"*" indicates required fields Get Your Quote in 30 Seconds! Thank you for your interest in Cinagi Gap Cover. Please fill in the details below to get your monthly premium. Then complete our quick and easy 4-minute online application form and have your cover in place in under 15 minutes. As easy as that! Sharing of Personal Information Declaration By providing the information in this form you agree that Cinagi (Pty) Ltd and its underwriter, Infiniti Insurance Ltd may : use this information to provide you with administrative and insurance services. disclose this information to persons and entities that it is necessary to disclose this information to in order to provide you with the aforementioned services. have the right to communicate with you electronically about any changes or general information relating administrative processes or changes to the Cinagi policy benefits and premiums. only transfer your personal information outside South Africa if you have provided an email address that is hosted outside South Africa or to administer certain services, for example, cloud services and/or the Medical Second Opinion service. You further agree that: if submitting your dependents’ relevant personal information, you hereby confirm that you are duly authorised to share such information with us. We will furthermore process their information for the purposes and in the manner as set out in our Privacy Statement if you are giving consent for a person under the age of 18 years (a minor), you confirm that you are a competent person and that you have authority to give their consent on their behalf. You also acknowledge that that you have read and agreed to the Cinagi Privacy Statement and the contents thereof. Consent* I agree to above declaration as it relates to my personal informationThis field is hidden when viewing the formQuote Type How would you like to complete your quote ?* Online Please give me a call Personal Details* First Name Surname Contact Number*Age of Oldest Person Joining*Please enter a number less than or equal to 110.Medical Scheme*Please select your Medical SchemeAlliance-MidmedPolmedRemedi HealthSAB Medical AidTBCThebemedUKZN Medical SchemeUMVUZOWitbank Coalfields Medical AidDiscoveryMomentumCAMAFProfmed (PPS)FedhealthMedihelpBonitasBankMedBestMedCape Medical PlanCompCareGEMSGenesisHealth SquaredHosmedKeyHealthLA-HealthMakotiMedshieldMotohealth CareOtherSizweSuremedTransmedMedical Scheme Option*Please select your planAlliance-MidmedAquariumMarineAllTBCtbctbcStandard PlanUltra AffordableUltra Affordable ValueStandardActivatorSupremeExtremetbcClassic ComprehensiveClassic Delta SaverClassic PriorityClassic SaverClassic SmartCoastal CoreCoastal SaverEssential CoreEssential Delta CoreEssential Delta SaverEssential SmartKeyCare PlusEssential PriorityExecutiveClassic Delta ComprehensiveEssential ComprehensiveEssential Delta ComprehensiveClassic CoreClassic Delta CoreEssential SaverKeyCare StartKeyCare CoreClassic Smart Comprehensive tbcEssential Dynamic SmartActive SmartSummitIncentiveExtenderCustomIngweEvolveAllianceDouble PlusEssential PlusFirst ChoiceNetwork ChoiceVitalEssential NetworkProActiveProActive PlusProPinnacleProSecure PlusProSecuremaxima Plusmaxima ExecmyFEDflexiFED 1flexiFED 2flexiFED 3flexiFED 4FlexiFED SavvyPrime 1Prime 2Prime 3NecesseUnifyPlusEliteMedElectMedSaverMedAddMedVitalBonEssentialBoncapBonClassicStandardBonSaveBonCompletePrimaryPrimary SelectStandard SelectBonComprehensiveBonEssential SelectBonFitHospital StandardBonStartBonstart PlusEssential PlanBasic PlanCore Saver PlanTraditional PlanComprehensive PlanPlus PlanPace 3Beat 2Pace 1Beat 1Beat 3Beat 4Pace 2Pace 4Pulse 1Pulse 2Rhythm1Rhythm2HealthPact PremiumHealthPact SilverHealthPact SelectPinnacleDynamixSymmetryMumedUnisaveSelfsureMedXTanzanite OneBerylRubyEmeraldOnyxEmerald Value (EVO)PrivatePrivate ChoicePrivate PlusPrivate ComprehensiveMed-100Med-200Med-200 PlusCobaltUltimateMillenniumOptimumAdvanceFlex PlusFlexAspireRiseFoundationEssentialPlusValue CoreAccessValueEquilibriumEssenceGoldSilverOriginPlatinumLA ActiveLA CoreLA KeyPlusLA FocusLA ComprehensivePrimaryComprehensiveMediValueMediSaverMedicoreMediBonusPremium PlusMediPlusMediPhilaOptimumClassicEssentialHospicareCustomOtherTitaniumPlatinumGoldSilverCopperAccessValueNavigatorChallengerShuttleExplorerState Plus NetworkGuardianPrivate NetworkState Plus Free ChoiceSelect PlanPlease make sure you provide us with your correct medical scheme option as this will determine your monthly premium. Spouse* Yes No No. of children (< 24 years)*Please enter a number less than or equal to 10. No. of children (24+ years)*Please enter a number less than or equal to 10.Would you like a copy of your Cinagi Gap Cover Quote ?* Yes No Please provide your email address Enter Email Confirm Email Δ