1Personal Particulars

2Address (in Singapore)

3Emergency Contact

4Vehicle Details

5Checkout

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REGISTRATION FORM

Personal Particulars

Title

Surname

Name

Gender(Required)

Male

Female

ID Type(Required)

NRIC / Passport No*(Required)

Date of Birth(Required)

Nationality*(Required)

Occupation*(Required)

Work Environment*(Required)

What is your marital status?*(Required)

Married

Single

Divorced

Widowed

Mobile Number*(Required)

Email Address*(Required)

Important notice

Statement to section 25(5) of the Insurance Act (Cap. 142). You are to disclose fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder may be void.

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REGISTRATION FORM

Address

House No./ Blk*(Required)

Building Name*(Required)

Street Name *(Required)

Unit No(Required)

Floor Level(Required)

Country *(Required)

Postal Code *(Required)

Important notice

Statement to section 25(5) of the Insurance Act (Cap. 142). You are to disclose fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder may be void.

Submit Your Motor Insurance Quote Request