Insurance

We provide one of the most competitive insurance premiums.  Please fill up the form below and we will contact you shortly.

Details of Registered Owner

• Name *
• Email *
• Contact Number *
• NRIC/Passport Number *
• Gender *
  MaleFemale
• Date of Birth *(DDMMYYYY)
• Marital Status *
  SingleMarriedDivorcedWidowed
• License Pass Date *(DDMMYYYY)
• Any claim made in past 3 years?
  YesNo
• If Yes, please indicate the accidental date and claim amount
• No Claim Discount (Upon Renewal)0%10%20%30%40%50% (Upon Renewal)50% (Currently)
• Occupation
• Job Natural
  IndoorOutdoor

 

Details of Named Driver

Are you the driver? If Yes, ignore this section and go straight to Other Information. If No, please fill up the driver information below.

• Driver Name
• NRIC/Passport Number
• Gender
  MaleFemale
• Date of Birth (DDMMYYYY)
• Marital Status
  SingleMarriedDivorcedWidowed
• License Pass Date (DDMMYYYY)
• Any claim in the past 3 years?
  YesNo
• If Yes, please indicate the accidental date and claim amount
• Occupation
• Job Natural
  IndoorOutdoor

 

Other Information

• Vehicle No. *
• Parallel Import
  YesNo
• Insurance Type *
  ComprehensiveThird Party Fire And TheftThird Party Only
• Insurance Expiry Date
• Current Insurer
• Referral Name (if applicable)
• Additional Information

 

Verification

• Please enter any two digits with no spaces (Example: 12) *
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