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About Yourself Company Name* Company R.O.C* Nature Of Business Name* Your Email (required) Any claims for the past three years? Yes No Please indicate claims amount and date NCB* Car Details Please note that if there is not a brand new vehicle, there is no need to fill in information on make, model. registration date, engine capacity. However, do indicate the full vehicle number. Type of Plan* ComprehensiveThird Party Fire and TheftThird Party Vehicle No.* Make Model Registration Date of Vehicle Engine Capacity Named Driver Name IC / FIN / Passport No. Date of Birth Driving Experience Gender Male Female
About Yourself
Company Name*
Company R.O.C*
Nature Of Business Name*
Your Email (required)
Any claims for the past three years? Yes No
Please indicate claims amount and date
NCB*
Car Details
Please note that if there is not a brand new vehicle, there is no need to fill in information on make, model. registration date, engine capacity. However, do indicate the full vehicle number.
Type of Plan* ComprehensiveThird Party Fire and TheftThird Party
Vehicle No.*
Make
Model
Registration Date of Vehicle
Engine Capacity
Named Driver
Name
IC / FIN / Passport No.
Date of Birth
Driving Experience
Gender Male Female