OneCENT - Member Area

Username:
Wallet Name:

**Please fill up this form and submit

The insurance will be processed within working hour 9:00 AM - 6:00 PM

Insurance Form (TAKAFUL IKHLAS)

Wallet Name

Name

IC Number

Occupation

Address

Phone Number (Mobile)

Phone Number (Office)

Phone Number (House)

Vechicle Reg. No/ Trailer No

Make

Model

Year Of Manufactured

Hire Purchase Company

Previous Insurer Particulars

Second Driver Name

Second Driver Identification Card Number

ADDTIONAL COVERAGE

STRIKE, RIOT AND CIVIL COMMOTION :

FLOOD, WINDSTROM & TYPHOON :

L.L.O.P. FOR ACTS OF NEGLIGEN :

WINDSCREEN :

LEGAL LIABILITY TO PASSENGER :

PRIVATE HIRE CAR ENDORSEMENT :

ADDTIONAL DRIVER

Additional Driver Name

Additional Driver Identification Card Number