SAFE HARBOUR
Motor
Motor Insurance Quotation
Commercial Vehicle Quotation Form
Personal
Home Insurance
>
Home Insurance Quotation
Personal Accident Insurance
>
Personal Accident Insurance Quotation
Domestic Maid Insurance
>
Domestic Maid Insurance Quotation
Commercial
CONNECT
SATISFACTION
ONLINE QUOTATION FORM - MOTOR INSURANCE
Applicant Information
*
Indicates required field
Insured Name :
*
Insured NRIC :
*
Gender :
*
Please select
Male
Female
Marital Status :
*
Please Select
Single
Married
Others
Date of Birth : (DD MMM YYYY)
*
Driving Licence Pass Date : (DD MMM YYYY)
*
Nationality :
*
Block :
*
Street :
*
Mobile No :
*
Unit No :
*
Postal Code :
*
Email
*
Employment Details
Occupation :
*
Work Environment :
*
Please Select
Indoor
Outdoor
Indoor & Outdoor
Vehicle Details
Kindly provide either your
LTA access code
or your
vehicle details
so we can assist with your motor insurance quotation.
LTA Access Code Link
:
https://vrl.lta.gov.sg/lta/vrl/action/pubfunc?ID=EnquireTransferFee
Need help retrieving your LTA Access Code?
Click
here
for the guide.
Vehicle No :
*
LTA Access Code
*
Year of Manufacture : (YYYY)
*
Make & Model (As Per LTA) :
*
Original Registration Date : (DD MMM YYYY)
*
Vehicle Type :
*
Please Select
Electric
Hybrid
Petrol
Diesel
Body Type :
*
Please select
Coupe
Convertible
Cabriolet
Hatch Back
MPV 6-seater
MPV 7-seater
MPV 8-seater
Jeep
Roadster
Saloon
Station Wagon
SUV
Motorcycle
Scooter
Accessories (if any) :
*
Please Select
Sunroof
Moonroof
Roof Rack
Wheelchair Lift
Others
Turbo Engine :
*
Please Select
No
Yes
Off-Peak :
*
Please Select
No
Yes
Parallel Import:
*
Please Select
No
Yes
Private Hire :
*
Please Select
No
Yes
Insurance Details
Renewal Date : (DD MMM YYYY)
*
Existing Insurer :
*
Type of Coverage :
*
Please Select
Comprehensive
Third Party Fire & Theft
Third Party Only
Good Driver Discount :
*
Please Select
Yes
No
NCD Upon Renewal :
*
Please Select
0%
10%
15%
20%
30%
40%
50%
Claim Experience for last 3 years :
*
Please Select
No
Yes
Own Damage Claim Amount, if any (S$) :
*
If yes, Date of Claim : (DD MM YYYY)
*
Third Party Damage Claim Amount, if any (S$) :
*
Additional Benefits Required (if any):
*
Please Select
NCD Protector (50% NCD Only)
Courtesy Car
Any Workshop
Warranty Workshop
Waiver of Excess
Details of Additional Driver
(if applicable)
Name :
*
Gender :
*
Please Select
Male
Female
Date of Birth : (DD MMM YYYY)
*
Occupation :
*
Claim Experience for last 3 years :
*
Own Damage Claim Amount, if any (S$) :
*
NRIC No:
*
Marital Status :
*
Please Select
Single
Married
Others
Driving License Pass Date : (DD MMM YYYY)
*
Work Environment :
*
Please Select
Indoor
Outdoor
Indoor & Outdoor
If yes, Date of Claim : (DD MM YYYY)
*
Third Party Damage Claim Amount, if any (S$) :
*
Relationship to Insured :
*
Remarks (if any) :
*
Granting Safe Harbour Permission to Contact Me
*
I consent Safe Harbour to contact me
Submit
Motor
Motor Insurance Quotation
Commercial Vehicle Quotation Form
Personal
Home Insurance
>
Home Insurance Quotation
Personal Accident Insurance
>
Personal Accident Insurance Quotation
Domestic Maid Insurance
>
Domestic Maid Insurance Quotation
Commercial
CONNECT
SATISFACTION