Car Quote - Coverme.my

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Car Quote Form (#14) - Updated 20Dec2022

Customer Details

Full Name (Vehicle Owner)

NRIC/Passport (Vehicle Owner)

Vehicle Number

Postcode

Phone/Mobile

Please Choose The Type Of Cover And Add On

Type Of Cover

Comprehensive

3rd Party Fire & Theft

Add On (Optional)

Windscreen - Cover the cost to replace or repair breakage of glass in windscreen, window or sunroof of your car.

Special Perils - Cover loss or damage to your car caused by natural disaster e.g. flood, landslide, landslip, storm, or other convulsions of nature.

Personal Accident - Cover in the event of accidental injury or death of the driver and passenger.

No Add On

No - I don't need any additional coverage.

Include Road Tax

Yes

Reference Code

Customer Details

Full Name :
NRIC/Passport :
Vehicle Number :
Postcode :
Insurance Type :

Add On :
Include Road Tax :
Contact :
Email :
Reference Code :

I have read and agree to the Terms and Conditions

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You're one step closer to getting the best insurance rate for your car

Car Insurance

Customer Details

Please Choose The Type Of Cover And Add On

Customer Details

Most Major Banks Accepted

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