FREE Car Insurance Quotes | Motor Insurance Singapore

Main Driver's Particulars

Referral Code (If any):

Name: *

NRIC: *

Birthdate: *

Nationality: *

Country of Origin: * Which country are you from?

Gender: * MaleFemale

Marital Status: *

Job Nature: * IndoorOutdoor

Job Title: *

Driving Experience: * E.g. less than 1yr, 20yrs etc.

Driving License Pass Date: * It must be SINGAPORE driving license. "Pass Date" can be found at the back of driving license.

Mobile No.: *

Email: *

Insurance Information

Current Insurer:

NCB Upon Renewal: *

Reason for NIL NCD: *

Insurance Expiry Date: *

No. of Claims (last 3yrs): *

Details of 1st Claim

Amount Claimed: * Enter ONLY numbers.

Claims Status: *

Date of Accident: *

Details of 2nd Claim

Amount Claimed: * Enter ONLY numbers.

Claims Status: *

Date of Accident: *

Details of 3rd Claim

Amount Claimed: * Enter ONLY numbers.

Claims Status: *

Date of Accident: *

Current Renewal Status

Have you been offered renewal by your current insurer?: * YesNo

Named Driver Details: You may name up to 2 additional driver/s who regularly drive your car (optional).
Click here to enter another "Named Driver Details"

Special Request

Types of Workshop:

TOP 3 Benefits: * Tell us the top 3 benefits which are of most important to you. Hold down "Ctrl" key to select 3 benefits.

Other Remarks:

Statement pursuant to Section 24(4) of the Insurance Act (Cap 142) or any subsequent thereof, you are to disclose in this enrolment form, fully and faithfully all facts which you know or ought to know in respect of the risk that is being proposed, otherwise, the policy issued hereunder may be void.

*Click "Submit" ONCE only