⏰ Submit before 30 June — I'll prioritise your quotation within 12 hours!  👇

📝 Get a Free Quotation

Fill in a few details and I will personally prepare your Takaful quotation within 24 hours.

🔒 Data is Private & Secure
⚡ Response within 24 hours
✅ No Obligation
⚙️ Agent Setup Required: To activate form submission, replace YOUR_GOOGLE_FORM_ACTION_URL in the page code with your actual Google Form action URL. See instructions below the form.

Personal Quotation Request

All information is kept strictly confidential and will only be used to prepare your personalised quote.

1 Personal Info
2 Health & Lifestyle
3 Plan Interest
👤 Personal Information
Please enter your full name as per NRIC
Format: 900101-14-1234 (used to verify age & identity)
Please enter a valid NRIC number
Will be auto-filled from NRIC if entered above
Please select your date of birth
Please enter your WhatsApp number
Please select your occupation
🏥 Health & Lifestyle
Smoking status affects your Takaful contribution rate
🌙 Plan Interest (select all that apply)

🔒 Your information is private and will only be used by Amirul Ridzuan to prepare your personalised Takaful quotation. We do not share your data with third parties.

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Request Received!

Terima kasih! Your quotation request has been submitted successfully. Jazakallah khair.
Amirul Ridzuan will contact you within 24 hours to discuss your personalised Takaful plan.

💬 WhatsApp Me Now to Follow Up
Agent Setup Guide
How to Link This to Google Forms & Spreadsheet
  1. Go to forms.google.com → Create a new form
  2. Add these fields: Full Name, NRIC, Date of Birth, WhatsApp No., Occupation, Smoking Status, Plan Interest (checkboxes)
  3. Click the 3-dot menu → "Get pre-filled link" → fill in dummy data → click "Get Link"
  4. From that URL, copy the part after /viewform? — these are your entry IDs (e.g. entry.123456789)
  5. Go to your form → click Send → copy the form action URL (ends in /formResponse)
  6. In this file, replace YOUR_GOOGLE_FORM_ACTION_URL with that URL, and replace each entry.XXXXXXXXX with your real entry IDs
  7. In Google Forms → click Responses tab → click the green Sheets icon to auto-export to Google Sheets ✅
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