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Borang Daftar Takaful Kenderaan
Bagi tujuan pengesahan maklumat dan keselamatan.
Proses ini berfungsi setelah dimaklumkan kepada saya, melalui SMS atau CALL.
Azim Barin
No Tel : 013-7132854
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Maklumat Pemilik Kenderaan
Nama
*
Pemilik kenderaan terkini.
Your answer
No K/P
*
k/p baru
Your answer
E-Mail
Your answer
No Tel
*
Rumah / Pejabat / Bimbit
Your answer
Alamat
*
Tetap ( Surat- menyurat, terkini )
Your answer
Maklumat Kenderaan
No Pendaftaran
*
Your answer
No Ejin
*
Your answer
No Casis
*
Your answer
Buatan
*
Your answer
NCD
*
No Claim Discount
Your answer
Model
*
Your answer
cc kenderaan
*
Your answer
Tahun buatan
*
Your answer
Bil tempat duduk
*
Your answer
Tarikh takaful/insurans
*
Your answer
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