Name

NRIC / Passport No. / Others

Phone No.

Select Vehicle Type Select Vehicle TypeCarMotocycle

Postcode

Plate No. (E.g. VAR1921)

Engine Capacity (CC) E.g 2000

Model E.g. Proton X70

Vehicle Year E.g 2010

ADDITIONAL COVERAGE: ADDITIONAL COVERAGE: Windscreen PA (Personal Accident) E-Hailing Limited Special Perils (Natural Disaster)