Private Vehicle Insurance Quotation (Mark * mandatory field for quotation request) Please provide the following details : - * Name of Insured * Address * NRIC No. / ROC * Date of Birth / Age * Sex : Male Female * Marital Status : Single Married Others * Occupation (Individual) : * Driving Experience (Individual) : * Vehicle Registration Number : * Make /Model * Year of Registration * Year of Manufacturing * Cubic Capacity * Seating Capacity (Including Driver) Engine Number Chassis Number * Type of Cover Required : Comprehensive Third Party Third Party Fire & Theft * Travel to Malaysia : Yes / No Yes No Annual Mileage *Claims Experience for Past 3 years: Yes / No (If Yes, State Claim amount) * Existing No Claim Discount / Insurer/ Policy No. * NCD Protector ( only for NCD 50%): Yes / No. * Goods Driver Discount: Yes / No. * Demerit Point: Yes / No. Name of Finance Co. (If applicable) Period of Insurance Annual Perimium.