N-51 AUTOMOTIVE PTE LTD

MOTO 51 PTE LTD

 

Car Insurance Registration Form

TELL US ABOUT THE OWNER

Owner's Name
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NRIC / Passport No.
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Handphone
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Email Address
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Occupation
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Gender
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Marital Status
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Date of Birth (DD/MM/YYYY)
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Date of Obtaining License (DD/MM/YYYY)
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VEHICLE INFORMATION

Vehicle Registration Number
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Vehicle Make
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Vehicle Model
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NCD Upon Renewal
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CLAIM HISTORY

Any claims experience in the past 3 years?
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Number of Claims (past 3 years)
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Date of Accident (DD/MM/YYYY)
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Amout of Last Claim ($)
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