top of page
Motor Insurance Application Form
Please fill in all the mandatory fields marked with *
Insurance Details
Insurance Type*
No Claim Discount (%)*
Details of Car
Car Make*
Car Model*
Body Type*
Year of Make*
Engine Capacity (cc)*
(input "0" if it is motorcycle)
Sum Insured (HKD)
Main Driver Details
Driving Experience*
Age*
Occupation*
Has the main driver accumulated more than 6 driving offence points in the past 24 months?*
Has the main driver had any accidents, claims or serious driving offence convictions or suspension (careless driving, dangerous driving, drink driving) in the last 5 years?*
Second Driver Details
Driving Experience*
Age*
Occupation*
Has the main driver accumulated more than 6 driving offence points in the past 24 months?*
Has the main driver had any accidents, claims or serious driving offence convictions or suspension (careless driving, dangerous driving, drink driving) in the last 5 years?*
Any other information?
Contact Details
Main Driver Full Name*
Corresponding Address
Phone Number*
Email*
Successfully submitted!
Please fill in all the mandatory fields marked with *
bottom of page