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Your Contact Details

Salutation *

Name *

NRIC/FIN Number (last 4 digits, e.g. 123A) *

Date of Birth *

Contact Number *

Email Address *

Gender *

Occupation *

Martial Status *

Driving Experience *

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

Vehicle Number *

Period of Insurance *

Type of Insurance *

I agree and consent, and if I am submitting information relating to another individual, I represent and warrant that I have the authority from the individual to provide that information to Trans Eurokars Pte Ltd (TEPL), and I have informed the individual about the purposes for which his/her personal information is collected, used and disclosed as well as the parties to whom such personal information may be disclosed by TEPL to their respective related corporations and affiliates, authorized service providers including but not limited to Eurokars Financial Services Pte Ltd (EFS) and 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 carry out the object of this insurance quotation service.

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 Financial Services Pte Ltd ("EPS"), its related corporations and affiliates (collectively, "Eurokars Service"), 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.

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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 Service for the purposes stated above.