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Tell us about your incident - we care, we see you and we are here to help!

Name

First Name

Last Name

ID Number

Please provide your South African Identification Number

Your Employer

Who are you currently providing Rider delivery services for?

Do you rent or own your bike?

Please choose from the drop-down list below:

Monthly Bike Repayments

What are your monthly bike repayments?

Rider Insurance

Do you have third party insurance, for accident damage / hospital cover?

Your Incident

Please answer the following questions to help us better understand the circumstances of your incident

When Did the Incident Occur?

Where did the Incident Occur?

What happened?

Please explain the events of and leading up to your incident

What happened after the Incident occurred?

Please answer the questions below about what happened after the incident occurred

Did you report the Incident to the Police?

Did you report the incident, and if so have you received help?

Has your company assisted you?

If yes, please tell us how your employer has aided you after the incident

How much would you be willing to pay for insurance?

Would you subscribe to a system wherein you would receive rewards?

Would you subscribe to a Delivery Rider Platform where you can receive discounts on Fuel, Pick n Pay / Checkers Vouchers, Health Insurance, Bike Maintenance, Protective Clothing and Funeral Cover?

If yes, how much would you be willing to pay in subscription fees?

Have you had any formal training?

Would you like to improve your riding skills and why?