Open Proposal Form
Comprehensive Insurance Proposal
Identity
Mr
Ms
Prefer not to say
First Name
Middle Name
Last Name
Email Address
Mobile Number
Vehicle Make
Vehicle Model
Vehicle Type
Select Vehicle Type
Sedan
Hatchback
Coupe
SUV (Sport Utility Vehicle)
Minivan (or MPV)
Wagon/Estate
Crossover (CUV)
Pickup Truck
Van
Convertible
Luxury Sedans/SUVs
Vehicle Year
Variant
Transmission
Automatic (AT)
Manual (MT)
Hybrid (HV)
Eletric Vehicle (EV)
Seating Capacity
Vehicle Latest Value
What is the primary use of your car? (Select one only)
Private
TNVS/Grab
Commercial Vehicle
Premium Rate for ODT
Premium Rate for AON
Mortgage (Select one only)
Yes
No
If Yes, provide Bank Name
Date of Expiring Policy
Would you like to receive promos, updates, and rewards?
Yes
No
Submit Proposal
