Client Consent Please enable JavaScript in your browser to complete this form.I, (Required) *Identity Number, (Required) *Address, (Required) *Contact Details, (Required) *Email, (Required) *hereby authorize SANET HORAK (or assistants)- Identity Number: 691003 0042 083 To obtain information on my behalf regarding my insurance with any assurer/financial institute/insurance company, ie: • Policy information • Claims history • Current Premium computation This authorization is granted until it is revoked in writing. *ConfirmDate, (Required) *Insurer, (Required) *Policy Number, (Required) *Submit
