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Motor Insurance Renewal Quotation - Personal Particulars
Name:
Email:
Mobile Contact:
Date of Birth
(DD-MM-YY):
Driving Experience:
Years
NCB Entitlement:
% (on Renewal)
Current Insurer:
Gender (Sex):
Male
Female
Marital Status:
Single
Married
Others
:
Occupation:
Indoor
Outdoor
Job Title:
Claim Experience:
No
Yes
If Yes (for last 3 yrs)
# of Claims
,
Total Claim Amount:$
Named Driver Particulars
Please include named drivers information (can be more than 1 named driver):
- You can ignore this section if the insured is the only named driver.
Name
Occupation
Driving experience
Age
Claims Exp
Relationship to Insured
Vehicle Details
Vehicle No.:
Engine Capacity:
cc
Year of Registration:
Make (Brand):
Model:
Body Type:
Saloon/Sedan
Coupe (2 doors)
Others:
Coverage Required:
Comprehensive
Third Party Only
Third Party Fire & Theft
Parellel Import:
No
Yes
Other Instructions
or Remarks:
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