About You
Name of Insured (as in NRIC)
*
NRIC No
*
Date of Birth (dd/mm/yyyy)
*
Marital Status
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Please Select
Single
Married
Gender
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Please Select
Male
Female
Contact No
*
Email
Occupation
*
Driving Experience (Years)
*
About Your Car
Registration No.
*
Make and Model
*
Type of Coverage
*
Please Select
Comprehensive
TPFT
Third Party
No Claim Discount (NCD) upon renewal
*
Please Select
0%
10%
20%
30%
40%
50%
Existing Insurer
Any claims for the past 3 years
*
Please Select
No
Yes
(If yes, please enter amount)
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