Register Now

Fields marked with * are mandatory.
Car Registration Number *
Car Brand *
Car Model *
Year Manufactured *
Payment Mode *	Online Payment
Payment Amount *	extra add on 5 days RM 80.00 (Allianz & Zurich members only) RM 138.00 (10 days) RM 260.00 (20 Days)
New IC Number *
Address *
Full Name *
Email Address *
Handphone *
Introducer *	Ira Thurgashini Raja Logendren Suren Prakesh Krishnan
From *	Allianz Zurich Berjaya Sombo Chubb Other
Remarks
To help prevent automated spam, please answer this question * Using only numbers, what is 10 plus 15?