Insurance Quotation Form without myinfo - Automobile Association Of Singapore

REGISTRATION FORM

Request for a motor insurance quote

"*" indicates required fields

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Full Name*

NRIC/Passport Number*

Gender*

MALE

FEMALE

Marital Status*

Single

Married

Divorced

Widowed

Occupation*

Mobile Number*

Email Address*

Date of Birth*

Car Registration No

Validate Your Car Registration No. Here

Date of License Passed*

Insurance Inception*

Vehicle Year of Make*

Vehicle Make*

Vehicle Model*

Vehicle Engine Capacity*

Personal Data Collection Statement

AAS Insurance Agency Pte Ltd. ("AAS-IA") recognises its obligations under the Personal Data Protection Act 2012 (PDPA) which includes the collection, use and disclosure of personal data for the purpose for which an individual has given consent to. The personal data collected by AAS-IA includes all personal data provided in this form, or in any document provided, or to be provided to us by you or your insured persons or from other sources, for the purpose of this insurance quotation request, application or transaction. It includes all personal data for us to generate motor insurance quotations from our appointed insurance partners. You may not alter any of the wordings in this "Personal data collection statement". Any attempt to do so will be of no effect.

1. Purpose of collection

We may collect and use the personal data to: generate motor insurance quotations from our appointed insurance partners; process, administer and/or manage your relationship, account and policy with our appointed insurance partners; carry out your instructions or responding to any enquiries by you.

2. Disclosure of personal data

We may disclose personal data belonging to you and your insured persons for the purpose set out in Section 1 above to the following parties: a. Automobile Association of Singapore b. AIG Asia Pacific Insurance Pte. Ltd. c. Liberty Insurance Pte Ltd d. Tokio Marine Insurance Singapore Ltd.

3. Marketing material option

Please indicate if you wish to receive marketing or promotional materials on our products and services via telephone calls, text messages, faxes, mails or emails.

Marketing material option*

Yes

4. Declaration and Authorisation to Automobile Association of Singapore

• In order for me to enjoy insurance services available to AA Members, I consent to be an AA Member and agree to the Privacy Policy of AA Singapore. • I also authorise and give consent to AA Singapore, its subsidiaries and partners to communicate with me via post , email, SMS text messaging and/or telephone on any insurance product, service, benefit and /or promotion.

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.