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Motor Insurance Quotation Request Form
(汽車保險報價表)
 
  Comprehensive (全保)
Third Party Only(第三保)
Sum Insured(投保金額):HK$

Vehicle Information(受保車輛資料)
Name of Insured:
(客戶名稱) :
Vehicle No.:
(車牌號碼) :
Manufacturer and Model :
(廠名及型號)
[e.g. HONDA ACCORD] :
Year of Manufacturing :
(製造年份) :
Capacity:
(氣缸容量) :
Body :
(車身類別) [e.g. SALOON] :

Driver’s Information (駕駛者資料)
Occupation :
(職業) :
Age :
(年齡) :		 Years
Driving Experience
(駕駛經驗) :		 Years
No Claim Bonus Entitlement
(無索償折扣優惠) :		 %
3 Years Claims Record :
(最近3 年遇事紀錄) :		 Yes(有) No(無)
(if yes, please give details) :
(如有, 請提供詳情) :
conviction/prosecution/driving offence point record :
(曾違例被扣分, 觸犯交通規則或被警方起訴) : 		Yes(有)
 No(無)
(if yes, please give details) :
(如有, 請提供詳情) :

Contact Information (聯絡人資料)

Name :
姓名 :

Phone No. (Mobile) :
電話（最好是手機） :

Fax No. (if available) :
傳真（如有）
e-mail Address
 
我們的職員收到請求後會盡快聯絡你。謝謝!
We will contact you once our staff receive your request. Thank you!
 
 
 
 

 
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