Referral Proposal Form for Motor Insurance Monday, 15 August 2022


* Name of Proposer :
* Postal Address :
  Postcode :
  I/C No. : Old I/C No.
 
New I/C No.
* Phone : Business
 
House
  Mobile Phone :
  Email :
 Type of Insurance Required : Comprehensive   Third Party
 
* Make * Model / Type
* Year of Manufacture * Log Book No.
* Vehicle Registration No. * Chassis No.
* Engine No.  
  Private Car : Private, Social & Domestic Purposes
  Carriage of goods and / or own personal
  Others (to specify)  
 
 Note: Items marked with * is required.


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