Car Insurance Renewal

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Name

First Name

Last Name

NIRC

Date of Birth

YYYY

Gender

Occupation

Contact Number

Years Of Driving Experience

NCD (%)

Vehicle Number

Vehicle Make (E.g. Toyota)

Vehicle Model (E.g. Altis)

Year of Make

Current Insurer

Current Premium

OPC

Have you made a claim or been in an accident before?

Do you have any demerit points?