Incorporated since 1996.
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Insured* (Full name)
Your Email (required)
Is the insured driving?*
Date of Birth*
Any claims for the past three years?
Please indicate claims amount and date
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
Registration Date of Vehicle
IC / FIN / Passport No.
Date of Birth