| Policy Motor Quotation

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Existing Quotations

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Insured Details

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Insured Name

Insured ID

Vehicle Details

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Vehicle No. *

Vehicle Model

Insured Details

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Details

Insured Details

Attn:

Type

Insured Name

NRIC/ ID

Date of Birth

Age

Gender

Race

Marital Status

Occupation

Address

Postcode

City

State

Email

Contact No. 1

Contact No. 2

Contact No. 3

Fax No.

Remarks

Insured Details

Type

Insured Name

Mother Company

Business Nature

Company No.

SST No.

SST Date

Person Contact

Remarks

Address & Contacts

Address

Postcode

City

State

Email

Contact No. 1

Contact No. 2

Contact No. 3

Fax No.

Risk Address & Contacts

Address

Postcode

City

State

Contact No. 1

Contact No. 2

Fax No.

Vehicle Information

Vehicle No.

Vehicle Model

Engine No.

Vehicle Body

Chassis No.

Year Make

KG/(CC)

Color

Log. Book

Use of Vehicle

Finance

Seat

Excess

Roadtax

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Quotation Detail

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Quotation No.

Quotation Date

Permit *

Company Code *

Reference No.

Insured Name

Vehicle No.

Principal Code *

Class Code *

Effective Date

Expired Date

Policy Type *

Remarks

Show Remarks in quotation

Drivers

Driver 1

Driver 2

Driver 3

Driver 4

Premium

Policy Type

Premium

Total Comm. %

Sum Insured

Total Comm. RM

Agreed Value

Total Rebate RM

All Riders

All Riders Premium

Comm. After Rebate RM

Loading % (Vehicle)

Loading % (Age)

Loading Premium

Company Comm. %

NCB Rate %

NCB Amount

Company Comm. RM

Windscreen

Windscreen Premium

Excess

Extra Benefits with Comm.

Debtor Comm.

Extra Benefits without Comm.

Introducer Comm.

Gross Premium

Tax

Principal RM

Tax Amount

Stamp Duty

Total Pemium

Other Amount

Company Rebate

Roadtax

Total Amount

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Vehicle Details

Vehicle No.	Vehicle Model	Year Make	Use of Vehicle	Select

Item	Tax	Amount	Action
			Add
		0.00

Search Debtor

Debtor	Production Rate	Actual Amount	assoId	Comm. %	Comm. Amount	Rebate	Delete

Search Introducer

Introducer	Actual Amount	intrId	Comm. %	Comm. Amount	Rebate	Delete

1

All Drivers

Premium

2

Legal Liability of Passengers (LLOP)

Standard RM 7.50

3

Legal Liability to Passengers (LLTP)

25% of T/Party Premium

4

Flood, Typhoon & Earthquake (Disaster)

0.5% of Sum Insured

Policy No

Motor PA

Policy Name

Benefit	Amount	Action
		Add
	0.00

Total Additional Premium

Benefit	Amount	Action
		Add
	0.00

Total Additional Premium