Estimated Value
RM
Engine CC
0 - 1400
1401 - 1650
1651 - 2200
2201 - 3050
3051 - 4100
4101 - 4250
4251 - 4400
4401 dan lebih
Age
Please Select
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
\n\r
Please Select
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
No Claim Discount (NCD)
0 %
25 %
30 %
38 1/3 %
45 %
55 %
Estimated Premium
RM
ABOUT SSL CERTIFICATES
Registration
Member Registration Form
Please fill in the compulsory fields that marked as
*
Please fill in one of the field that marked as
**
1. Personal Information
Full Name
*
:
(as in IC)
Old IC / Passport / Army / Police
**
:
A
G
H
I
K
R
RF
R/F
RF/
T
S
New IC
**
:
-
-
Gender
*
:
Please select
Male
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Race
*
:
Please select
Malay
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Others
Date of Birth
*
:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Jan
Feb
Mar
Apr
Mei
Jun
Jul
Ogos
Sept
Okt
Nov
Dec
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
Home Address
*
:
Town
*
:
State
*
:
Please select
Johor
Kedah
Kelantan
Melaka
Negeri Sembilan
Penang
Pahang
Perak
Perlis
Sabah
Selangor
Sarawak
Terengganu
Wilayah Persekutuan K.Lumpur
Wilayah Persekutuan Labuan
Wilayah Persekutuan Putrajaya
Postcode
*
:
Email
*
:
House Phone
**
:
02
03
04
05
06
07
09
082
083
084
085
086
087
088
089
012
013
014
016
017
018
019
-
Office Phone
**
:
02
03
04
05
06
07
09
082
083
084
085
086
087
088
089
012
013
014
016
017
018
019
-
Handphone
*
:
010
012
013
014
016
017
018
019
-
Are you Government Servant?
*
:
Yes
No
Are you an Insurance / Takaful Agent?
*
:
Yes
No
Agent Code
*
:
Agent Type
*
:
Please select
Family
General
Insurance Company Name
*
:
Please select
ACE SYNERGY INSURANCE BHD
AIA TAKAFUL INTERNATIONAL BERHAD
AIG General Insurance (Malaysia) Berhad
ALLIANZ GENERAL INSURANCE COMPANY (MALAYSIA) BERHAD
AM ASSURANCE BHD
AMERICAN INTERNATIONAL ASSURANCE BHD
AXA AFFIN ASSURANCE BHD
BERJAYA SOMPO INSURANCE BERHAD
BH INSURANCE ( M ) BERHAD
CHARTIS MALAYSIA INSURANCE BERHAD
CIMB AVIVA TAKAFUL BERHAD
ETIQA INSURANCE BERHAD
ETIQA TAKAFUL BERHAD
HONG LEONG ASSURANCE BHD
HONG LEONG TOKIO MARINE TAKAFUL BERHAD
HSBC AMANAH TAKAFUL BHD
ING INSURANCE BERHAD
JERNEH INSURANCE BHD
KURNIA INSURANS (M) BHD
LONPAC INSURANCE BHD
MAA TAKAFUL BERHAD
MALAYSIAN ASSURANCE ALLIANCE BHD
MALAYSIAN MOTOR INSURANCE POOL
MAYBAN GENERAL ASSURANCE BERHAD
MAYBAN TAKAFUL BERHAD
MCIS ZURICH INSURANCE BHD
MSIG INSURANCE (MALAYSIA) BHD (CO INS)
MUI CONTINENTAL INSURANCE BHD
MULTI-PURPOSE INSURANS BHD
ORIENTAL CAPITAL ASSURANCE BHD
OVERSEAS ASSURANCE CORP. (M) BHD
PACIFIC & ORIENT INSURANCE CO. BHD
PACIFIC INSURANCE BHD
PROGRESSIVE INSURANCE BHD
PRUDENTIAL BSN TAKAFUL
QBE INSURANCE (MALAYSIA) BHD
RHB INSURANCE BERHAD
SYARIKAT TAKAFUL MALAYSIA BERHAD (INS CO)
TAHAN INSURANCE MALAYSIA BHD
TAKAFUL IKHLAS SDN BHD
TOKIO MARINE INSURANCE (M) BERHAD(KL)
UNI. ASIA GENERAL INSURANCE BERHAD
Bank Name
*
:
Please select
ABN AMRO BANK BERHAD
AEON CREDIT SERVICE (M) BERHAD
AFFIN ACF FINANCE
AFFIN BANK BERHAD
AFFIN BANK BERHAD
AFFIN ISLAMIC BANK BERHAD
AGRO BANK
AHLIP CREDIT & MORTGAGE SDN BHD
AKAUNTAN NEGARA MALAYSIA
AKAUNTAN NEGERI PAHANG
AL-RAJHI BANK BERHAD
ALLIANCE BANK (MALAYSIA) BERHAD
ALLIANCE FINANCE BERHAD
ALLIANCE ISLAMIC BANK BERHAD
ALLIANCE MERCHANT BANK BERHAD
AM BANK (M) BERHAD
AM FINANCE BERHAD
AM INVESTMENT BANK BHD
AM ISLAMIC BANK BERHAD
AMBANK BERHAD
AMISLAMIC BANK BERHAD
ANZ BANK
ARAB MALAYSIAN MERCHANTS BANK BERHAD
ASEAMBANKERS MALAYSIA BERHAD
ASIA COMMERCIAL FINANCE (M) BERHAD
ASIAN FINANCE BANK BERHAD
BANGKOK BANK BERHAD
BANK BUMIPUTERA (MALAYSIA) BERHAD
BANK INDUSTRI & TEKNOLOGI MALAYSIA BERHAD
BANK ISLAM MALAYSIA BERHAD
BANK KERJASAMA RAKYAT MALAYSIA BERHAD
BANK MUAMALAT MALAYSIA BERHAD
BANK NEGARA MALAYSIA
BANK OF AMERICA MALAYSIA BERHAD
BANK OF CHINA (MALAYSIA) BERHAD
BANK OF COMMERCE (MALAYSIA) BERHAD
BANK OF TOKYO-MITSUBISHI (MALAYSIA) BERHAD
BANK PEMBANGUNAN & INFRASTRUKTUR MALAYSIA BERHAD
BANK PERSATUAN (MALAYSIA) BERHAD
BANK PERTANIAN MALAYSIA
BANK SIMPANAN NASIONAL
BANK SIMPANAN NASIONAL
BANK UTAMA (MALAYSIA) BERHAD
BBMB KEWANGAN BERHAD
BMW CREDIT (MALAYSIA) SDN BHD
BSN COMMERCIAL BANK (MALAYSIA) BERHAD
BUMIPUTRA COMMERCE BANK BERHAD
BUMIPUTRA COMMERCE FACTORS LEASE BERHAD
BUMIPUTRA-COMMERCE FINANCE BERHAD
CHINA BANK
CIMB ISLAMIC BANK BERHAD
CITIBANK BERHAD
COMMERCE INTERNATIONAL MERCHANT BANK
DEUTSCHE BANK (MALAYSIA) BERHAD
DEWAN BAHASA DAN PUSTAKA
EON BANK BERHAD
EON BANK BERHAD
EON BANK BERHAD
EON FINANCE BERHAD
EONCAP ISLAMIC BANK BHD
EXPORT-IMPORT BANK OF MALAYSIA BERHAD
EXXON MOBIL
HOCK HUA BANK BERHAD
HONG LEONG BANK BERHAD
HONG LEONG FINANCE BERHAD
HONG LEONG ISLAMIC BANK BERHAD
HSBC BANK MALAYSIA BERHAD
KERAJAAN MALAYSIA
KEWANGAN BERSATU BERHAD
KUMPULAN WANG SIMPANAN PEKERJA
KUMPULAN WANG SIMPANAN PEKERJA
KUWAIT FINANCE HOUSE
LEMBAGA PELABUHAN KELANG
MAJLIS AMANAH RAKYAT
MALAYAN BANKING BERHAD
MALAYSIAN INTERNATIONAL MERCHANT BANK
MAYBAN FINANCE BERHAD
MAYBANK BERHAD
MAYBANK BERHAD
MBF FINANCE BERHAD
MIDF BERHAD
NAZA CREDIT LEASING
OCBC BANK (MALAYSIA) BERHAD
OVERSEAS UNION BANK (MALAYSIA) BERHAD
PERBENDAHARAAN MALAYSIA
PERDANA MERCHANT BANKERS BERHAD
PERWIRA AFFIN MERCHANT BANK BERHAD
PETRONAS
PLK Credit (ELK Desa Capital Sdn. Bhd.)
POS MALAYSIA BERHAD
PUBLIC BANK BERHAD
PUBLIC BANK BERHAD
Public Bank Berhad (Segambut)
PUBLIC FINANCE BERHAD
PUBLIC MERCHANT BANK BERHAD
RHB BANK BERHAD
RHB BANK BERHAD
RHB DELTA FINANCE BHD
RHB ISLAMIC BANK BERHAD
RHB SAKURA MERCHANT BANKERS BERHAD
SECURITIES COMMISSION MALAYSIA
SIRIM Berhad
SME BANK (M) BERHAD
SOUTHERN BANK BERHAD
SOUTHERN FINANCE BERHAD
STANDARD CHARTERED BANK
SURUHANJAYA SYARIKAT MALAYSIA
TAKAFUL NASIONAL SDN BERHAD
TELEKOM MALAYSIA BERHAD
TENAGA NASIONAL BERHAD
THE BANK OF NOVA CSOTIA BERHAD
THE CHASE MANHATTAN BANK (M) BERHAD
TOYOTA CAPITAL MALAYSIA BHD
UMW TOYOTA CAPITAL SDN BHD
UNITED MERCHANT FINANCE BERHAD
UNITED OVERSEAS BANK (M) BERHAD
UTAMA MERCHANT BANK BERHAD
Bank Account Name
*
:
Bank Account No.
*
:
Bank Account Type
*
:
Please select
Current
Savings
Own Credit Card?
*
:
Yes
No
2. Spouse / Close Relative Information
Full Name
*
:
(as in IC)
New IC No.
**
:
-
-
Old IC / Passport / Army / Police
**
:
A
G
H
I
K
R
RF
R/F
RF/
T
S
Relationship
*
:
Please select
Father
Mother
Husband
Wife
Brother
Sister
Contact No.
*
:
02
03
04
05
06
07
09
082
083
084
085
086
087
088
089
012
013
014
016
017
018
019
-
MOTORTAKAFUL.COM
– BENEFIT FOR CYBER MEMBERS WHO ARE GOVERNMENT SERVANTS –
A Cyber Member who is a Malaysian government servant
is entitled to a 10% rebate on private comprehensive individual motor takaful policies upon approval by the Company.
Such approved Cyber Members will enjoy the rebate for up to 5 such policies purchased within a 1 year period. The 10% rebate does not apply to subsequent transactions (6
th
and onwards within the same year).
Cyber Members must login to MotorTakaful.com with the username and password provided upon completion of registration process. The issue of a username and password does not mean that the 10% rebate will be automatically given and the said 10% rebate will only be given upon approval by the Company.
I hereby acknowledge that I have read the terms and conditions of access to the motortakaful.com website and the above terms relating to the benefit for certain Cyber Members and hereby declare that I fully and unconditionally agree with the said terms and conditions of access and understand that the benefit contained above only apply to Cyber Members who are existing government servants.
Kumpulan
Underwritten by