Car Insurance Quotes

Ladies and Gentlemen,

The information below are required in order for an accurate quotation. Please state your renewal date too. Thanks :-)

PS: You can also send me your vehicle log card via email or fax.

PS2: If you are recommended by someone, please let me know too.


Personal Information
Name:
Sex:
Date of Birth:
Contact no.:
Address:
Email:
Occupation1:
Occupation2: Indoor/Outdoor
Company Name:

Vehicle Details
Vehicle Make/Model:
Parallel Import: Yes/No
Body Type: Saloon, MPV, SUV, Turbo, Coupe, High Performance
Sum Insured:
Vehicle No.:
Date of Registration:
Year of Manufacture


Personal Driver Details
License Date:
NCD (Upon renewal):
Claim Experience (past 3 years):
Existing Insurer:
Renewal Date:
Hire Purchase Company :


Thank you