Vehicle Owner's Details

Campaign ID (leave it blank if not applicable)
 
Start Coverage on... (renewable annually)
   
Name as per NRIC
   
NRIC - - (new)
  (old, if any)
   
Marital Status
   
Driving Experience years
   
Nature of Work (Rocket Scientist)
   
Mailing Address:
Postcode
   
Contact No: (e.g: 012-1234567)
   
Email:
   
Claims in the past 3 years
   
Approximate claim amount (RM) (e.g. 2500)


Vehicle Information

Vehicle Registration No. (e.g. BAT 2244)
   
Engine No. (e.g. 4W25P-ED339D)
   
Chassis No. (e.g. PL1C57SVTB984527)
   
Use of Vehicle
   
Place of Use
   
Make
(e.g. Proton Gen 2 1.6AT Hatchback. Refer to car registration card.)
   
Seating Capacity (e.g. 5)
   
Engine Capacity (CC) (e.g. 1468)
   
Year of Manufactured (e.g. 2003)
   
Desired Sum Insured
(Market Value) (RM)		 (e.g. 70000)
   
Current NCD %
   
Garage
   
Safety Features
   
Anti-Theft
   
No. of Drivers (including vehicle's owner)
   
Details of drivers
(include Name, NRIC, Driving Experience, Occupation and Relationship with Vehicle Owner)
   
Previous Insurer (e.g. Kurnia)

 

Extra Coverages

Strike, riot and commotion
Inclusion of Special Perils
(Flood, Typhoon, Hurricane, Storm, Volcanic Eruption, Earthquake, Landslide, Landslip or Other Convulsion of Nature)
Legal Liability of Passengers for Negligence Act
Legal Liability to Passengers
Breakage of Windscreen. Coverage Amount (RM):
(e.g. 800)


 

To calculate your premium, use our Motor Insurance Premium Calculator (opens up a new window).

Malaysia Car Insurance Application

Before you apply, please take note:

i) Vehicle is for private use only.
.
ii) Comprehensive coverage. (No third party).

iii) Vehicle must not be more than 15 years.

All payments are made directly to the underwriting Insurance Company.