Motor Car Insurance Quotation

Fields with * denotes compulsory information
Your Name*
NRIC / FIN No.*
Address
Singapore	(Please enter postal code)
Contact Number*	(e.g. mobile phone number)
Email*	(Required to send the quotations to you)
Date of Birth*	(DDMMYYYY)
Marital status*	Single Married
Sex*	Male Female
Occupation*
Occupation Type*	Indoor Outdoor
Year Driving Licence Obtained*	1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Registration Number*	(Eg. SBV1234A)
Vehicle Registration Date*	(DDMMYYYY)
Vehicle Make*
Vehicle Model*
Year of Manufacture*	1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Engine capacity (cc)*
NCD % (No Claim Discount)*	0% 10% 20% 30% 40% 50% (NCD at NEXT renewal, not current NCD)
Any claims in the last 3 years*	0 1 2 3 more than 3
Total claim amount in last 3 years*	None $1,500 and below $1,501 to $3,000 $3,001 to $5,000 $5,001 to $10,000 $10,000 to $15,000 $15,000 to $20,000 $20,001 & above
Any demerit points in the last 2 years*	(If none, put 0)
Estimated sum assured (Mkt value of car)*	$
Name of Current Insurer*
Expiry Date (Current Insurance)*	(DDMMYYYY)

Please indicate also if you would be interested in the following.
We will contact your and/or send your information when available:

Retirement Planning	CPF Investment Strategies	Investment Planning
Children's Education Planning	Mortgages and Financing	Financial Planning

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