of change (required) Please state the make/model/serial/value of item