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 * Private Hire Use? YESNONot Sure 2. Proposer (Vehicle Registered Owner Only) Full Name (As per NRIC) * Date of Birth * NRIC Number * Licence Passing Date * Email * Contact No. * Previous Insurer (Optional) NCD (Optional) 0%10%20%30%40%50% 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 AGI Agent * —Please choose an option—Wern YieJoeyJiahuiVickyDavid KangAshleyOthers 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
