AYA SOMPO Travel Insurance

Policyholder Details

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Policyholder Information

Name

NRC

Passport

Birth Date

Phone Number

Email

Mailing Address

Building

Street

Region

District

Township

Town

Ward

Policy Details

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Policy Information

Proposed Insured Vehicle Value

Intended Policy Start Date

Intended Policy End Date

Registration No (Vehicle No) eg:1C/1234(YGN)

Make (Please reference to Wheel Tax and Owner Book)

Model (Please reference to Wheel Tax and Owner Book)

Type Of Body

Year Of Manufacture

Vehicle Usage

Electric Vehicle

Engine

Engine Power (CC)/Battery Capacity (Watt)

Chassis No eg:URJ202-4088343

Commercial License Information

License Expiry Date

Has engine been specifically adapted to increase performance?

Yes

No

Policy Details

Please fill driver information

Driver Information

Driver Name

Driver NRC

Date of Birth

Driving License No eg:E/01926/09

Driver License Expiry Date

Year Obtained

Whether the driver been convicted for motoring offence during the past 3 years

Remark

Driver Relationship with the Car Owner

Other Information

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Other Information

Usage Way/Route

Parking Location

CCTV

Security Guard

Previously Insured?

Yes

No

Any loss record?

Yes

No

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Live taking images

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* NRC (front)
* NRC (back)
* Wheel Tax, License, Owner Book (front & back)
* Market Value Reference

Motor Underwriting Form

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Personal Insurance

Commercial Insurance

Services

Promotions

OUR COMPANY

Our Corporate Policies

Our Corporate Information

Motor Underwriting Form

Policyholder Details

Policy Details

Policy Details

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