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Car Insurance Quotation Form

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Vehicle Registration Number*
Existing Car Insurance Expiry Date*
Vehicle Use*
Private Use For Own Use Only
Type Of Cover*
For vehicles under financing; you are required to pick comprehensive cover.
Off-Peak Vehicle?*
Do You Hold A Certificate Of Merit*
Vehicle Transmission*
Is Your Vehicle A Parallel Import?*
Current Insurer*
Please State Your Current Insurer*

Any Claims in the Last 3 Years?*
- Yes
- No
Please Provide Claims Details*
Your Contact Details
We Contact You Only If We Need To Verify Some Details With You.
Contact Number*
Email*
Do You Have Any Special Requests?
Number Of Named Drivers*
Named Driver 1
Full Name*
NRIC Number*
Gender*
Date Of Birth*
Marital Status*
License Clear Date*
Occupation*
Please State Your Occupation*
Nature Of Job*
Any Claims In The Last 3 Years*
- Yes
- No
Please Provide Claims Details*
Named Driver 1
Full Name*
NRIC Number*
Gender*
Date Of Birth*
Marital Status*
License Clear Date*
Occupation*
Please State Your Occupation*
Nature Of Job*
Any Claims In The Last 3 Years*
- Yes
- No
Please Provide Claims Details*
Named Driver 2
Full Name*
NRIC Number*
Gender*
Date Of Birth*
Marital Status*
License Clear Date*
Occupation*
Please State Your Occupation*
Nature Of Job*
Any Claims In The Last 3 Years*
- Yes
- No
Please Provide Claims Details*
Terms And Conditions
We value your privacy. In accordance with the Personal Data Protection Act in Singapore, by and upon submitting this contact form, you are consenting to us contacting you with regards to your enquiries or orders and subsequent follow-ups, and to also contact you after the order completion to seek your feedback on our services and to contact you for future promotions organised by us.
Required*
- I have read and agree to the terms.
Comments
This field is for validation purposes and should be left unchanged.