Motor Insurance Contact Number * Email * Name of Insured * NRIC / FIN * Date of Birth * Gender * Male Female Nationality * Singaporean Singaporean PR Others Marital Status * Single Married Divorced Widowed Occupation * Nature of Business Indoor Outdoor Driving Experience * less than 1 1 2 3 4 5 6 7 8 9 10 more than 10 No License Claims Information Claims Experience for Past 3 Years * Yes No Date of Accident Nature of Claim Claim Amount Own Damage Third Party Damage Other Vehicle Registration Number * Type of Coverage * Comprehensive TPFT TPO Any Workshop or Authorised Workshop * Any Workshop Authorised Workshop No Claim Discount (On Renewal) * 0 10% 20% 30% 40% 50% How many years have you enjoyed 50% No Claim Discount? This is the first year 1 - 2 years 4 - 5 years More than 5 years Reason NCD Protector Yes No Additional Named Driver Yes No Additional Named Driver Name * NRIC / FIN * Gender * Male Female Date of Birth * Occupation * Driving Experience * less than 1 1 2 3 4 5 6 7 8 9 10 more than 10 No license Existing Insurer Renewal Premium Inclusive GST Vehicle Make / Model Year Of Manufacture Registration Date Vehicle Body Type CRV Coupe High Performance SUV Saloon Station Wagon MPV Others Parallel Import Yes No Vehicle Usage Private Use Private and Business Use Private Hire Private Use (Off Peak Car) Private and Business Use (Off Peak Car) Cubic Capacity (cc) Period Of Insurance From * To * Good Driver Discount (5%) * Yes No Remark Terms and Conditions * I have read and agree to the Terms and Conditions Please read our Terms & Conditions before submitting this form. reCAPTCHA If you are human, leave this field blank. Submit
