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Motor Insurance
Motor Warranty
Name
NRIC / UEN No.:
Date of Birth.:
Gender
Select
Male
Female
Phone No.:
Email:
Address:
Marital Status
Select
Single
Married
Widowed
Separated
Divorced
Occupation:
License Pass Date:
Select
BELOW 2 YEARS
2-5 YEARS
5-10 YEARS
10-20 YEARS
ABOVE 20 YEARS
Vehicle No.:
Type of Coverage:
Select
Comprehensive
Third Party Fire and Theft
Third Party Only
NCD Level:
Select
10%
20%
30%
40%
50%
NCD Protector:
Yes
No
Sunroof Cover:
Yes
No
Any claims in past 3 years?
Yes
No
Claim Amount
(if Any):
Named Driver 1
(if Any):
NRIC No.
(if Any):
Date of Birth
(if Any):
License Pass Date
(if Any):
Select
BELOW 2 YEARS
2-5 YEARS
5-10 YEARS
10-20 YEARS
ABOVE 20 YEARS
Named Driver 2
(if Any):
NRIC No.
(if Any):
Date of Birth
(if Any):
License Pass Date
(if Any):
Select
BELOW 2 YEARS
2-5 YEARS
5-10 YEARS
10-20 YEARS
ABOVE 20 YEARS
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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