Please email
GARY @
gary@shogunracing.com for the following details, together with your contact no & email, OR fax us your Log Card will do too.
(FAX; +65 64002158) Thanks.
Name:
Contact no:
Email:
REQUEST FOR CAR INSURANCE QUOTATION
Name of Insured:
NRIC No:
Nationality:
Date of Birth:
Gender:
Marital Status:
Occupation: Indoor/Outdoor:
Nature of Business:
Make & Model:
Type of Vehicle Body: Saloon/Station Wagon/SUV/
Vehicle Registration No:
Date of Registration:
Year of Manufacture:
Engine Capacity:
Off Peak Car: Yes/No
Driving Experience:
NCD Upon Renewal:
Good Driver Discount:
Claim Experience for the past 3 year:
If yes, state Date/Claims Amount/description:
Type of Coverage: Comprehensive/3rd Party Fire & Theft/3rd Party Only
Existing Insurer:
Renewal Date:
Finance Company:
Renewal Premium:
*Particular of other Named Driver: if any
NRIC No:
Date of Birth:
Gender:
Marital Status:
Occupation (Please state whether is indoor/outdoor):
Nature of Business:
Driving Experience:
Claim Experience for the past 3 year:
If yes, state Date/Claims Amount/description