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Proposer Information

HKAA Membership No. :
Name of Proposer :
Age :
Driving Experience :
Occupation :
Contact No. :
Fax No. :
Email Address :

Vehicle Information

Make and Model :
Year of Make :
Body Type :
Saloon Coupe Convertible MPV
No. of Doors :
2 3 4 5
Cubic Capacity :

Coverage

Comprehensive 
Third Party Only 
Sum Insured : HK$

Named Drivers Information

# of Named Drivers
2nd Driver
Name :
Age :
Driving Experience :
Occupation :
3rd Driver (if any)
Name :
Age :
Driving Experience :
Occupation :

Other information

No Claim Discount (NCD) % Entitled :
Any claim reported in the past 3 years :
Yes No
If yes, please provide the details  
 

 


 
 
 
 
 

  

 

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