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Quotation Form - Private Motorcar Insurance
Hi my name is Priscilla. Thanks for completing my form.
All information obtained shall be held with the strictest confidence and used solely for the purpose of this quotation only.
If you need assistance, call or sms 98286366.
Full Name
*
NRIC Number
*
Date Of Birth
*
Gender
*
-select one-
Female
Male
Marital Status
*
-select one-
Married
Single
Occupation
*
-select one-
Indoor
Outdoor
Driving Licence Pass Date
(or years of driving experience)
*
Pass date is printed on the back of your driving licence.
Contact
(email + phone)
*
Please bear with us that forms with invalid contacts will not be processed.
Car Plate Number
*
Make / Model
*
eg: toyota/altis , nissan/teana , VW/jetta
Parallel Import
*
-select one-
No
Yes
Current Insurer
*
-select one-
Allianz
Aviva
AXA
Chartis AIG
China Taiping
EQ Insurance
Etiqa
Federal
First Capital
HSBC
India Insurance
Liberty
Lonpac
Mayban
Mitsui Sumitomo
MSIG
NTUC Income
OAC
QBE Insurance
Royal & Sun Alliance
SHC Capital
Tenet
Tokio Marine
United Overseas Insurance
Zurich
Others
Renewal Date
*
New NCD On Renewal
*
-select one-
0%
10%
20%
30%
40%
50%
Please complete, if you have claim in the past 3 years.
1-date of accident
2-amount claimed
3-own damage or 3rd party damage
4-other details(another car crashed into my car, etc.)
Please complete, if you wish to add Named Driver(s).
1-full name & nric number
2-date of birth
3-gender & marital status
4-occupation
5-years of driving experience
Please confirm that the information provided are correct, otherwise the generated quotation may not be accurate.
Your request will be processed once you click on the [send email] button below.
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