Request for Quote

01. Type of Coverage

02. If register under company name

Company Name
ROC No.
Type of Business

03. Vehicle Details

Vehicle No.
Make & Model
Year of Reg.
Year of Mfg.
Max Laden weight(kg)
Unladen Weight(kg)
Vehicle Usage

Body Type
No Claim Discount (NCD)

04. Any accident / claim in past 3 years? If yes please declare

Date of accident
Driver Name
Claim amount (incurred)

05. Contact Details

Contact Number
Email

01. Type of Coverage

02. Applicant Details

Full Name
NRIC
Gender
D.O.B
Nationality
Marital Status
Occupation
Driving Licence Passed Date

03. Vehicle Details

Vehicle No.
Make & Model
Capacity (cc)
Year of Reg.
Year of Mfg.
No Claim Discount (NCD)
Include NCD Protector
Current Insurer

04. Any Named Drivers? If yes, pls provide

Full Name
NRIC
Gender
D.O.B
Nationality
Marital Status
Occupation
Driving Licence Pass Date

05. Any accident / claim in past 3 years? If yes please declare

Date of accident
Driver Name
Claim amount (incurred)

06. Contact Details

Contact Number
Email