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About
Auto Leasing
Lease to Own
PHV Scheme
Auto Financing
- COE Renewal
- New car loan
- Used Car Loan
- Trade Fair Scheme
Insurance
Services
Career
Contact
Insurance
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Insurance
Details of Registered Owner
Name
*
Email
*
Contact Number
*
NRIC/Passport Number
This field will allow us to add in NCD discount that you entitle.
Gender
*
Male
Female
Date of Birth
*
(DDMMYYYY)
Material Status
*
Single
Married
Divorced
Widowed
License Pass date
*
(DDMMYYYY)
Any claim made in past 3 years?
Yes
No
If Yes, please indicate the accidental date and claim amount
No Claim Discount
0%
10%
20%
30%
40%
50% (Upon renewal)
50% (Curernt)
Occupation
Job Natural
Indoor
Outdoor
Details of Named Driver
Are you the driver? If Yes, ignore this section and go straight to Other information. If No, please fill up the driver information below.
Driver Name
NRIC/Passport Number
Gender
Male
Female
Date of Birth
(DDMMYYYY)
Material Status
Single
Married
Divorced
Widowed
License Pass Date
Any claim in past 3 years?
Yes
No
If Yes, indicate the accidental date and claim amount
Occupation
Job Natural
Indoor
Outdoor
Other Information
Vehicle Number
*
Parallel Import
Yes
No
Insurance Type
*
Comprehensive
Third Party Fire And Theft
Third Party Only
Insurance Expiry Date
Current Insurer
Referral Name (if applicable)
Additional Information
Verification
Please enter any two digits
*
Example: 12
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please leave it blank
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