Membership Form – Family – AUTOMOBILE ASSOCIATION OF SINGAPORE

REGISTRATION FORM

Personal Details

Salutation*

Gender*

Male

Female

Full Name as Per NRIC*

Occupation*

Last 3 digits + checksum of NRIC/FIN no.*

(E.g. "567A" from the full NRIC number “S1234567A”)

Date of Birth*

Nationality*

Race*

Email*

Mobile Phone*

Telephone

What is your marital status?*

Single

Married

Divorced

Widowed

REGISTRATION FORM

Residential Address

Postal Code*

ZIP / Postal Code

Block/House No.*

Street Name*

Building Name

Floor Level

Unit No.

Country*

REGISTRATION FORM

Driving License

Driving License No.*

Driving License Class*

Driving License Expiry Date

(Not applicable for Singaporeans)

Car Details

Registration No.

Brand

Model

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Colour

REGISTRATION FORM

Membership Registration Type

I would like to apply for:*

Family

Term and Gift*

Family New 3 year(s)
New Family 3yrs (1-FOR-1 Family Membership Promotion + $15/yr)

Term and Gift*

Promo Code (If applicable)

Total

Details of Principal Member

Name*

AA Membership No.*

Applicant Relationship to Principal Member*

Spouse

Child below 21 years

MEMBER-GET-MEMBER (MGM) PROGRAMME I have been referred by a friend who is a valid member.

Referrer’s Name ( If applicable )

Referrer’s Membership No. (If applicable)

Note: By providing the above information, you have agreed to be recommended by your referrer who may qualify for AA MGM Programme. Click here for the Terms and Conditions of the programme.

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