Motor Insurance

PROPOSER

REGISTERED OWNER OF VEHICLE

Name of Proposer *

NRIC / Passport / ROC No. *

Date of Birth *

Gender *

Male

Female

Nationality *

Marital Status *

Contact No. *

Email *

An email notification will be sent to this email address

Address *

Postal Code *

Occupation *

Job Nature *

DRIVER

Will proposer be driving the vehicle? *

Yes

No

Driving Experience *

Years Months

Driver Age Condition *

The policy will indemnify the insured or any named driver(s) only if he/she meets the age condition.

VEHICLE

USER MAY REFER TO THE LTA'S ONE MOTORING SITE FOR MORE INFORMATIONS

Policy Inception Date *

Policy Expiry Date *

Registration No. *

Make and Model *

Year of Registration *

Engine Capacity / Tonnage *

Seating Capacity *

Chassis No. *

Engine No. *

Body Type *

Insured with COE / PARF *

Yes

No

Off Peak Car *

Yes

No

Hire Purchase Company *

DECLARATIONS

NCD (%) *

If NCD is 0 or 10% with no claims experience, please provide reason:

Have you ever made any claims or been involved in an accident? *

Yes

No

Have your driving license ever been revoked? *

Yes

No

AGENT

Agent Code *

Motor Insurance Quotations

PROPOSER

DRIVER

VEHICLE

DECLARATIONS

REVOKED AND ENDORSED LICENCE

AGENT