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Personal Information
Full Name
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NRIC/Passport
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Gender
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Marital Status
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Single
Married
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Date of Birth
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Driving License Date
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Occupation
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Academic, Educator
Actor, Actress, Entertainer
Agriculture and Fishing (eg: Farms)
Aircraft Pilot/Cabin Crew
Arts, Entertainment & Recreation
Banker, Accountant, Fund Manager
Clerical, Administrative
Computer Engineer, Technician
Computer Engineer, Technician (Outdoor)
Construction, Supervisor, Worker (Indoor)
Contractor, Subcontractor
Doctor, Medical or Lab Staff
Electrical Works
Executive, Managerial
Gas Supply
Hawker/Hotel/Restaurants/Food Catering
Homemaker
Housewife
Insurance, Property Agent
Junk dealers, refuse & garbage removal
Landscaping & maintenance Co
Lawyer, Legal Profession
Management, Director, CEO
Manufacturing
Mechanic
Military, Police, Civil, Defence, etc
Motor Trade/Motor Repair Activities
News Reporter, Journalist
Other, Technician, Engineer
Others, Indoor
Others, Outdoor
Professional
Professional, Scientific & Technical Activities
Real Estate
Renovation, Contractor
Rental and Leasing Activities
Retiree
Sales, Marketing, Service, Surveyors, Valuers
Security Firms (eg: CISCO)
Self, Employed, Own, Company
Service, Customer, Support, in, house
Social & non-profit organizations
Student
Transport and Storage
Unemployed
Water Supply, Sewerage and Waste Management
Contact No
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Email
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Vehicle Information
Vehicle No
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Period of Insurance
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Please Select Start Date
05 Aug 2026
06 Aug 2026
07 Aug 2026
08 Aug 2026
09 Aug 2026
10 Aug 2026
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26 Jul 2027
27 Jul 2027
28 Jul 2027
29 Jul 2027
30 Jul 2027
31 Jul 2027
01 Aug 2027
02 Aug 2027
03 Aug 2027
04 Aug 2027
to 04 Aug 2027
NCD %:
0%
10%
20%
30%
40%
50%
50% Current Year
Current Insurer:
Please Select
---
AIG
Allianz
Allied World
Budget Direct Insurance
Direct Asia
ECICS
EQ Insurance
ERGO Insurance
Etiqa
FWD Insurance
Great American Insurance Company
Great Eastern General Insurance Ltd
HL Assurance
Income Insurance
India
Liberty Insurance
Lonpac
MS First Capital
MSIG
QBE
Singlife
SOMPO
Tokio Marine Insurance
United Overseas Insurance
Renewal Premium:
Insurance Cover:
Comprehensive
Third Party, Fire & Theft
Third Party Only
Off-Peak Day:
No
Yes
Claims History
Claims made in Aug-2025 to Aug-2026:
0
1
2
3+
Claims made in Aug-2024 to Aug-2025:
0
1
2
3+
Claims made in Aug-2023 to Aug-2024:
0
1
2
3+
Named Drivers
(Excluding the registered owner of the car)
Total Named Drivers:
0
1
2
Named Driver #1
Full Name:
NRIC/Passport:
Gender:
Select
Male
Female
Marital Status:
Select
Single
Married
Divorced
Widowed
Date of Birth:
Driving License Date:
Occupation:
Select
Academic, Educator
Actor, Actress, Entertainer
Agriculture and Fishing (eg: Farms)
Aircraft Pilot/Cabin Crew
Arts, Entertainment & Recreation
Banker, Accountant, Fund Manager
Clerical, Administrative
Computer Engineer, Technician
Computer Engineer, Technician (Outdoor)
Construction, Supervisor, Worker (Indoor)
Contractor, Subcontractor
Doctor, Medical or Lab Staff
Electrical Works
Executive, Managerial
Gas Supply
Hawker/Hotel/Restaurants/Food Catering
Homemaker
Housewife
Insurance, Property Agent
Junk dealers, refuse & garbage removal
Landscaping & maintenance Co
Lawyer, Legal Profession
Management, Director, CEO
Manufacturing
Mechanic
Military, Police, Civil, Defence, etc
Motor Trade/Motor Repair Activities
News Reporter, Journalist
Other, Technician, Engineer
Others, Indoor
Others, Outdoor
Professional
Professional, Scientific & Technical Activities
Real Estate
Renovation, Contractor
Rental and Leasing Activities
Retiree
Sales, Marketing, Service, Surveyors, Valuers
Security Firms (eg: CISCO)
Self, Employed, Own, Company
Service, Customer, Support, in, house
Social & non-profit organizations
Student
Transport and Storage
Unemployed
Water Supply, Sewerage and Waste Management
Job Type:
Indoor
Outdoor
Claims Year 1:
0
1
2
3+
Claims Year 2:
0
1
2
3+
Claims Year 3:
0
1
2
3+
Named Driver #2
Full Name:
NRIC/Passport:
Gender:
Select
Male
Female
Marital Status:
Select
Single
Married
Divorced
Widowed
Date of Birth:
Driving License Date:
Occupation:
Select
Academic, Educator
Actor, Actress, Entertainer
Agriculture and Fishing (eg: Farms)
Aircraft Pilot/Cabin Crew
Arts, Entertainment & Recreation
Banker, Accountant, Fund Manager
Clerical, Administrative
Computer Engineer, Technician
Computer Engineer, Technician (Outdoor)
Construction, Supervisor, Worker (Indoor)
Contractor, Subcontractor
Doctor, Medical or Lab Staff
Electrical Works
Executive, Managerial
Gas Supply
Hawker/Hotel/Restaurants/Food Catering
Homemaker
Housewife
Insurance, Property Agent
Junk dealers, refuse & garbage removal
Landscaping & maintenance Co
Lawyer, Legal Profession
Management, Director, CEO
Manufacturing
Mechanic
Military, Police, Civil, Defence, etc
Motor Trade/Motor Repair Activities
News Reporter, Journalist
Other, Technician, Engineer
Others, Indoor
Others, Outdoor
Professional
Professional, Scientific & Technical Activities
Real Estate
Renovation, Contractor
Rental and Leasing Activities
Retiree
Sales, Marketing, Service, Surveyors, Valuers
Security Firms (eg: CISCO)
Self, Employed, Own, Company
Service, Customer, Support, in, house
Social & non-profit organizations
Student
Transport and Storage
Unemployed
Water Supply, Sewerage and Waste Management
Job Type:
Indoor
Outdoor
Claims Year 1:
0
1
2
3+
Claims Year 2:
0
1
2
3+
Claims Year 3:
0
1
2
3+
Additional Comments
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