"*" indicates required fields

1Personal Particulars

2Address (in Singapore)

3Emergency Contact

4Vehicle Details

5Checkout

REGISTRATION FORM

Personal Particulars

Salutation*

Surname*

Name*

Gender*

Male

Female

ID Type*

NRIC / Passport No*

ID Others*

Date of Birth*

Nationality*

Occupation*

Work Environment*

What is your marital status?*

Married

Single

Divorced

Widowed

Mobile Number*

Email Address*

Important notice

Statement to section 25(5) of the Insurance Act (Cap. 142). You are to disclose fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder may be void.

REGISTRATION FORM

Address

House No./ Blk*

Building Name

Street Name*

Floor Level

Unit No

Postal Code*

Country*

Important notice

Statement pursuant to section 25(5) of the Insurance Act (Cap. 142) -You are to disclose fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder may be void.

Personal Data Collection Statement

AAS Insurance Agency Pte Ltd. ("AAS-IA") recognises its obligations under the Personal Data Protection Act 2012 (PDPA) which includes the collection, use and disclosure of personal data for the purpose for which an individual has given consent to. The personal data collected by AAS-IA includes all personal data provided in this form, or in any document provided, or to be provided to us by you or your insured persons or from other sources, for the purpose of this insurance quotation request, application or transaction. It includes all personal data for us to generate motor insurance quotations from our appointed insurance partners. You may not alter any of the wordings in this "Personal data collection statement". Any attempt to do so will be of no effect.

Purpose of collection

We may collect and use the personal data to: generate motor insurance quotations from our appointed insurance partners; process, administer and/or manage your relationship, account and policy with our appointed insurance partners; carry out your instructions or responding to any enquiries by you.

Disclosure of personal data

We may disclose personal data belonging to you and your insured persons for the purpose set out in Section 1 above to the following parties:

a) Automobile Association of Singapore b) AIG Asia Pacific Insurance Pte. Ltd. c) Liberty Insurance Pte Ltd d) Tokio Marine Insurance Singapore Ltd. You may request to withdraw your consent, access or correct your personal data by contacting AAS-IA at; Tel: 6389 4241 Email: [email protected] Service counter: 2 Kung Chong Road, #04-01 AA Centre, Singapore 159140

Declaration and Authorisation to Automobile Association of Singapore

• In order for me to enjoy insurance services available to AA Members, I consent to be an AA Member and agree to the Privacy Policy of AA Singapore. • I also authorise and give consent to AA Singapore, its subsidiaries and partners to communicate with me via post , email, SMS text messaging and/or telephone on any insurance product, service, benefit and /or promotion.

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