Motor Quotation Form CN

Motor Quotation Form

We do not handle direct quotation. All enquires will be forwarded to our agents to follow up. Therefore we will release your personal information / data to our agent to process the quote for you. The estimated time to get a quote from our agent is 2 working days.

Coverage *

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From

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Owner's Particulars

Name*

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Date of Birth *

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Gender*

Female Male

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Email Address*

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NRIC*

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Singapore Class 3 Licence Pass Date *

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Occupation*

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Contact No.*

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Vehicle's Particulars

Registration No. *

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Year of Registration *

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Off-Peak Car *

No Yes

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Make & Model *

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NCD *

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Parallel Import *

No Yes

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Claims History (Past 3 Years) *

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Important Notes

1. Under Section 25(5) of the Insurance Act (Chap142), you are required to disclose in this Motor Quotation Form, fully and faithfully all the facts
which you know,ought to know, otherwise the Quotation generated hereby may be invalid.

*Required field

Motor Quotation Form CN

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