REQUEST FOR INFORMATION

Thank you for taking the time to register your request for information about our insurance products. Please fill in as much information as you can to help guide us to respond properly to your request with the information you require.

Contact Information

Title: Mr. Ms. Mrs. Miss Dr.

Surname:

Other Name(s):

Business Title:

Organization:

Street Address 01:

Street Address 02:

City:

State (Malaysia only):

Postal Code:

Country:

Phone:

Fax:

E-Mail Address:

I prefer to be notified via: Mail E-Mail Phone Fax

Insurance Product(s):

All Risks Insurance
Boiler & Pressure Vessel
Bond Insurance
Burglary
Contractors All Risk (CAR)
Employer's Liability Insurance
Equipment Insurance
Erection All Risks (EAR)
Fidelity Guarantee
Fire Insurance
Golfers' Insurance
Goods-In-Transit Insurance
Hospital Income Plan
Houseowners Insurance (Building)
Householders Insurance (Content)
Machinery & Equipment Insurance
Machinery Breakdown Loss Of Profit
Electronic Equipment

Machinery Breakdown Insurance
Marine Cargo Insurance
Marine Hull
Money Insurance
Passenger's Driver Plan
Personal Accident Insurance (Continential Scheme)
Personal Accident Insurance (PA 10 Plus)
Personal Accident Insurance (Unit Scheme)
Plate Glass
Professional Indemnity Insurance
Public Liability Insurance
Sporting Guns Insurance
Traveler's Personal Accident
Vehicle Occupants Insurance
Workmen's Compensation Insurance
Yacht & Pleasure Craft

Please have an agent contact me as soon as possible

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