EARs

Mailing Address:
Suite #108 MBE Puchong,
No.10 Persiaran Puteri 1,
Bandar Puteri Puchong,
47100 Puchong, Malaysia.
Fax:
+603-22890695
Office:
+603-80635412
Email:
info@ears.my

Please read our Rules & Regulation before signing-up. Click here.
*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