Redeem

SAFE HARBOUR ASSURANCE AGENCY

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- Motor Insurance Quotation Form
- Commercial Vehicle Quotation Form
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REDEMPTION FORM

* Submit the redemption form now and get a Free RFID Blocking Card

* Free non-obligated motor insurance quotation for your comparison when your insurance is due for renewal

Terms & Conditions

* Exclusively for new customers only
* Limit to one redemption per person

Personal Particulars

* Indicates required field

Name : *

Gender : *

Male Female

NRIC : (Last 5 characters e.g. 1234A) *

Marital Status : *

Single Married Others

Date of Birth : (DD MMM YYYY) *

Years of Driving Experience *

Less than 1 yr 1 - 2 yrs 2 - 3 yrs 3 - 4 yrs 4 - 5 yrs 5 - 10 yrs More than 10 yrs

Occupation : *

Work Environment : *

Indoor Outdoor Indoor & Outdoor

Insurance Details

Vehicle Registration Number : *

NCD Upon Renewal : *

0% 10% 15% 20% 30% 40% 50%

Any claim for last 3 years : *

No Yes

Type of Coverage Required : *

Comprehensive Third Party Fire & Theft Third Party Only

Do you want to add a named driver? *

No Yes

Contacts Details

Please provide the following details for us to send you the gift :

Mobile Number : *

Email : *

Block and Street Name : *

Unit : # *

Building Name : *

Singapore Postal Code : *

Please tick below to give consent : *

I consent Safe Harbour to contact me

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Motor
- Motor Insurance Quotation Form
- Commercial Vehicle Quotation Form
Personal
CONNECT
SATISFACTION