Compare multiple home insurance plans, please complete the form below and our friendly staff will get back to you as soon as possible. Thank you. 1. Particulars of Proposer Full Name (As per NRIC) * NRIC Number * Date of Birth * Gender * ---MaleFemale I am a * ---SingaporeanSingapore PRForeigner Dwelling Type * ---CondoLandedHDB Address * Postal Code * 2. Contact Information Email * Tel (HP) * Tel (Home) Tel (Office) 3. Questionnaire Have you suffered any loss or damage by fire, flood, theft or other causes at your premises in the past 3 years? * ---YesNo If yes: a) What is the cause of the loss or damage? b) When did the loss or damage occur? c) Was a claim made for the loss or damage? Please give details on the claim amount. Have you ever been refused cover, or imposed special terms by any insurance company on insurance relating to the premises to be insured and/ or its contents? * ---YesNo If yes: Please provide details. 5. Additional Information Promotional Code How Did You Hear of Us/Find Us? * ---Social mediaRecommended by friend/familySearch engineRadioBusiness associateInternet adLink from another pageFlyer/Banner/PosterRoad ShowBloggerEmailOther Remarks I/we hereby understand that I/we need to disclose our personal data in order for Assure (Singapore) Pte Ltd to generate a quotation for me/us. I/we have read the Privacy Policy and I/we consent to the collection and use of my/our personal data in accordance with its terms and conditions. I/we agree and understand that accuracy of quotation premium is solely reliant on information provided by me/we only. *indicates required field. By clicking Submit, you agree to our Privacy Policy.
