Accord Insurance Agency

Vehicle & Owner Details

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Name*

Han Yu Pin Yin Name

NRIC Number*

Gender*

Date of Birth*

Occupation

Driving Experience*

Mobile Number*

Email*

Vehicle Details

Vehicle Number*

Vehicle Type

Vehicle Make*

Vehicle Model*

Vehicle Chassis Number*

Vehicle Engine Number

Vehicle Motor Number

Vehicle Year of Manufacture*

Vehicle Original Registration Date*

Vehicle Road Tax Expiry Date*

Vehicle Attachment 1

Vehicle Attachment 2

Vehicle Attachment 3

Vehicle Scheme*

Vehicle Engine Capacity*

Vehicle Power Rate

Vehicle Propellant*

Vehicle Maximum Laden Weight

Vehicle Maximum Unladen Weight

NCD*

Vehicle Usage

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