Please complete the form below for a quote and our friendly staff will get back to you as soon as possible. Thank you. 1. Coverage and Vehicle Details Choice of Coverage * ---Comprehensive (Recommended)Third party fire & theftThird party only Choice of Workshop Plan* ---Any WorkshopAuthorised Workshop Vehicle Number * Private Hire Use? YESNO Off-peak car? * ---YesNo SHVHC membership no. * 2. Proposer (Vehicle Registered Owner Only) Full Name (As per NRIC) * Date of Birth * NRIC Number * License Passing Date * Email * Contact No * Previous Insurer (Optional) NCD (Optional) 0%10%20%30%40%50% 3. Claim Experience Any claims for past 3 years ? * ---YesNo Suspension of Driving * ---YesNo 4. Additional Information Attachment (Optional) (Please attach your renewal notice. Max allowed file size is 10MB.) Remarks (Optional) 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.
