wealthservices-singapore_motor_insurance

Surname

Given Name

IC No. / Passport No.

Date of Birth (dd/mm/yyyy)

Sex

Marital Status

Occupation

Phone (H/O)

Mobile

Years of Driving Experience

Car Registration No.

Car Model

Other Car Models (if not found)

Vehicle Type

Cubic Capacity (cc)

Vehicle Usage

Purchase Type

Year of Manufacture

Date of Registration (mm/yyyy)

No Claim Discount (NCD, this year)

Good Driver Discount 5% (please check box)

Type of Coverage

Current Insurer

Next Renewal Date (dd/mm/yyyy)

Any Claims Last 3 Years

If yes, please state when and claims amount

The information required in this form are all relevant information to acquiring a quotation. Therefore to ensure that this quotation system is effective, all fields are required to be filled. Thank you.

Singapore Motor Insurance Quotation

Off-Peak Car (pls check box if car is off-peak)

Petrol/CNG/Hybrid