1. Workshop Information


2. Policy Information

3. Details Of Policy

4. Particulars of Driver



5. Particulars of Accident





6. Repair Estimate


7. Declaration By Owner & Driver

  1. I/We understand that my claim may be rejected if any relevant information given is later proven false or intentionally omitted by me/us. I/We solemnly declare that to the best of my/our knowledge and belief the foregoing particulars are true and correct in every aspect.

  2. I/We further declared that the information written in this claim form or held by Etiqa Insurance Pte. Ltd. whether contained in my/our insurance application or otherwise obtained may be used and disclosed to your authorised staff, associated individuals and/or companies or any independent third parties (within or outside Singapore) who will provide claims administrative, advice and/or information or claims services in relation to my/our claim. I/We understand my/our data that may also be used for audit, business analysis and reinsurance purposes. My/Our signature below will signify this consent.

8. Documents Required For Claim Assessment

Below is a list of minimum documentation required to process your claim. Additional information may be required for further assessment.


Type Of Loss/Accident

Document Required (Please tick against the documents you have submitted)





8. Supporting Documents Upload

Upload Supporting Documents
Please note: Total file size should not exceed 10MB.
Please only upload files that end in types: .jgp, .gif, .png, .jpeg, .pdf
Please attach the relevant supporting documents with your claims submission to expedite claim processing.
Drop files here to upload

Final Step

Please review and ensure all details are accurate before you proceed.