REGISTRATION DETAILS

Application Center (Required)

Type of Registration (Required)

Warranty Card Number (Required)

Date of Treatment (Required) ex. (dd-mm-yy)

Vehicle Make (required)

Vehicle Model (required)

Color (required)

Licence Plate Number (required)

LTA Registration Date (required) ex. (dd-mm-yyyy)

Tell us more, How do you get to know about us and how can we improve to serve you better? (Required)

VEHICLE OWNER DETAILS

Name (Required)

NRIC / Passport Number if Nationality Is Others (Required)

Date Of Birth (Required)

Nationality (Required)

RACE (Required)

Mobile Number (For SMS annual Reminder)

Email (Required)

Occupation (Required)

Annual Income

MAILING ADDRESS

House / Block (Required) ex. (No 3 or Blk 242)

Unit Number ex. (#05-67)

Street Name (Required) ex. (Serangoon Ave 3)

Building Name: (Leave Blank if not applicable) ex. (North View)

Postal Code (required)

I have read and agreed to the Terms and Conditions