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Please select an insurance product and complete the form below

*Providing false or inaccurate information result in policy cancellation

投保人/車主英文姓氏

Name of Owner

Name of Company

Vehicle Owner

Company as insured

Occupation/ Working field

WhatsApp Number

Driver Info

Relationship between Owner and ND?

Age of 1st Named Driver (Owner of Vehicle)

Working field of 1st Named Driver (Owner of Vehicle)

Age of 2nd Named Driver (Min 25)

Working field of 2nd Named Driver

Age of 3rd Named Driver (Min 25)

Working field of 3rd Named Driver

Age of 4th Named Driver (Min 25)

Working field of 4th Named Driver

Driving Exp of 1st Named Driver (Owner of Vehicle)

Occupation of 1st Named Driver (Owner of Vehicle)

Driving Exp of 2nd Named Driver

Occupation of 2nd Named Driver

Driving Exp of 3rd Named Driver

Occupation of 3rd Named Driver

Driving Exp of 4th Named Driver

Occupation of 4th Named Driver

Vehicle Information

Year of Manufacturing

Make

Weight (Tons)

c.c.

Model

Body Type

Driving record

if yes, please state

Police Statement/ Court Outcome/ Submitted Claim Form

Upload File

NCB% records

Transferring NCB to this policy?

if Yes, please state the insurance company

Others

Referee

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Contact Us

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Room 902 , 9/F, Iuki Tower, 5 O'Brien Road, Wan Chai, Hong Kong

Phone

+852 2520 0883

Chat

WhatsApp +852 9889 0556

Mail

info@cjplus.com.hk