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APPLICATION SUMMARY
Provider Description Total Premium
Insurer
  • Insurer Plan
  • Cover Type : COMPREHENSIVE
  • Login and use code CAR20 to get RM20 off!
  • Policy Start Date : 15-Apr-2021
  • RM 0.00
  •  
  •  
Total RM 0.00
The amount shown above is the total premium payable for your policy.
NOTE: Premium and excess amount may be subject to changes after review by the insurer. Addtional excess may apply to young/inexperienced/elderly drivers (if any). All private car policyholders are responsible for an unnamed driver excess.
On verification with your previous insurer and if NCD does not tally with the advice, the insurer shall proceed to recover NCD either via additional premium or via endorsement and shorten the period of insurance concurrently. Please note that NCD Protector (if any) is non-transferrable to another insurer. The NCD Protector will not necessarily protect you against non-renewal or cancellation of your policy by your insurer.
ORDER SUMMARY
Car Details
Car Registration Number
Car Make
Car Model
Engine or Motor Number
Chassis Number
Car Cubic Capacity
Year of Manufacturing
Vehicle Purchase Date
Car Purchase Price
Performance and Aesthetic Modifications
Car Body Type
Local or Imported Vehicle
Airbags
Use of Vehicle
Car Fuel Type
Vehicle Type
Number of Seats
Anti-Lock Braking System or ABS
Vehicle Market Valuation
Functional Modification
Driver Details
MAIN DRIVER
DRIVER 2
Gender
Salutation
Name
Date of Birth
Race
Marital Status
Total driving-offence Points in the Last 3 Years
Occupation
Occupation Status
Nature of Occupation
Mailing Address Line 1
Mailing Address Line 2
IC Number
Email
Current Insurance Cover Details
Current Insurer
-
Current Renewal Premium
RM 0.00
Current Sum Insured
RM 0.00
Have you suffered losses or made any claim in past 3 years
Yes
Number of Claims in the Past 3 Years on
-damage to own vehicle
0
-windscreen
0
-theft
0
-third party claim
>0
New Insurance Cover Details
Basic of Coverage
Market Value Sum Insured
NCD Protector
Old Car Registration Number
Optional Cover Selections
Compensation for Assessed Repair Time - CART
RM 0.00
Inclusion of Special Perils
RM 0.00
Passenger Liability
RM 0.00
Private Hire Car / E-Hailing
RM 0.00
Strike, Riot and Civil
Commotion
RM 0.00
Waiver of Betterment
RM 0.00
Windscreen Damage on Tempered or Laminated Glass (Inclusive of Labour Cost)
RM 0.00
Windscreen Damage on Tinting Film (Inclusive of Labour Cost)
RM 0.00
IMPORTANT NOTICE & POLICYHOLDER DECLARATIONS
Important notice:

  • My existing car insurance will be expired within 3 months’ time;
  • I agree not to lend my car to a person to drive who is under 25 years of age or a person who has not held for a period of 2 years a driving license.
  • I and all named drivers have not suffered from any physical or mental infirmity that may affect my/their ability to drive.
  • I understand that any incorrect information provided may invalidate the quote and the insurance.
  • I/We clearly understand this declaration shall be incorporated in and taken as the basis of a proposed contract.

I / We hereby declare and agree that:

  • No information or representation made or given by or to any person shall be binding on the Company unless it is in writing and is presented and approved by the Company.
  • All written information, whether or not written by my own hand, submitted by me / us in this application form and in the Company issued questionnaires or other documents submitted by me / us in connection with this application are true, complete and correct. In respect of any information or answers that I / we did not provide personally, I / we have checked their contents to ensure that they are true, correct and complete. I / We understand that the Company, believing them to be such, will rely and act on them, otherwise any policy issued hereunder may be void.
  • All information and documents provided by me / us (as defined under (b)) together with the relevant policy issued shall constitute the entire contract between myself / ourselves and the Company.
I / We have read, understood and accepted the above statements which apply to all person covered under this policy.
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