Insurance Quote – Vin's Automotive Group

Vin's Automotive Group›Insurance Quote

Insurance Claims

Request for Quotation

Is your motor insurance expiring within the next 2 months? Fill up the below form to get the lowest priced quote from us!

Please fill out your information below. * Required Fields

Personal Information

Full Name

NRIC/FIN/Passport No.

Date of Birth

Contact No.

Email Address

Gender

Marital Status

Occupation

Job Nature

License Pass Date

Claim Experience

If YES, state date and amount below:

Year & Month

Amount

Year & Month

Amount

Year & Month

Amount

Named Drivers

(EXCLUDING THE REGISTERED OWNER OF THE CAR)

Total Named Drivers

Named Driver #1

Full Name

NRIC/Passport No

Date of Birth

Marital Status

Gender

Occupation

Job Nature

License Pass Date

Contact No.

Named Driver #2

Full Name

NRIC/Passport No

Date of Birth

Marital Status

Gender

Occupation

Job Nature

License Pass Date

Contact No.

Named Driver #3

Full Name

NRIC/Passport No

Date of Birth

Marital Status

Gender

Occupation

Job Nature

License Pass Date

Contact No.

Insurance Details

Insurance Type

Vehicle Information

Vehicle No. To Be Insured

Make/Model

Off Peak Car?

Year of Registration

Manufacture Year

Engine Capacity

Parallel Imported?

Previous/Current Insurance Details

(FOR CLIENTS WHO WISH TO TRANSFER THEIR NCD)

Previous/Current Insurer

Previous/Current Vehicle Number

Previous/Current No Claims Discount%

Comments

By submitting this form. I hereby consent that my personal data be disclosed by Insurance Company to its third party service providers, agents or insurers for the purpose of providing me with the quotations I have requested. I also agree to receive calls, smses and emails from Insurance Company & ther respective partners.