Private Motor Vehicle Quotation Please complete the form below for a quote and our friendly staff will get back to you as soon as possible. Thank you. 1. Coverage and Vehicle Details Choice of Coverage —Please choose an option—ComprehensiveThird party onlyThird party fire & theft Vehicle Number * Vehicle Make and Model * Year of Manufacturer * Engine Capacity * Hire Purchase/Loan Provider* 2. Proposer (Vehicle Registered Owner Only) Full Name (As per NRIC) * Date of Birth * NRIC Number * Licence Passing Date * Email * Contact No. * Occupation * Marital Status * —Please choose an option—SingleMarriedWidowedDivorced Full Address * Previous Insurer (Optional) NCD (Optional) —Please choose an option—0%10%20%30%40%50% Windscreen (Optional) —Please choose an option—YesNo All Driver (Optional) —Please choose an option—YesNo Special Perlis (Optional) —Please choose an option—YesNo Bettlerment (Optional) —Please choose an option—YesNo 3. Claim Experience Any claims for past 3 years ? * —Please choose an option—YesNo Suspension of Driving * —Please choose an option—YesNo 4. Additional Information Promotional Code (Optional) Attachment (Optional) (Please attach your renewal notice/log card/driving licence & etc. If more than 1 file, zip it before attaching. Max allowed file size is 10MB.) Remarks (Optional) *indicates required field. By clicking Submit, you agree to our Privacy Policy. Δ
