Motor Insurance Manual Entry

Motor Insurance Form

Access Code | Log Card

Enter your details below to request a motor insurance quote. You may use an access code or upload your log card.

Personal Information

Full Name *

Date of Birth *

NRIC/FIN *

Gender *

Marital Status *

Occupation

Driving Experience *

Email *

Mobile Number *

Vehicle Information

Choose how you want to provide vehicle information.

Access Code

Log Card Upload

Access Code *

Vehicle Number *

Vehicle Usage *

NCD *

Other Information

Insured Driving

Named Driver's Name

Named Driver's NRIC/FIN

Named Driver's Gender

Named Driver's Marital Status

Named Driver's Driving Experience

Named Driver's Claims (past 3 years)

Relationship

Special Instructions

I agree and confirm that all information provided is accurate and complete.

By submitting, I agree to the collection, use and disclosure of my personal data for AIB Insurance Brokers' affiliated agencies to contact me about this quote, its products, services and other personalised marketing content.