safe Harbour assurance agency
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Motor Insurance Quotation Form
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Home Insurance Quotation Form
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Personal Accident Insurance Quotation Form
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SATISFACTION
ONLINE QUOTATION FORM - HOME INSURANCE
Personal Particulars
Name (As per NRIC) :
*
Gender :
*
Male
Female
Block :
*
Street :
*
Unit :
*
Postal :
*
Contact Details
Home Number :
*
Office Number :
*
Mobile Number :
*
Email Address :
*
Details of property to be insured
Location of insured property
(If different from above)
Block :
*
Street :
*
Unit :
*
Postal :
*
Types of property :
*
HDB Flats
Condo
Semi-Detached
Landed
Others (Please specify below)
Others :
*
Home to be insured :
*
Self-occupied
Tenant-occupied
Any claims made under similar insurance for past 3 years :
*
No
Yes
If yes, please provide details here :
*
Coverage Required
Period of insurance From : (DD/MM/YYYY)
*
Period of insurance To : (DD/MM/YYYY)
*
Building :
*
Yes
No
Sum insured (S$) :
*
Renovation, Fixtures & Fittings :
*
Yes
No
Sum insured (S$) :
*
Household Contents :
*
Yes
No
Sum insured (S$) :
*
Personal Liability :
*
Yes
No
Sum insured (S$) :
*
Consent for Safe Harbour Assurance Agency to call me for any further clarification and/ or providing quotation pertaining to the service that I enquire.
Please tick below to give consent
*
I consent
Submit
Motor
Motor Insurance Quotation Form
Commercial Vehicle Quotation Form
Personal
Travel Insurance
>
Travel Insurance Quotation Form
Home Insurance
>
Home Insurance Quotation Form
Personal Accident Insurance
>
Personal Accident Insurance Quotation Form
Domestic Maid Insurance
>
Domestic Maid Insurance Quotation Form
CONNECT
SATISFACTION
✕
