Private / Commercial Vehicle / Motor Cycle Quotation


Important Notice

1) To get accurate quotes, please kindly provide detail and accurate information as the accuracy of premium depend on the accuracy of information given.

2) All data or information given will be kept confidential and only use for our company data usage and quotation.


Class of Vehicle: Private Car        Commercial Vehicle     Motor Cycle

Name : * Individual Company
For Individual Name : Insured Driving    Insured NOT Driving
Email :  (quote will be emailed to you)
NRIC No (e.g. S1234567E) : Date of Birth : 
Marital Status : Gender :         Male Female
Phone : * Fax No :          
Nationality :
Occupation : Indoor Outdoor
  Others, please Specify:
Nature of Business :
  Others, please Specify:
Driving Experience in Singapore : Singapore Driver's Licence :  Yes No
Claim Experience in last 3 years : Yes No No. of claims in last 3 years : 
Claims Details : Own Damage: $ Third Party: $
  Own Damage: $ Third Party: $
  Own Damage: $ Third Party: $
Vehicle Details
Brand New / Used Car : Used Car  New Car Company Car :    Yes  No
Registration Number :
Make :
Model : (E.g. Corolla Altis 1.6, Dyna 1500)
Engine Capacity : cc
 
Vehicle Type : No. of Seaters (incl. of Driver) :  
Vehicle Use : Off Peak/Normal Vehicle :    
Transmission Type : Body Kit/Side Car attach :    Yes No
Propellant :
Year of  Make : Registration Year/Month :     
Additional Accessories  to be insured (E.g. Sunroof, Hi-Fi, Sport Rims)
Yes No    If Yes Sum Insured $
Parallel Import : Yes No    Finance Company :                 Yes No
Insurance Details
Type of Cover : Comprehensive    Third Party, Fire & Theft (TPFT)   Third Party Only (TP Only)
    (TPFT and TP Only is available only if there is no Finance company)
NCD Protection : No Yes (Only applicable for private car NCD 50%)
NCD upon Renewal : Reason if NCD is 0% : 
Safe Driver Discount from Traffic Police : (Provide IC to check for Eligibility) Demerit Point :           
Current Insurer : Competitive Quote : $   Excess : $
Insurance Start Date : Insurance Exp. Date :
     
How You get to know about us :
Your friend/Relative/Associate Name :
Named Drivers Details
Sex Date of Birth Marital
Status
Relationship Occupation
Driving
Exp.
Any
Claims
Remarks
 
   

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