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Your Contact Details

Salutation *

Name *

Contact Number *

Insurance Brands *

Insurance Expiry Date *

Email *

Vehicle Number *

Message

By providing my personal data and submitting this form, I confirm that I have read, understood and consent to the collection, use, disclosure and processing of my personal data by Eurokars Services (“EPOPL”), its related corporations and affiliates (collectively “Eurokars Group”) and their authorised service providers and relevant third parties, in accordance with the purposes set out in the Eurokars Group Data Protection Policy available at www.eurokarsgroup.com/data-protection or made available to me upon request, for the purposes of contacting me regarding my enquiry.

Where I have provided the Eurokars Group with the personal data of third parties, I hereby confirm that I have obtained the consent of those third parties for the disclosure of their personal data to the Eurokars Group for the purposes set out in the Eurokars Group Data Protection Policy.

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 Services"), 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

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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 Group for the purposes stated above.