Referral Proposal Form for Motor Insurance
Friday, 19 April 2024
Please answer the following questions:
*
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
Description of Vehicle that is to be Insured.
*
Make
*
Model / Type
*
Year of Manufacture
*
Log Book No.
*
Vehicle Registration No.
*
Chassis No.
*
Engine No.
Purpose for which vehicle is to be used
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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