Scribd
Upload
109 views1 page

Cover Note

This document is a cover note for a Takaful insurance policy for a private car owned by Norzawati Binti Aziz, with a coverage period from October 29, 2024, to October 28, 2025. The total amount due for the policy is RM 866.65 after deductions and taxes. It also includes important notices regarding the duty of the participant to provide accurate information and notify any changes post-application.

Uploaded by

queenkazai
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
109 views1 page

Cover Note

This document is a cover note for a Takaful insurance policy for a private car owned by Norzawati Binti Aziz, with a coverage period from October 29, 2024, to October 28, 2025. The total amount due for the policy is RM 866.65 after deductions and taxes. It also includes important notices regarding the duty of the participant to provide accurate information and notify any changes post-application.

Uploaded by

queenkazai
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

ePolicy Agent Debit Note Cancellation Notice

COVER NOTE

STAMP DUTY PAID

Participant Cover Note No. : 85376445-02


Account No. : V0009705
NORZAWATI BINTI AZIZ Agent Name : PERNIAGAAN TANJUNG
NO 2 LORONG IMPIANA 5
TAMAN IMPIANA ROMPIN SERATUS
KUALA ROMPIN Product Type : Private Car - Private Use
26800 PAHANG
Period of Takaful from 29/10/2024 To 28/10/2025 (both Dates
Inclusive). Any subsequent period for which the Participant shall pay
and the Takaful Operator shall agree to accept a renewal contribution..

NRIC No : 690120-06-5476 Business Reg No : Sum Covered RM 24000.00


Business/Occupation : Clerk Other ID No : A1140932 Gross Contribution RM 1004.56
Vehicle Information Less: No Claim Discount RM 301.37
JPJ Document No : 30.00%
Vehicle Reg No : CEE2920 Log Book No : NIL Drive Less Save More RM 0.00
Make : PROTON Windscreen (RM600.00) RM 90.00
Model : PROTON SAGA 1.3L PREMIUM ______
Engine No : S4PEVY1678 Cover Type : Comprehensive RM 793.19
Chassis No : PL1BT3SRRLB096299 Vehicle Type : Private Car Add : Service Tax 8.00 % RM 63.46
Stamp Duty RM 10.00
Year of : 2019 License Type : Normal Vehicle
Manufacture
Cubic Capacity : 1332 Use For : Private Use TOTAL AMOUNT DUE RM 866.65
Seating Capacity : 5
Financial Interest : NIL
Authorised Driver Excess All Claims RM 0.00
1 NORZAWATI BINTI AZIZ 690120-06-5476
2 ANY AUTHORISED DRIVER -

IMPORTANT NOTICE - APPLICABLE TO ALL CONSUMER PRODUCTS


(Takaful wholly for purposes unrelated to your trade, business or profession)
Where You have applied for this Takaful wholly for purposes unrelated to Your trade, business or profession, You had a duty to take reasonable
care not to make a misrepresentation in answering the questions in the Application Form (or when You applied for this Takaful) i.e. You should
have answered the questions fully and accurately. Failure to have taken reasonable care in answering the questions may result in avoidance of
Your contract of Takaful, refusal or reduction of Your claim(s), change of terms or termination of Your contract of Takaful in accordance with the
remedies in Schedule 9 of the Islamic Financial Services Act 2013. You were also required to disclose any other matter that You knew to be
relevant to our decision in accepting the risks and determining the rates and terms to be applied.

You also have a duty to tell Us immediately if at any time after Your contract of Takaful has been entered into, varied or renewed with Us any of
the information given in the Application Form (or when You applied for this Takaful) is inaccurate or has changed.

Issue Date : 25-10-2024/09:58 AM For and on behalf of


Issue At : C1 Etiqa General Takaful Berhad
Issue By : v0009705

You might also like