Notify us in case of a car accident

Personal Info

Upload Driver's NRIC or Passport

Upload Driver's License

Upload Insured's NRIC or Passport

Upload Insured's License

Upload Police Report

Upload Vehicle Ownership Certificate

Upload Other Supportive Document

Upload Other Supportive Document

Upload Other Supportive Document

Upload Other Supportive Document

Upload Other Supportive Document

Upload Other Supportive Document

Confirmation

Confirmation

Claim Type

Motor


Date Of Loss

02/08/2019


Insured Name

Jason Smith


Vehicle Registration Number

WWW 9999


Email

abc@example.com


Mobile Number

0123456789


Damage/Loss Type

Own Damage Claim


I am submitting as (intimation)

Myself


Uploaded File