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Motor Insurance
Motor Warranty
Insured Name:
NRIC / UEN No.:
Date of Birth.:
Nationality:
Select
S'porean
Malaysian
PR
Marital Status:
Select
Single
Married
Widowed
Separated
Divorced
Gender:
Select
Male
Female
Address:
Contact No.:
Email:
License Pass Date:
Select
BELOW 2 YEARS
2-5 YEARS
5-10 YEARS
10-20 YEARS
ABOVE 20 YEARS
Occupation:
No Claim Discount:
Select
10%
20%
30%
40%
50%
NCD under which Vehicle No.:
Current Policy Expiry Date:
Type of Policy:
Comprehensive
Third Party Fire & Theft
Third Party only
Usage of Vehicle:
Private
Private Hire (PHV)
Vehicle No.:
NCD Protector:
Yes
No
Any claims in past 3 years?
Yes
No
Claim Amount
(if Any):
Named Drivers (If any: other than insured)
Named Driver 1
(if Any):
NRIC No.
(if Any):
Date of Birth
(if Any):
Gender:
Select
Male
Female
License Pass Date
(if Any):
Select
BELOW 2 YEARS
2-5 YEARS
5-10 YEARS
10-20 YEARS
ABOVE 20 YEARS
Occupation:
Relationship to
Insured (If Any):
Select
Spouse
Parent
Fiancé
Son
Daughter
Friends
Employee
Named Driver 2
(if Any):
NRIC No.
(if Any):
Date of Birth
(if Any):
Gender:
Select
Male
Female
License Pass Date
(if Any):
Select
BELOW 2 YEARS
2-5 YEARS
5-10 YEARS
10-20 YEARS
ABOVE 20 YEARS
Occupation:
Relationship to
Insured (If Any):
Select
Spouse
Parent
Fiancé
Son
Daughter
Friends
Employee
Submit
Name:
NRIC / UEN No.:
Phone No.:
Email:
Vehicle No.:
New/Pre-Owned:
New
Preowned
Car Make:
Car Model:
Duration of Use:
Select
3 Years
5 Years
Select
6 Months
1 Year
2 Years
3 Years
Servicing at preferential rates:
Select
1
2
3
4
5
6
7
8
9
10
Submit
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