Please fill in this form for quotation

Your Name: Hand Phone: E-Mail: Insured Name: Date of Birth: New Identity Card No: Other Identity Card: Insured Address 1: Insured Address 2: Post Code and City: State : Prefer Takaful / Insurance:Etiqa Takaful BerhadCIMB Aviva TakafulTakaful MalaysiaAllianz InsuranceKurnia Insurance Berhad Vehicle Number: Cubic Capacity: Seating Capacity Year of Make: Body Type: Engine No: Chasis No: Sum Insured: Name of Financial Institution Name of Current Insurance Company: How To Deliver Your Cover Note?FaxEmailCourier (RM5)Normal Post Delivery Instructions: Other Comments:If you would like to write your note, please type here. Please take note that we will threat all your information given in the above form as confidential. Our PIAM (Persatuan Insuran Am Malaysia) No: 132997-00. TQ.

The Flow

1. After we receive your details, we will check your information and generate the quotation into your email.

2. If you agree to proceed, bank-in the payment into our current account.

Maybank ~ 5590 1200 3542 ~ NN Ikhlas Trading

3. We will convert the Quotation to Cover Note, and sent to JPJ online.

(within 2 working days; after we receive the payment)

4. We will fax / email / courier your Cover Note according to your request.