Commercial Auto Insurance

Applicant details (for REGISTERED OWNER of vehicle)
Name	A value is required.*
NRIC/Passport/ROC No	A value is required.*
Address	A value is required.*
Postal Code	A value is required.*
Contact No.	A value is required.* (Mobile) (Home) (Office)
Email
Type of Business	A value is required.*
Nature of Business	A value is required.*
Is insured a commercial entity	Please select an item.*

vehicle
Period of Insurance	A value is required.* (ddmmyyyy) to A value is required.* (ddmmyyyy)
Registration No.	A value is required.*
Make and Model	A value is required.*
Year of Registration	A value is required.*
Engine Capacity / Tonnage	A value is required.*
Seating Capacity	A value is required.*
Chassis No.	A value is required.*
Engine No.	A value is required.*
Body Type	A value is required. *
Insured with COE / PARF	Please select an item.*
Off Peak Car	Please select an item.*
Hire Purchase Company	A value is required.*
Would vehicle be used to carry	Own Goods Own Passenger(s) Passenger(s) on the cargo deck who are not employee(s) of the insured For Hire or Reward to carry goods and/or passengers Third Party Goods If carrying Third Party Goods, please specify ->
Are goods carried flammable, corrosive or explosive in nature?	If yes, please specify ->

declarations
NCD (%)	A value is required.* If NCD is 0 or 10% with no claims experience, please provide reason: If others, please specify reason ->
Is NCD to be transferred from existing/previous insurer?	Please select an item.* Existing/Previous Insurer Existing/Previous Registration No Existing/Previous Policy No Existing/Previous Policy Expiry/Cancellation Date (ddmmyyyy)
Have you ever made any claims or been involved in an accident?	Please select an item.*

Have your driving license ever been revoked?

Please select an item.*

Optional covers

Additional equipment or fixtures on the vehicle

Required Sum Insured

Make of Model (if applicable)

Attach invoice

Referrer (if any)
Referrer Name
Referrer Contact No.
Referrer Email