RapidCare | Road Accident Assistance

RapidCare Application

Complete the application yourself or continue with assistance from an InsureEasy representative.

Choose Application Method

How would you like to complete this application?

Self-Service I am registering myself and will complete the RapidCare application directly.

Agent-Assisted An InsureEasy representative is helping me complete this application.

Agent-Assisted Application

Verify the representative

Enter the cellphone number registered on the assisting representative's InsureEasy profile.

RapidCare

Member details

Capture the details of the person who will be registered for RapidCare.

First Name *

Surname *

Identity Type *

Identity / Passport Number *

Upload Copy of ID *

Upload a clear PDF, JPG or PNG copy of the member's South African ID.

Cellphone *

Email Address *

Physical Address *

Province *

Postal Code *

RapidCare

Plan & payment

Select the RapidCare membership option and how the first monthly payment will be made.

RapidCare provides road-accident assistance and facilitation services through Accisure.

Important information

RapidCare is an assistance and facilitation service for qualifying road-accident incidents and is not medical insurance.

Access to private medical treatment is subject to the circumstances of the accident, applicable Road Accident Fund requirements and the terms of the relevant service providers.

Certain incidents may be excluded, including accidents outside South Africa, criminal activity and circumstances where the member's liability may prevent qualification.

Choose your RapidCare plan *

Main R49 / month Main member only

Main + 1 R79 / month Main member plus one additional covered member

Family R119 / month Main member plus up to five additional covered members

Driver R149 / month Main driver plus up to five additional covered members

YOUR MONTHLY PREMIUM

Based on the selected RapidCare plan

R 49,00

Who will pay the premium?

Choose the person responsible for the monthly payment.

Premium payer

Payment Method

Choose when you would like to make the first payment.

Pay Online Now Continue to PaymentEasy for secure online payment after submitting the application.

Pay Online Later Submit now and request a payment reminder for a date you choose. No payment is taken now.

RapidCare

Covered members

Add the people who will be covered under this RapidCare membership. They do not have to be related to the main member.

Selected Plan

Plan -

Main Member -

Number of Additional Covered Members *

Additional members do not need to be related to the main member.

RapidCare

Review and submit

Application

Reference

Sales Channel / Representative

RapidCare Membership

Member

Plan

Monthly Premium

Covered Members

Premium Payer

Payment Method

I confirm that the information provided is true and correct.

I understand that RapidCare is an assistance and facilitation service for qualifying road-accident incidents and is not medical insurance.

I understand that access to private medical treatment is subject to the circumstances of the accident, applicable Road Accident Fund requirements and the terms of the relevant service providers.

I understand that certain incidents are excluded, including accidents outside South Africa, criminal activity and circumstances where the member's liability may prevent qualification.

I consent to my personal, accident and medical information being used and shared where reasonably required to administer the RapidCare service.

I confirm that the applicable RapidCare terms and conditions have been explained to me and that I accept them.

Member Signature *

The RapidCare member must sign below to confirm the application, declarations and acceptance of the applicable service terms.

Signature required before submission.

InsureEasy Brokers

Phone Number

Contact Address

Email Address

RapidCare Application

How would you like to complete this application?

Verify the representative

Member details

Plan & payment

Important information

Who will pay the premium?

Payment Method

Covered members

Review and submit

Application

RapidCare Membership