Products & Services

101 Kitchener Road
#02-30 Jalan Besar Plaza
Singapore 208511

Tel:  (65) 6297 2038
        (65) 6297 6732
Fax: (65) 6297 2836

  Home Products & ServicesMotorPrivate


The insurance will not be in force until the application and premium have been received and accepted by the company.

Important Notice:
Uder the Insurance Act, you must tell us all the facts that you know, or ought to know, about the risk that you are proposing. If you do not tell us everything that is relevant or if you mislead us, we may refuse to pay a claim or part of it, or cancel the policy.

Applicant's Particulars
Registered Owner of Vehicle *
Type of Cover *
Period of Insurance *   To   (DD/MM/YYYY)
Name of Registered owner *
NIRC/Passport/ROC No. * e.g: S1234567A
Contact No. *
Email Address 
Date of Birth * (DD/MM/YYYY)
Marriage Status * Yes     No
Nationality *
Occupation *
Demerit Points *
Years of Driving Experience *
Vehicle Details
Vehicle Registration no. *
Engine Capacity (cc) *
Vehicle Make * e.g BMW
Vehicle Model * e.g 5 Series
Vehicle Type *
Vehicle Usage *
Date of Registration * < (DD/MM/YYYY)
NCD Upon Renewal *
Claims in the last 3 years *
Total value of claim *
Please select the Options
Do you or any of the named drivers have: *
any physical or mental infirmity or defective vision or hearing? Yes     No
any traffic conviction or suspension in the last 3 years? Yes     No
any records of drink driving or accdents resulting in serious injuries or death? Yes     No
Has any insurance company, in respect of motor insurance (new or renewal) for you or any of the named drivers: *
declined any porposal? Yes     No
cancelled any policy? Yes     No
imposed an excess or other special terms? Yes     No
refused to renew any policy? Yes     No
Details of 2 named drivers in addition to the registered owner
Check the box to enter driver name details.
Driver 1   Name 
Date of Birth   < (DD/MM/YYYY)
Driving Experience  
Driver 2   Name 
Age   < (DD/MM/YYYY)
Driving Experience  

Design by