RENEW ROAD TAX / INSURANCE / TAKAFUL WITH AT VENTURE
Renew Road Tax / Insurance / Takaful for your vehicle with AT Venture. With This Form Submission, I Agree To The Terms & Conditions.

Perbaharui Road Tax / Insurance / Takaful untuk kenderaan anda dengan AT VENTURE. Dengan Penghantaran Borang Ini Saya bersetuju Dengan Terma & Syarat.

http://atventure.com.my/termsandconditions.html
I WOULD LIKE TO CHOOSE ( Saya Ingin Pilih) *
VEHICLE REGISTRATION NO. (No. Penftaran kenderaan) *
Eg. (Contoh) : ABC123
TYPE OF VEHICLE (Jenis Kenderaan) *
OWNER'S I/C (No. Kad Pengenalan) *
NRIC OR OLD IC OR ARMY OR POLICE OR PASSPORT. TO DETECT NO-CLAIM DISCOUNT UP TO 55%. (Untuk mengesan Diskaun Tiada Tuntutan Sehingga 55%. Eg. (Contoh) : 890924435009 .
OWNER'S FULL NAME ( Nama Penuh Pemilik Kenderaan) *
Eg. (Contoh) : Diana Binti Danial
POSTCODE (Poskod) *
FOR COVER NOTE. (Untuk Nota Perlindungan) Eg. (Contoh) : 48300
EMAIL (Emel)
Eg. (Contoh) : dianadanial@gmail.com
CONTACT NO. (No Untuk Dihubungi) *
Eg. (Contoh) : 0123456789
PLEASE SEND QUOTATION TO.. (Mohon Hantar Sebut Harga Ke..) *
THANK YOU. WE'LL SEND YOU THE QUOTATION AS SOON AS POSSIBLE =)
Terima Kasih. Kami Akan Memberikan Sebut Harga Secepat Yang Mungkin =)
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy