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Motor Quotation
Required fields marked with an asterisk (*)
Company Name
Title
Mr
Mrs
Ms
Miss
Dr
*
First Name
*
Last Name
*
Contact Phone no. (H) (Mobile)
*
NRIC / Business registration No.
*
Email
Business Address
*
City / Town / Country
Vehicle Registration Number
*
Make
(e.g. Toyota, Honda, Proton)
*
Model
(e.g. Vios, Civic, Perdana)
Cubic Capacity
NCD %
0%
25%
30%
38.33%
45%
55%
*
Sum Insured
(Current vehicle market value)
Manufacturing Year
Use of Vehicle
Business use
Private use
Area of Coverage
West Malaysia
East Malaysia
Anti-Theft
Alarm
Alarm with immobilizer
Alarm with immobilizer and GPS tracking system
Policy Inception Date
(When do you want the policy to start)
*
Any other enquiry
Please enter text in the image above
