SAFE HARBOUR
Motor
Motor Insurance Quotation Form
Commercial Vehicle Quotation Form
Personal
Home Insurance
>
Home Insurance Quotation
Personal Accident Insurance
>
Personal Accident Insurance Quotation
Domestic Maid Insurance
>
Domestic Maid Insurance Quotation
CONNECT
SATISFACTION
Exclusively for New Customers Only
* Submit the quotation form now and get a
Free RFID Blocking Card
*
Limit to one redemption per person
* While Stocks Last
Motor Insurance Quotation Form
Applicant Information
*
Indicates required field
Insured Name :
*
Insured ID : (Last 4 characters e.g. 123A)
*
Gender :
*
Male
Female
Marital Status :
*
Single
Married
Others
Date of Birth : (DD MM YYYY)
*
Driving Licence Pass Date : (DD MM YYYY)
*
Mobile Number :
*
Email :
*
Employment Details
Occupation :
*
Work Environment :
*
Indoor
Outdoor
Indoor & Outdoor
Insurance Details
Vehicle Registration Number :
*
Existing Insurer :
*
Renewal Date : (DD MM YYYY)
*
NCD Upon Renewal :
*
0%
10%
15%
20%
30%
40%
50%
Claim Experience for last 3 years :
*
No
Yes
Type of Coverage Required :
*
Comprehensive
Third Party Fire & Theft
Third Party Only
Details of Additional Driver
(if applicable)
Name
*
Gender :
*
Male
Female
Marital Status :
*
Single
Married
Others
Date of Birth : (DD MMM YYYY)
*
Relationship to Insured :
*
Occupation :
*
Work Environment :
*
Indoor
Outdoor
Indoor & Outdoor
Driving License Pass Date : (DD MMM YYYY)
*
Mailing Information
Please furnish the following information to enable us to mail the gift to you.
Block and Street Name
*
Unit
*
Postal
*
Granting Safe Harbour Permission to Contact Me
*
I consent Safe Harbour to contact me
Submit
Motor
Motor Insurance Quotation Form
Commercial Vehicle Quotation Form
Personal
Home Insurance
>
Home Insurance Quotation
Personal Accident Insurance
>
Personal Accident Insurance Quotation
Domestic Maid Insurance
>
Domestic Maid Insurance Quotation
CONNECT
SATISFACTION