Vehicle Owner's Particulars (DETAILS OF INSURED)
Name:
*
(as of NRIC)
NRIC:
*
(e.g S1234567A)
Date of Birth:
*
(dd/mm/yy)
Gender:
*
Male
Female
Nationality:
*
Singaporean
PR
Foreigner
Occupation:
*
Nature of Business:
*
Occupation Nature:
*
Select
Indoor
Outdoor
Marital Status:
*
Single
Married
Driving Experience:
*
Select
0
1
2
3
4
5
6
7
8
Above 8
Years
License Pass Date:
*
(dd/mm/yy)
Email Address:
*
Mobile Number:
*
Address:
*
Details of Current Vehicle
Period of Insurance:
*
To
(dd/mm/yy)
Type Of Coverage:
*
Select
Comprehensive
Third Party Fire & Theft
Third Party Only
NCD:
*
Select
0
10
20
30
40
50
%
Safe Driver Discount:
*
Select
Yes
No
?
Click here to find out more
Motorists with a clean driving record for a continuous 3 years will enjoy 5% discount from the Traffic Police. (only applicable if NCD is 30% or above)
Vehicle Reg No.:
*
Vehicle Make:
*
Vehicle Model:
*
Registration Date:
*
(dd/mm/yy)
Seating Capacity
*
Select
2
4
5
6
7
8
10
14
Person
Engine Capacity:
*
cc
Year of Manufacture:
*
(yyyy)
Weekend Car:
*
Select
Yes
No
Vehicle Type:
*
Select
Saloon
Coupe
High Performance
Commerical Vehicle
Motocycle
Any claims experience in last 3 years:
*
Select
Yes
No
Date:
*
(dd/mm/yy)
Insurance Company:
*
Select
ACE INSURANCE
ALLIANZ INSURANCE
AMERICAN HOME ASSURANCE
AMERICAN INT'L ASSURANCE
ASIA INSURANCE
AVIVA LTD
AXA INSURANCE
CHINA INSURANCE
FEDERAL INSURANCE
FIRST CAPITAL INSURANCE
HSBC INSURANCE
INDIA INT'L INSURANCE
LIBERTY CITYSTATE
LONPAC INSURANCE
MAYBAN GENERAL ASSURANCE
MITSUI SUMITOMO INSURANCE
NANYANG INSURANCE
NIPPONKOA INSURANCE
NTUC INCOME
OVERSEAS ASSURANCE CORP
OVERSEAS UNION INSURANCE
PRUDENTIAL ASSURANCE
QBE INSURANCE
ROYAL & SUN ALLIANCE
S'PORE AVIATION & GENERAL
SAMPO JAPAN INSURANCE
TENET INSURANCE
TOKIO MARINE & FIRE INSURANCE
UNITED OVERSEAS INSURANCE
ZURICH INSURANCE
Claim Amount:
*
$
Named Drivers:
*
Select
None
1
2
Named Driver #1
Full Name:
*
Gender:
*
Select
Male
Female
Date of Birth:
*
(dd/mm/yy)
Occupation:
*
Nature of Business:
*
Relationship with Policy Holder:
*
Driving Experience:
*
Years
License Pass Date:
*
(dd/mm/yy)
Remark:
Named Driver #2
Full Name:
*
Gender:
*
Select
Male
Female
Date of Birth:
*
(dd/mm/yy)
Occupation:
*
Nature of Business:
*
Relationship with Policy Holder:
*
Driving Experience:
*
Years
License Pass Date:
*
(dd/mm/yy)
Remark:
Current/Past Insurer
Do you have a Current/Past Insurer?
*
Select
Yes
No
Company Name:
*
Select
ACE INSURANCE
ALLIANZ INSURANCE
AMERICAN HOME ASSURANCE
AMERICAN INT'L ASSURANCE
ASIA INSURANCE
AVIVA LTD
AXA INSURANCE
CHINA INSURANCE
FEDERAL INSURANCE
FIRST CAPITAL INSURANCE
HSBC INSURANCE
INDIA INT'L INSURANCE
LIBERTY CITYSTATE
LONPAC INSURANCE
MAYBAN GENERAL ASSURANCE
MITSUI SUMITOMO INSURANCE
NANYANG INSURANCE
NIPPONKOA INSURANCE
NTUC INCOME
OVERSEAS ASSURANCE CORP
OVERSEAS UNION INSURANCE
PRUDENTIAL ASSURANCE
QBE INSURANCE
ROYAL & SUN ALLIANCE
S'PORE AVIATION & GENERAL
SAMPO JAPAN INSURANCE
TENET INSURANCE
TOKIO MARINE & FIRE INSURANCE
UNITED OVERSEAS INSURANCE
ZURICH INSURANCE
Period of Insurance:
*
To
(dd/mm/yy)
Type Of Coverage:
*
Select
Comprehensive
Third Party Fire & Theft
Third Party Only
Vehicle No:
*
Expiry Date:
*
(dd/mm/yy)
Policy No:
*
NCD Upon renewal:
*
Select
0
10
20
30
40
50
%
Required NCD Protector Scheme:
*
Select
Yes
No
?
Its protect against the NCD of 50% for the 1st accident involve during the insured period. (Only applicable if NCD is 50%)
Safe Driver Discount:
*
Select
Yes
No
?
Click here to find out more
Motorists with a clean driving record for a continuous 3 years will enjoy 5% discount from the Traffic Police. (only applicable if NCD is 30% or above)
Other Remarks
Remarks
