Supercars – Desktop
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Vehicle
Plan Type
Comprehensive
Third Party, Fire and Theft
Third Party only
Choice of Workshops
Preferred workshops
Authorised workshops
Sum Insured
Market Value at Time of Loss
Other Value
Current Market Value
Sum To Insure
* Optional Coverage to Include
Soft Top / Canvas Top
Other Types of Coverage
Include Cover For
Sum Insured
Other Coverage To Include
Include Cover For
Sum Insured
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Vehicle Usage
What will the car be used for?
Private use
To and from work
Insured’s / employer’s business
Embassy use
Motor trade
Test driving
Rental
Private hire
Other purposes (please state)
What other purposes the car will be used for?
How often will the vehicle be driven to Malaysia?
Weekly or more
Monthly
Less than 12 times a year
Never
Vehicle Details
Tick here if this applies
This is a new vehicle / 2nd hand vehicle about to be taken over
Take Over Date
Vehicle Financing
On Hire Purchase or Loan
Fully Paid Up
Name of Finance Company
Scheme
Non Off Peak
Off Peak
Engine Type
Non Turbo Engine
Turbo Engine
Vehicle Type
Non Parallel Import
Parallel Import
Number of Seats
Modifications
Does this car have any modification, conversion, customisation and / or alteration (including the addition of accessories)?
Yes
No
Note :
You might have to provide invoice and LTA’s approval documents at a later date.
Modification Details
Fixture / Accessory / Spare Part
Cost Price / Invoice Amount
Will this fixture / accessory / spare part affect vehicle performance?
Yes
No
Was this provided without charge by the car manufacturer and / or new car distributor?
Yes
No
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