Statement pursuant to section 25(5) of the Insurance Act (Cap. 142) -You are to disclose fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder may be void.
 

Personal Particulars

Title*:
Sur Name*:
Name*:
ID Type*:
NRIC/ Passport No*:
Date of Birth*:
Occupation*:
Work Environment*:
Gender*:
Marital Status*:
Mobile*:
Email*:

Contact Address

Street Name*:
Floor Level*:
Unit No*:
Building Name:
House No / Blk*:
Postal Code*:
Country*:

Driver Details

Driving Experience*:
Claim Experience (Past 3 years)*:
NCD Entitlement Upon Renewal*:
Are you the main driver?* :

Car Detail

About Your Car* :
Car Make* :
Car Model* :
Car Registration Number* :
Vehicle Type* :
Engine Capacity :
Years of Registration:
Type of Coverage* :
Current Insurance Company* :
Insurance Expiry Date:

Want to know more about us?

ABOUT US

E.A. Conquest Pte Ltd is a general insurance agency incorporated in 2008.

In the initial stages, the company was headed by the late Mr Arifin Abu who had more than 40 years of experience in the general insurance industry. A young and dynamic team was eventually groomed. More about us here.

Keep in touch

CONTACT INFORMATION

45 Kallang Pudding Road #10-08 Alpha Building Singapore349317

Tel: 62230025, Fax: 68482051

E-Mail: 

Web: http://eaconquest.com