AutoExpo RS - Spin & Win - Assure General Insurance

Thank you for participating in our Spin & Win campaign at AutoExpo 2019! Please fill up the below form and you will received your discount eVoucher within 7 days.

1. Contact Information

Salutation *

Full Name (As per NRIC) *

Date of Birth *

Contact No *

Email *

Company Name (Optional)

Job Title (Optional)

2. Driving experience and Vehicle detail

Years of Driver Experience *

Vehicle Number *

3. Mailing Address

Address Line 1 *

Address Line 2 *

Postal Code *

Country *

3. For Staff Use Only

Prize of SPIN & WIN Contest *

Agent *

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AutoExpo RS – Spin & Win