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AA INSURANCE ENQUIRY FORM
I am interested to find out
more about:
- AA Motor Insurance
- AA Travel Insurance
- AA Home Protection
- AA Personal Accident Insurance
AA MOTOR INSURANCE (For Private Cars Registered
in Singapore)
Contact Me
Name (as
in NRIC):
Mr
Mdm
Ms
Dr
NRIC/Passport
No.:
Membership
Expiry Date:
Date
of Birth:
Occupation:
Marital
Status:
Address:
Email:
Tel.
No. (Home):
Handphone/Pager:
Tel
No. (Office):
Driving
Experience: year(s)
Any
accident(s) in the last 3 years? Yes
No
If Yes, please state nature and year(s) of
accident, and amount claimed:
Current
NCD entitlement: %
Are
you the main driver? Yes No
If No, please state the main driver's
particulars below:
Name
(as in NRIC):
Mr Mdm Ms Dr
NRIC/Passport
No.:
Date
of Birth:
Occupation:
Marital
Status:
Driving
Experience: year(s)
Relationship:
Any
accident(s) in the last 3 years? Yes
No
If Yes, please state nature and year(s) of
accident, and amount claimed:
ABOUT
YOUR CAR
Currently in
your name Car intended
to purchase
Vehicle
Make/Model:
Vehicle
Registration No.:
Engine
Capacity:
Year
of Registration:
Type of Coverage Required:
Comprehensive
Third Party Fire & Theft
Third Party Only
Name
of Current Insurance Company:
Expiry
Date of Insurance Policy:
Please allow
3 to 5 days for quotation.
For enquiries,
please contact the Insurance Department at 6333 8811
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