Motor Enquiry

Motor Insurance

Contact No. *
Email *
Name of Insured *
NRIC/FIN/ROC *
Date of Birth
Gender
Nationality
Marital Status
Occupation
Nature of Business
Driving Experience *

Claims Information

Claims Experience for Past 3 Years *
Date of Accident
Nature Of Claim
Claim Amount
Own Damage
Third Party Damage
Other
Vehicle Registration Number *
Type of Coverage *
Any Workshop or Authorised Workshop *
No Claim Discount (On Renewal) *
Reason for 0% NCD / How many years have you enjoyed 50% No Claim Discount
NCD Protector
Additional Named Driver
Driver Name
NRIC No
Gender
Date of Birth
Driving Experience
Occupation
Relationship
Other
Existing Insurer
Renewal Premium (incl. GST)
Vehicle Make / Model
Year of Manufacture
Registration Date
Laden Weight
Unladen Weight
Vehicle Body Type
Parallel Import
Vehicle Usage
Cubic Capacity (cc) / Tonnage
Good Driver Discount (5%) *
Period of Insurance *
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Remarks
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