Private Vehicle Form Commercial Vehicle Form Name: NRIC): Date Of Birth: License Passed Date: Gender: MaleFemale Marital Status: MarriedSingleNAOthers No Claim Discount: 0%10%20%30%40%50% Vehicle Plate Number: Any claims for the past 3 years? If yes, please provide details below: Renewal Premium: Contact No: Email Insurance Expiry Date: Referral (if any): Your Message to us: Attachment of file, if any: I consent to Premiergen Pte Ltd and its employees to use my personal data for insurance quotations represented by the company, processing of renewals and to contact me via Emails/Voice Calls/SMS at contact information provided or registered in their database. * Company Name: UEN: Nature of Business: Type of Vehicle: No Claim Discount: 10%20%30%40%50% Vehicle Plate Number: Any claims for the past 3 years? If yes, please provide details below: Current Insurer: Renewal Premium: Contact No: Email: Insurance Expiry Date: Your Message to us: Attachment of vehicle log card: I consent to Premiergen Pte Ltd and its employees to use my personal data for insurance quotations represented by the company, processing of renewals and to contact me via Emails/Voice Calls/SMS at contact information provided or registered in their database. *
