Insurance

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Insurance Quotation Request

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* Compulsory fields

Insured Name*

NRIC/Passport no/Fin no.*

Date of Birth (ddmmyy)

Marital Status

Single Married Divorced

Gender

Male Female

Occupation

Contact No*

Email*

Comments

Registration No.

Vehicle Model

Year of Manufacture

Year of Registration

Type of Coverage

Comprehensive Third Party, Fire & Thief Third Party Only

Engine Capacity

Accident clain for last 3 years

Yes No

If Yes to above, please give details and claims amount:

Been Entitled to any No Claim Discount(NCD)?

Yes No

Previous Insurer

Eligibility of Certificate of Merit

5% N.A.

Vehicle Type

Parallel Import Authorized Dealer