Owner Name:

NRIC Number:

Date Of Birth (YYYY-MM-DD):

Gender:
FemaleMale
Marital Status:
MarriedSingle
Occupation:

Occupation Nature:
IndoorOutdoor
Property (Home) Address:

Property (Home) Postal Code:

Property Type:
—Please choose an option—Executive CondoCondoHDBLanded
Occupancy Type:
—Please choose an option—Owner & OccupierLandlordTenant
Coverage Plan:
—Please choose an option—All-in-One (Building/Collectibles/Contents)Exterior Building OnlyInterior Building & Contents OnlyCollectibles & Contents Only
Coverage Type:
—Please choose an option—Named PerilsAll Risks
Insure with High Valuable Contents?
YesNo
To include Personal Belongings with worldwide coverage?
YesNo
To include Personal Collectibles with worldwide coverage?
YesNo
To include Jewelries/watches with worldwide coverage?
YesNo
To include Family Personal Accident?
YesNo
To include Cyber Protector for You & Your Family?
YesNo
List of Valuable Items & its' values (Optional):

Current Insurer:

Coverage Period-From (YYYY-MM-DD):

Any Claim(s) for the past 3 years?
YesNo
If yes, please enter accident(s)/claim(s) details:

Existing Renewal Notice (Optional):

Contact Personnel:

Contact Number:

Email:

Prefer to contact via:
Phone CallSMSE-Mail

By submitting this request, I understand that all information provided above are correct and PERLE is given the permission to use my information. I acknowledge having read through the Privacy Policy and consent to use my information for the purpose of obtaining insurance quotes and to be contacted for quotation updates. Where the data provided is not mine, I confirm that I have the consent of the owner to provide such data.

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