EARS: Emergency, Assistance and Rescue Services

Please read our Terms and Conditions before signing-up.
*Plan Type:**

PERSONAL DETAILS
*Name (as per IC):**
*IC Number / Passport:**
*Gender:**
*Address:**
Mailing Address (if your mailing address is different, please fill this):
*Nationality:**
*Mobile Phone No:**
Telephone No:
Facsimile No:
*Email:**
Where did you hear about EARS?

VEHICLE DETAILS
*Car Details - (You must be the Owner of the Car)*
*Car Make:**	(e.g. Toyota, Honda, Proton)
*Car Model:**	(e.g. Vios, City, Wira)
*Year:**	(manufactured year as stated in car grant)
*Colour of the Car:**
*Insurance Company:**
*Reg Plate No:**
*2nd Car (If Any)*
Car Make:
Car Model:
Year:
Colour of the Car:
Insurance Company*
Reg Plate No:

* Denotes required fields

Fax: +603-22890695 Email: info@ears.my
B-3A-07, Plaza Mont' Kiara No. 2, Jalan Kiara Mont' Kiara 50480, Kuala Lumpur Malaysia