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Identity
Mr
Ms
First Name
Middle Name
Last Name
Email Address
Mobile Number
Vehicle Information
Vehicle Make
Vehicle Model
Vehicle Year
Variant
Transmission
Automatic (AT)
Manual (MT)
Seating Capacity
Vehicle Latest Value
What is the primary use of your car? (Select one only)
Private
TNVS/Grab
Mortgage (Select one only)
Yes
No
If Yes, provide Bank Name
Date of Expiring Policy
Would you like to receive promos, updates, and rewards?
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