Certificate of Motor Insurance by yvh52457

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									                                                                       SHC CAPITAL LIMITED
                                                                                     302 ORCHARD ROAD, #09-01 TONG
                                                                          BUILDING,
                                                                       SINGAPORE 238862
                                                                            TEL: 6829-9199 FAX: 6829-9248
                                                                            WEB : www.shccapital.com.sg
                                                                                   E-MAIL: info@shccapital.com.sg
                                                 PRIVATE MOTOR INSURANCE PROPOSAL
IMPOTANT NOTES
1. Under Section 25(5) of the Insurance Act Cap 142 or any subsequent amendment thereof, you are to disclose in this Proposal Form, fully and faithfully, all the facts you
know or should know, otherwise the Policy may be void.
                       2. All questions in this Proposal Form must be answered before this Proposal can be considered. Any question not answered will be taken as answered
in the negative.
DETAILS OF REGISTERED OWNER
Name:                                                                                                                    Tel (Office):
Address:                                                                                                                 Tel (Home):
NRIC / Passport / ROC No.:                                                                                               Handphone / Pager:
Nationality:                                                                                                             Email / Fax:
Occupation:                                                                                     Indoor / Outdoor * Sex:
Employer:                                                              Certificate of Merit: YES /NO *                   Date of Birth:
Driving Licence Pass Date:                                             Marital Status:                                   Demerit Point:

DETAILS ON PAST INSURANCE
Existing / Past Insurer :                                              Policy No. :                                                           NCD:
Vehicle Registration No. :                                             No. of Claims over last 3 years :
Renewal Declined: YES / NO *                                           Quantum of Claims: Own Damage                                          3rd Party

DETAILS OF VEHICLE TO BE INSURED
Make :                                                                                          Model :
Body Type :                                                                                     Vehicle Registration No.:
Seating Capacity:                                                                               Engine Capacity :
Year of Registration :                                                                          Year of Manufacturing :
Engine No. :                                                                                    Chassis No.:
Finance Company :                                                                               Usage (indicate if others) : Pte / Own Biz *
Parallel Import : YES / NO *                                                                    Transmission Type : AUTOMATIC / MANUEL *
Modification to Vehicle original specifications:
Other options / accessories to be insured :
Off-Peak Car: YES NO *

DETAILS OF COVERAGE
Type of Cover : Comprehensive / Third Party Fire & Theft / Third Party Only *
Insurance Plan: SHC-Authorized Workshop Plan / Dealer's Workshop Plan (terms and conditions apply) *
Period of Insurance :                                  to                                       NCD Protector (50% NCD required): YES / NO *
Premium Payable (inclusive of GST):
Own Damage Excess (Sect I):                                                                     Excess (Sect II):
Other Restrictions / Conditions:


   * Delete whichever is not applicable                                                                                                               Ver_010806
                                                                          SHC CAPITAL LIMITED
                                                                                        302 ORCHARD ROAD, #09-01 TONG
                                                                             BUILDING,
                                                                          SINGAPORE 238862
                                                                               TEL: 6829-9199 FAX: 6829-9248
                                                                               WEB : www.shccapital.com.sg
                                                                                      E-MAIL: info@shccapital.com.sg
DETAILS OF NAMED DRIVERS
                                   Please provide details of any person, who in your knowledge, will drive the vehicle. Kindly noted that an additional excess of S$2,500 (Section
I & II) will apply for Young or Inexperience or Elderly drivers, ie any person (whether named or unnamed) who is below 25 years old or has held a driving licence for less than 3
years or is above 65 years old. An additional excess S$500 (Sect I & II) for unnamed drivers will be imposed. First 2 named drivers free. Subsequent additional named driver
at $52.50 (inclusive of GST) each.
Name                                          Sex                         Date of Birth            Occupation                 Relationship          Licence Pass Date




NAMED DRIVER(S) DRIVING HISTORY
Please provide details if any named drivers has accident and/or claims in the past 3 years:




DECLARATION AND AUTHORISATION
I declare that
1) The information in this form and attached documents are correct and truthfully disclosed. I understand that any material omission or
      misrepresentation may render the Policy void.
2) The vehicle will be kept in good condition.
3) I will pay SHC Capital Limited additional premium if the NCD confirmed by my previous insurer is less than what I have disclosed
4) I accept the Policy subject to SHC Capital Limited standard terms, conditions and provisions, as detailed in the Certificate of
      Insurance (CI) and Policy Schedule and any subsequent Endorsements.
5)     I agree to SHC Capital Limted to verify pertinent information with my ex-insurers, LTA, Traffic Police and bodies / organizations in relation to this
       motor insurance.
6)     I understand that in the event of an accident:
                                                               - Repairs at SHC-Authorized Workshops - repairs are to be carried out at SHC authorized
       workshops. Otherwise an additional excess S$1,000 will apply.
                                                                                  - Repairs at Dealer's Workshops - repairs are allowed at the Dealer's
       workshop, subject to an additional excess S$200. Otherwise an additional excess S$1,000 will apply for unauthorized workshops.
7)  I understand that the proposal is subject to additional excess S$2,500 (Sect I & II) for Young or Inexperience and/or Elderly drivers.
8)  I understand that the proposal is subject to additional excess S$500 (Sect I & II) for Unnamed drivers.
9)  I understand the Liability of SHC Capital Limited in respect of this Proposal does not commence until acceptance has been communicated to the
    Proposer or its intermediaries.
10) I undertand this Policy carries a Premium Payment Warranty which requires the premium to be paid in full before commencement of cover


       Signature of Registered Owner:

       Name / Company Stamp:
       Date:

Quotation ref:                                                            For Office use:
For Agency / Broker use:                                                  Insured Code:
       Name:                                                              Approved by:
       Code:                                                              Date:
                                                                          Remarks:
       Collect from Orchard office
       Collect from Toa Payoh office
       Print from own office (need to enable)
       Mail to agent


     * Delete whichever is not applicable                                                                                                                   Ver_010806

								
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