Insprop Services Pte Ltd

                      52 Florence Road Singapore 549506

                   Business Registration No : 200407344E

Motor Ins
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Motor Insurance Quotation

Comprehensive Third Party Fire & Theft Third Party Only

Personal Information

Name Sex                
NRIC/Passport No. Marital Status
Address DOB               
Contact (home)    (office)    (HP)
Occupation Nature           
Driving experience years
E-mail

 

Vehicle Particulars

Vehicle Reg No      
Vehicle type    (if others)
Make/Model
Year of manufacture           Registration date :
Imported / Reconditioned Yes   No
Seating capacity (inc driver)    Engine capacity (cc) :
Engine No    Chassis No :
Usage   (if others)
Modification (other than factory fitted accessories)
NCD upon renewal %  NCD Protector (only if 50%) Yes   No 

Current Insurance

  Renewal premium

Insurance coverage period

To 

Safe driver discount

Yes   No   (only for NCD >= 30%)

Accident in last 3 years?

Yes   No 

Accident details (including settled cases)

For commercial vehicles only
Laden weight    Unladen weight
Feature (if others)     

 

Named Drivers

  Named Driver 1 Named Driver 2
Name
Sex
DOB
Relationship
Occupation
Driving experience years years
Accident records in last 3 years

 

Additional information

 

Referred by :

Important note : Statement pursuant to Section 25(5) of the Insurance Act (Cap 142) or any subsequent amendments thereof, you are to disclose in this form, fully and faithfully, all the facts which you know or ought to know in respect of the risk that is being proposed, otherwise, the policy issued hereunder may be void.

  

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Copyright © 2004 Insprop Services Pte Ltd
Last modified: 08/13/05