Fire Insurance Quotation Form

1. Applicant Information

Applicant Capacity *

Property Owner

Tenant

Full Name (as per IC / Passport) * Please enter your full name.

Identification Type * Please select ID type.

Identification Number * Please enter a valid 12-digit MyKad number.

Phone Number (WhatsApp) * Please enter a valid phone number.

Email Address * Please enter a valid email address.

2. Property & Risk Assessment

Coverage Start Date * Please select coverage start date.

Property Postcode * Please enter a valid 5-digit postcode.

Property Building Type * Please select property type.

Is the Property Currently Flooded? *

Yes

Will the Property Be Unoccupied for 90 Days or More? *

Yes

Any Loss or Damage Within the Past Two Years? *

Yes

Loss or Damage Details * Please specify loss/damage details.

Disclosure Notice Pursuant to Schedule 9 of the Financial Services Act (FSA 2013)

Pursuant to Paragraph 5 of Schedule 9 of the Financial Services Act 2013, you have a duty to take reasonable care not to make a misrepresentation when answering the questions in this quotation form. You must answer all questions fully and accurately. Failure to take reasonable care in answering the questions may result in voidance of your contract, refusal or reduction of claim(s), change of terms or termination of your contract.

I confirm that I have read, understood, and agree to the disclosure notice above and declare that all details provided are true and complete.

You must agree to the disclosure declaration before proceeding.

Get Your Fire Insurance Quotation

Ahmad Fedaeez