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Personal Information
Full Name
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NRIC/Passport
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Gender
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Male
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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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Please 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
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
10 Jun 2026
11 Jun 2026
12 Jun 2026
13 Jun 2026
14 Jun 2026
15 Jun 2026
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01 Jan 2027
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29 May 2027
30 May 2027
31 May 2027
01 Jun 2027
02 Jun 2027
03 Jun 2027
04 Jun 2027
05 Jun 2027
06 Jun 2027
07 Jun 2027
08 Jun 2027
09 Jun 2027
to 09 Jun 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 Jun-2025 to Jun-2026:
0
1
2
3+
Claims made in Jun-2024 to Jun-2025:
0
1
2
3+
Claims made in Jun-2023 to Jun-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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