Motor Insurance Enquiry - Assure General Insurance

Dear valued customer, as you are referred from Ah Beng Foodie, you get to enjoy an additional 5% discount off your premium.

• Applicable to first time car owners and renewal • 30% discount based on basic premium excluding GST

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 Period of Insurance

Choice of Coverage *

Period of Insurance *

To *

2. Vehicle Details

Vehicle Number *

Parallel Import *

Modified Vehicle *

Vehicle Make and Model *

Off-peak car? *

Finance Company

Sum Insured (Optional)

3. Proposer (Vehicle Registered Owner Only)

Full Name (As per NRIC) *

Date of Birth *

NRIC Number *

Gender *

Marital Status *

Occupation *

Licence Passing Date *

Email *

Contact No. *

Address *

Postal Code *

Previous Insurer *

No Claim Discount (NCD) *

4. Claim Experience

Any claims for past 3 years ? *

Suspension of Driving *

5. Additional Named Driver

Additional Named Driver *

Attachment

(Please attach your renewal notice/log card/driving licence & etc. If more than 1 file, zip it before attaching. Max allowed file size is 10MB.)

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.

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