Product Lead Form
Who introduced you to PMD?
How can we contact you?
Please insert your personal details below.
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Important: Please note that by completing and delivering this Product Lead Form you are merely expressing an interest in one or more of the products distributed by Prime Meridian Direct (Pty) Ltd (“PMD”). The submission of this form does not mean that PMD or any of its underwriting insurers has accepted your proposal nor that you enjoy any kind of cover whatsoever. Before any policy is issued, you will be contacted telephonically by PMD and offered a full product explanation.

Only after PMD (on behalf of the insurers it represents) has performed the necessary underwriting procedures and agreed to accept your risk, will a policy schedule be issued to you and debit orders raised on the agreed dates. You will then be afforded a further 44 day “free review” period in which to peruse the product terms and conditions contained in your Starter Guide. Through the payment of premiums you will indicate your ultimate acceptance of the written policy contract.

Thank you.

You have successfully submitted this form.

One of our client service team members will be in contact with you shortly.
If you have any questions please feel free to contact us on 011 745 7810 or