Part 1 - Owner Information

Owner's name

Phone (WhatsApp)

Part 2 - Policy Information

Car insurance expiration date

No Claim Discount (NCD)

The NCD is calculated as follows: if the insured does not make any claims in the first year, they will only have to pay a 20% discount on the premium in the second year (a 20% no-claim discount), and a 30% discount on the premium in the third year (a 30% no-claim discount). The no-claim discount increases by 10% each year, accumulating to a maximum of 60% in the fifth year.

Part 3 - Insured Vehicle Information

Vehicle make and model

Year of production

Engine capacity (CC)

Insurance Items

Part 4 - Driver Information

Number of registered drivers

1 person

2 people

3 digits

4 digits

Driver 1's profile

Driver (1) Age

Driver (1) driving age

Driver (1) Occupation*

Has the driver (1) made any non-windscreen private car insurance claim in the past three years?

No claim

There is a claim

Has the driver (1) been incurred with any “driving offence points” or had his/her driving licence revoked in the past three years (the number of points before the driver received the driver improvement programme)?

No points deduction

There are points deductions