Insurance Quotation Form without myinfo – AUTOMOBILE ASSOCIATION OF SINGAPORE

REGISTRATION FORM

Request for a motor insurance quote

"*" indicates required fields

Full Name*

NRIC/Passport Number*

Marital Status*

Single

Married

Widowed

Divorced

Occupation*

Mobile Number*

Email Address*

Vehicle License Number**

Owner of Vehicle*

Yes

Date of License Passed*

Insurance Expiry*

Receive Promotional Material*

Important notice statement to section 25(5) of the Insurance Act (Cap. 142). You are to disclose fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder may be void.