insurance@lq.com.sg alliance@lq.com.sg Our Services - Free Quote

Motor Insurance Form


Free Quotation

Just fill up the form (SECTION 1,2,3 and 4) appropriately and send to us OR print out the form from your computer, fill up and fax to us at fax no. 3340624 or 3345238. We will revert to you.


SECTION 1 : OWNER'S PARTICULARS

Owner's Name
Address
Telephone No.Fax No./PagerDate of BirthAgeDriving Experience/Years
Occupation Email

SECTION 2 : VEHICLE INFORMATION

Vehicle Registration No. Estimated Value of VehicleEngine Capacity
Model Of Vehicle
Type of Vehicle Private       Others Imported

Commercial               Others

Motorcycle     
Year Of Manufacture Original Date of RegistrationSeating Capacity

SECTION 3 : FOR VANS AND LORRIES ONLY

Tonnage
If tonnage is not available, please complete the following:
Laden Weight Unladen Weight

SECTION 4 : CLAIM HISTORY

Previous Insurance Company
No claim discount% Enjoy 5% OFD(ROV)No of accident for the past three (3) years
Details of accident/s (Date/Summary/Amount)

Press a button to submit or reset the motor Insurance form.

180B Bencoolen Street #10-05 The Bencoolen
Singapore 189648
Tel: (65)3340783, (65)3399309 (9 lines)
Fax: (65)3340624, (65)3345238, (65)3334165 [LQ Card]