Motor Quotations

    1. Coverage and Period of Insurance

    Choice of Coverage

    Period of Insurance*

    to*

    2. Vehicle Details

    Vehicle Number*

    Parallel Import*

    Modified Vehicle*

    Vehicle Make and Model*

    Off-peak car?*

    Finance Company*

    Sum Insured (Optional)

    3. Proposer (Vehicle Registered Owner Only)

    Full Name (As per NRIC or ROC)*

    Date of Birth*

    NRIC/ROC Number*

    Gender*

    Occupation*

    Marital Status*

    Licence Passing Date*

    Email*

    Contact Number*

    No Claim Discount (NCD)*

    Address*

    Previous Insurer*

    4. Claim Experience

    Claims in the past 3 years?*

    Suspension of Driving*

    5. Additional Named Driver

    Additional Named Driver*

    Named Driver Details 1

    Salutation*

    NRIC/FIN No.*

    Driver Name*

    Date of Birth*

    Gender*

    Marital Status*

    Nationality*

    Driver's Age*

    Driving Exp.(Years)*

    Driving License Pass Date(For SG/MY)*

    Add Named Driver*

    Named Driver Details 2

    Salutation*

    NRIC/FIN No.*

    Driver Name*

    Date of Birth*

    Gender*

    Marital Status*

    Nationality*

    Driver's Age*

    Driving Exp.(Years)*

    Driving License Pass Date(For SG/MY)*

    Add Named Driver*

    Named Driver Details 3

    Salutation*

    NRIC/FIN No.*

    Driver Name*

    Date of Birth*

    Gender*

    Marital Status*

    Nationality*

    Driver's Age*

    Driving Exp.(Years)*

    Driving License Pass Date(For SG/MY)*

    Remarks

    (If attaching more than 1 file, zip it before attaching)

    I/we hereby understand that I/we need to disclose our personal data in order for Winner Consultancy Pte Ltd to generate a quotation for me/us. I/we agree that my/our declaration and disclosures herein are truthful and to the best of my knowledge. I/we agree and understand that accuracy of quotation premium is solely reliant on information provided by me/we only.