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Your Contact Details

Salutation *

Name *

NRIC/FIN Number (full NRIC/FIN number to validate NCD) *

Date of Birth *

Contact Number *

Email Address *

Gender *

Occupation *

Martial Status *

Driving Experience *

Make / Model (e.g. MINI One 5-door) *

Vehicle Number *

Year of Vehicle Registration *

Current Insurer *

Policy End Date/Month *

Vehicle Usage

Normal

Off-Peak

Private Hire

Referrer *

Promo Code (if applicable)

I consent to the collection, use and disclosure of my personal data by Eurokars Financial Services (“EFS”)^[1], its affiliates and their related corporations ("Eurokars Group"), and their authorised and/or appointed service providers, agents, business partners (including but not limited to our insurance partners) and other relevant third parties, in accordance with the Personal Data Protection Act 2012 and the purposes set out in the Eurokars Group Data Protection Policy available at https://www.eurokarsgroup.com/data-protection/ in order to provide you with the requested information, products and/or services including providing insurance quotations from our insurance partners; processing, administering and/or managing your relationship, account and policy with us and/or our insurance partners; providing body and paint services; and/or carrying out your instructions or responding to any enquiries by you.

If I am submitting information relating to another individual, I represent and warrant that I have the authority from that individual to provide his/her information (including his/her personal data) to Eurokars Group, and I have informed the individual about the abovementioned purposes for which his/her personal data is collected, used and disclosed.

I also request for and consent to the collection, use or disclosure of my personal data (including where applicable my Singapore telephone numbers) by ("Eurokars Group"), and its business partners and marketing partners for the purpose of sending me marketing and promotional material about products and services, benefits, promotions and rewards or to identify products or services which may be relevant to me, via the following channels.

Phone Call

SMS

I confirm and agree that leaving any of the boxes [or: “fields”] above blank will not be treated as a withdrawal of any other consent(s) that I may have previously provided to the Eurokars Group for the purposes stated above.

^[1] Eurokars Financial Services (UEN 53491457L) is a registered business of Indo Universal Pte. Ltd. and an affiliate of Eurokars Group.