1. Coverage and Vehicle Details Choice of Coverage (Optional) ---ComprehensiveThird party onlyThird party fire & theft Vehicle Number * Vehicle Make and Model * Off-peak car? * ---YesNo 2. Proposer (Vehicle Registered Owner Only) Full Name (As per NRIC) * Date of Birth * NRIC Number * Licence Passing Date (Optional) 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 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.
