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*Applicable to first time car owners and renewal
*Up to 30% discount for LYNLEX customer
Copyright © Assure (Singapore) Pte. Ltd. (Co. Reg. No. 201610162R ) trading as Assure General Insurance (AGI)

Coverage and Vehicle Details

Choice of Coverage*

Vehicle Make And Model*

Vehicle Number*

Off-Peak Car?*

yesno

Private Hire Use?

YesNoNot Sure

Proposer (Vehicle Registered Owner Only)

Full Name (As per NRIC)*

NRIC Number*

Email*

Contact Number*

Date Of Birth*

License Passing Date*

NCD (Optional)

Previous Insurer

CLAIM EXPERIENCE

Any claims for past 3 years?*

Suspension of Driving*

ADDTIONAL INFORMATION

Promotional Code (Optional)

How Did You Hear / Find Us?*

Remarks

Attachment

CHOOSE FILE

No File Choosen

Please attached your renewal notice / log card / driving license & etc. If more than 1 file, zip it before attaching. (Max allowed file size is 10MB)

I’ve read and accept the terms & conditions