BORANG CADANGAN TAKAFUL KEDIAMAN SAHAJA TAKAFUL PROPOSAL FORM - RESIDENTIAL ONLY
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- Andra Gaines
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1 TAKAFUL IKHLAS BERHAD ( U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, Kuala Lumpur Tel : (General Line) Fax : (General Fax Line) Call Centre No : Website : (A wholly-owned subsidiary of MNRB Holdings Berhad) Untuk Kegunaan Pejabat / For Office Use Only: No Nota Lindungan / Cover Note No. No Sijil / Certificate No. Kod Ejen / Agent Code No Siri / Serial No. RESIDENTIAL A. BUTIRAN PENCADANG / THE PROPOSER BORANG CADANGAN TAKAFUL KEDIAMAN SAHAJA TAKAFUL PROPOSAL FO - RESIDENTIAL ONLY Sila tandakan ( ) untuk mana-mana jenis perlindungan yang diperlukan. / Please tick the appropriate box(es) ( ) for the type of coverage(s) chosen IKHLAS Fire Takaful IKHLAS Houseowner Takaful IKHLAS Householder Takaful Nama penuh pencadang / Full name of proposer Gelaran Dato Datin Encik Cik Tuan Puan Dr Lain-lain Title Dato Datin Mr Ms Mr Mrs Dr Others 3. Alamat surat menyurat Correspondence Address Poskod / Postcode Negeri / State Bandar / Town 4. No. Telefon / Telephone No. : Pejabat / Office Rumah / House Bimbit / Hand Phone 5. Alamat E-mel : Address : 6. Nama dan No. Akaun Bank (Untuk tujuan pulangan Sumbangan pembahagian lebihan dan / atau tuntutan. Contoh: MBB0001) Name and Bank Account No. (For the purpose of refund of Contribution, surplus distribution, and / or claim. E.g.: MBB0001) 7. No. Kad Pengenalan Baru Lama NRIC No. New Old 8. Pekerjaan / Occupation 9. Nama Pemegang Gadai Janji / Gadaian (Jika berkenaan) / Name of Mortgagee / Chargee (If applicable) 10. Jenis Perniagaan / Type of Trade 1 Tempoh Takaful : Dari Hingga Period of Takaful : From HH/DD BB/MM TTTT/YYYY To HH/DD BB/MM TTTT/YYYY B. BUTIR HARTA YANG DILINDUNGI / DETAILS OF PROPERTY TO BE COVERED Jika anda memilih IKHLAS Fire Takaful, sila nyatakan Jumlah Dilindungi bagi harta yang hendak dilindungi di dalam kotak yang berkenaan. / If you choose IKHLAS Fire Takaful, please state Sum Covered in respect of property to be covered in the box provided. No. Diskripsi Harta Jumlah Dilindungi No. Description of Property Sum Covered Bangunan tidak termasuk asas Building excluding foundation Bangunan termasuk asas Building including foundation bulan months 3. Lekapan dan lengkapan Fixtures and Fittings 4. Pengalihan debris (puing) Removal of debris 5. Fi Jurutera Perunding, Arkitek Engineering Consultant, Architect Fees
2 6. Perabot Furniture Jumlah / Total C. IKHLAS HOUSEOWNER TAKAFUL - SEKSYEN I / SECTION I Jika anda memilih IKHLAS Houseowner Takaful, sila nyatakan Jumlah Dilindungi bagi harta yang hendak dilindungi di dalam kotak yang berkenaan. If you choose IKHLAS Houseowner Takaful, please state Sum Covered in respect of property to be covered in the box provided. No. Diskripsi Harta Jumlah Dilindungi No. Description of Property Sum Covered Bangunan tidak termasuk asas Building excluding foundation Bangunan termasuk asas Building including foundation D. IKHLAS HOUSEHOLDER TAKAFUL - SEKSYEN II / SECTION II Jika anda memilih IKHLAS Householder Takaful, sila nyatakan Jumlah Dilindungi bagi harta yang hendak dilindungi di dalam kotak yang berkenaan. If you choose IKHLAS Householder Takaful, please state Sum Covered in respect of property to be covered in the box provided. No. Butiran Diskripsi Harta Jumlah Dilindungi Items No. Description of Property Sum Covered Kandungan Rumah Home Contents E. KETERANGAN HARTA YANG HENDAK DILINDUNGI / DESCRIPTION OF PROPERTY TO BE COVERED Lokasi Risiko Location of Risk Kegunaan Premis Occupation of Premise 3. Binaan Bangunan Berangkai Berasingan Pangsapuri Building Construction Non detached Detached Apartment F. PERIL TAMBAHAN / ADDITIONAL PERILS Dinding Batu-bata Bil. Tingkat Wall Concrete No. of storeys Atap Genting Lain-lain, sila nyatakan Roof Tiles Please specifiy if others Jika anda memilih IKHLAS Fire Takaful, sila tandakan ( ) sekiranya perlindungan tambahan diperlukan If you choose IKHLAS Fire Takaful, please tick ( ) for additional coverage required Banjir / Flood Pecahnya atau melimpahnya tangki, peralatan atau paip air rumah / Bursting or overflowing of domestic water tanks, apparatus or pipes Lain - lain, sila nyatakan Please specify if others a. Untuk IKHLAS Houseowner Takaful, perlindungan yang ditawarkan termasuklah Peril yang disebut di atas serta kerosakan akibat daripada pesawat udara, kerosakan hentaman (termasuk dan tidak termasuk kenderaan sendiri), banjir, letupan tanpa / dengan dandang, gempa bumi & letusan gunung berapi, ribut dan taufan. IKHLAS Houseowner Takaful provides a comprehensive coverage that includes the above Perils plus aircraft damage, impact damage including and excluding own vehicles, flood, explosion with or without boilers, earthquake and volcanic eruption, storm and tempest. Sila tandakan ( ) sekiranya anda memerlukan perlindungan tambahan untuk Peril tambahan di bawah / Please tick ( ) if you need additional cover for additional Perils below Rusuhan, mogok & kerosakan akibat niat jahat / Riot, strike & malicious damage Kepingan kaca / Plate glass Penenggelaman tanah & tanah runtuh / Subsidence & landslip (Tertakluk kepada survei / Subject to survey ) b. Untuk IKHLAS Householder Takaful, sila tandakan ( ) sekiranya perlindungan tambahan diperlukan (Tertakluk kepada Sumbangan tambahan) For IKHLAS Householder Takaful, please tick ( ) if additional coverage is required. (Subject for additional Contribution) Rusuhan, mogok & kerosakan akibat niat jahat / Riot, strike & malicious damage Kecurian sepenuhnya / Full theft Penenggelaman tanah & tanah runtuh / Subsidence & landslip (Tertakluk kepada survei / Subject to survey )
3 G. SOALAN-SOALAN AM / GENERAL QUESTIONS a) Sekiranya bangunan ini adalah berasingan, sila nyatakan binaan a) dan kegunaannya. 3. If the building is detached, please state the distance from the nearest building, the construction and occupation. b) Jika terdapat Premis bersebelahan, sila nyatakan binaan dan b) kegunaannya. If there are adjoining Premise, please state the construction and occupation. Adakah terdapat apa-apa Takaful atau Insurans lain yang diambil ke atas harta yang sama? (Jika ya, sila nyatakan nama pengendali Takaful atau syarikat Insurans dan Jumlah Dilindungi) Is there any other Takaful or Insurances in force on the same property? (If yes, please state the name of the Takaful operator / Insurance company and Sum Covered) Pernahkah mana-mana pengendali Takaful atau syarikat Insurans, membatalkan, pembaharuan tidak diterima, atau dikenakan syarat tertentu? Has any Takaful operator or Insurance company cancelled, refused renewal or subjected to special terms? Ya / Yes Tidak / No 4. Pernahkah anda mengalami kerugian disebabkan oleh kebakaran atau apa-apa Peril lain dimasukkan di dalam Cadangan ini di Premis tersebut atau Premis lain yang dimiliki atau diduduki oleh anda? (Jika ya, sila nyatakan secara terperinci) Have you suffered losses due to fire or other Perils that are included in this Proposal on the Premise or other Premise owned or occupied by you? (If yes, please specify in detail) Ya / Yes Tidak / No 5. Adakah menjadi kebiasaan kediaman tersebut ditinggalkan dan tidak berpenghuni? Will the dwelling regularly be left unoccupied? Nota : Perlindungan terhadap Kecurian akan digantung sekiranya kediaman tersebut ditinggalkan dalam tempoh atau melebihi 90 hari tanpa didiami kecuali dipersetujui oleh pihak Syarikat. Note : Cover against Theft will be suspended for any period or periods in excess of 90 days which the dwelling be left without an inhabitant therein unless specially agreed to by the Company. 6. Pernahkah bangunan dan / atau kandungan mengalami "kerosakan oleh sebab hurikan, siklon, taufan, angin ribut atau banjir dalam tempoh lima (5) tahun yang lalu?" (Sila potong yang mana tidak berkenaan) Jika ya, sila berikan butirannya. Have the buildings and / or contents been "damaged by hurricane, cyclone, typhoon, windstorm or flood during the past five (5) years?" (Please delete whichever is not applicable) If yes, please give the particulars. 7. Adakah kediaman tersebut hanya dihuni oleh anda dan keluarga anda serta orang gaji anda? Jika tidak, nyatakan bilangan penyewa lain, penghuni tumpang, penginap atau tetamu yang membuat bayaran. Is the dwelling occupied solely by you and your family and servants? If not, state number of other tenants, lodgers, boarders or paying guests.
4 H. NOTA PENTING / IMPORTANT NOTES 3. Sijil ini tidak melindungi harta yang dilindungi secara khusus atau kecuali diisytiharkan terutamanya di dalam ini :- Surat ikatan bon, bil pertukaran, nota janji, cek, jaminan untuk wang, setem, sebarang bentuk dokumen, wang tunai, mata wang kertas, nota bank, manuskrip, pingat dan duit syiling, kenderaan bermotor dan aksesori. 4. This Certificate does not cover property more specifically covered or, unless specially mentioned declared herein :- Deeds, bonds, bills of exchange, promissory notes, cheques, securities for money, stamps, documents of any kind, cash, currency notes, bank notes, manuscripts, medals and coins, motor vehicles and accessories. 5. Segala terma dan syarat-syarat di dalam Sijil adalah termaktub kepada persetujuan dari Takaful Ikhlas Berhad All terms and conditions in the Certificate is subject to the approval of Takaful Ikhlas Berhad 6. Perlindungan ini tidak akan berkuatkuasa selagi Borang Cadangan ini belum diterima oleh pihak Syarikat. No cover is in force until this Proposal Form has been accepted by the Company Tidak ada satu barangan pun (perabot, piano, organ, perkakas rumah tangga, radio, peralatan hi-fi, set wayarles, perakam video, dan televisyen dikecualikan) akan dianggap mempunyai nilai lebih besar daripada lima (5) peratus daripada keseluruhan Jumlah Dilindungi ke atas kandungan tersebut kecuali barangan sedemikian diisytiharkan dengan khas sebagai suatu butiran yang berasingan. No one article (furniture, pianos, organs, household appliances, radios, hi-fi equipment, wireless, video recorder, and television sets are excepted) will be deemed of greater value than five (5) per cent of the total Sum Covered on the said contents unless such articles is specially declared as a separate item. Sijil ini adalah untuk Kediaman Persendirian dan / atau kandungan yang terkandung di dalamnya, yang dihuni semata-mata bagi tujuan kediaman atau tujuan kediaman dan pejabat domestik. Tidak ada pembuatan atau perlonggokkan atau penyimpanan barang niaga boleh dibenarkan di dalam Kediaman Persendirian atau di dalam mana-mana bahagian Premis yang merupakan sebahagian daripada Kediaman persendirian. This Certificate is for Private Dwellings and / or contents contained therein, occupied solely for residential purposes or residential and domestic office purposes. No manufacture or deposit or storage of merchandise may be allowed in the Private Dwelling or in any portion of the Premise of which the Private Dwelling forms a part. Untuk perhatian anda, perlindungan ini adalah tertakluk kepada Waranti Sumbangan 60 hari. Dengan waranti ini, perlindungan ini akan dihentikan dengan serta-merta melainkan Sumbangan penuh telah dibuat kepada pihak Syarikat dalam tempoh 60 hari dari tarikh perlindungan ini berkuatkuasa. Your attention is drawn to the 60 days Contribution Warranty attached to the Certificate. By this warranty, the coverage is automatically cancelled unless the full Contribution is paid to the Company within 60 days from the commencement date of cover. Sebarang perubahan kepada maklumat yang diberikan hendaklah dimaklumkan kepada pihak Syarikat dengan segera. Kegagalan melaporkannya boleh memberi hak kepada pihak Syarikat untuk menolak semua tanggungan. Any changes in the information given must be reported to the Company immediately, otherwise the Company will reserve the right to decline all liabilities. Perlindungan yang disebutkan di dalam Borang Cadangan ini tidak bermaksud sebagai bahan bukti penerimaan oleh pihak Syarikat melainkan ianya telah dinyatakan di dalam Sijil / nota perlindungan yang mengesahkan perlindungan. Coverage(s) requested in this Proposal Form is not to be construed as an acceptance or commitment on the part of the Company unless the same is incorporated in the Certificate / cover note evidencing such cover. Sijil akan dikeluarkan dalam tempoh tiga puluh (30) hari bekerja selepas permohonan anda diterima oleh pihak Syarikat, jika kesemua dokumendokumen (termasuk semua maklumat dan dokumen tambahan dari penaksiran pengunderaitan) yang lengkap diterima. Upon receipt of completed documents (including all additional information and documents arising from underwriting assessment), a Certificate will be issued within thirty (30) working days after your application is accepted by the Company. 10. Adalah penting bagi anda untuk menyimpan resit yang diterima daripada pihak Syarikat sebagai bukti pembayaran Sumbangan. It is important for you to keep the receipt from the Company as proof of payment of the Contributions. 1 Caj kami tidak termasuk cukai yang dikenakan oleh kerajaan dan/atau pihak berkuasa pada masa akan datang (termasuk Cukai Barangan dan Perkhidmatan (GST)). Setelah perlaksanaan GST, kami berhak mengenakan caj GST bagi maksud Sijil Takaful ini yang dikehendaki dibayar di bawah undang-undang. Our charges exclude tax that would be imposed by government and/or the authority in the future Goods and Services Tax (GST)). Upon implementation of the GST, we shall be entitled to recover from you in the respect of this Takaful Certificate that is required under the law.
5 I. AQAD DAN KEBENARAN / DECLARATION AND AUTHORIZATION Saya / Kami dengan ini mengaku bahawa semua pernyataan di atas dan dokumen yang disertakan berhubung dengan permohonan ini adalah lengkap dan benar sepanjang pengetahuan dan kepercayaan Saya / Kami. Saya/ Kami bersetuju bahawa segala pernyataan dan akuan yang terkandung dalam borang permohonan ini akan menjadi asas kepada Sijil Takaful antara Saya / Kami dan Takaful Ikhlas Berhad (selepas ini dirujuk sebagai "pihak Syarikat") dan ianya disifatkan sebagai termaktub dan menjadi pelengkap Sijil. Saya / Kami bersetuju bahawa Sumbangan Takaful Saya / Kami akan dimasukkan ke dalam Akaun Pelaburan Risiko Am (GRIA) dan akan diuruskan oleh pihak Syarikat berdasarkan prinsip Wakalah sebagaimana yang ditakrifkan oleh pihak Syarikat serta menepati Syariah. Saya / Kami bersetuju membenarkan pihak Syarikat mengambil 60% daripada Sumbangan tersebut sebagai Yuran Wakalah. Lanjutan daripada itu, Saya / Kami juga bersetuju bahawa baki daripada Sumbangan Takaful Saya / Kami akan disalurkan ke dalam Dana Risiko berdasarkan Tabarru' (derma) untuk membantu Peserta lain yang ditimpa musibah dan baki yang masih ada di dalam Dana Risiko berkenaan akan dilaburkan oleh pihak Syarikat. Sebarang keuntungan daripada pelaburan tersebut, jika ada, akan dimasukkan semula ke dalam Dana Risiko. Saya / Kami juga bersetuju membenarkan pihak Syarikat menolak Caj Pengurusan Lebihan (SAC) 50% daripada lebihan boleh-agih kasar dari Dana Risiko pada setiap tahun. Walau bagaimanapun, pihak Syarikat boleh, mengikut budi bicara dan di mana bersesuaian, mengenakan caj kurang daripada 50% daripada lebihan boleh-agih kasar sebagai SAC. Saya / Kami juga memahami bahawa lebihan boleh-agih bersih dari Dana Risiko, jika ada, akan dikendalikan oleh pihak Syarikat mengikut kaedah dan peruntukan berlandaskan prinsip Syariah yang akan memanfaatkan Peserta. (Untuk maklumat lengkap, sila rujuk kepada Sijil Takaful yang berkenaan). "I / We hereby agree that all statements made above and other documents submitted in connection with this application are complete and true to the best of My / Our knowledge and belief. I / We agree that this declaration and all statements made above shall form the basis of the Takaful Certificate between Me / Us and Takaful Ikhlas Berhad (herein referred as "the Company") and they are deemed to be incorporated as an integral part of the Certificate. I / We agree that My / Our Takaful Contribution shall be placed in the General Risk Investment Account (GRIA) and shall be managed by the Company based on the Wakalah principle as defined by the Company and in accordance to Shariah. In return, I / We agree to allow the Company to deduct 60% of the Contribution as Wakalah Fee. I / We further agree that the balance of My / Our Contribution shall be allocated into the Risk Fund on a Tabarru' (donation) basis and be used to help other Participants in time of misfortune and the remaining balance in the Risk Fund shall be invested by the Company. Any profit arising out of this investment, if any, shall be allocated to the Risk Fund. I agree to allow the Company to deduct a Surplus Administration Charge (SAC) of 50% from any gross distributable surplus arising from the Risk Fund. However, the Company may at its discretion and where appropriate charge less than 50% from any gross distributable surplus as SAC. I/Wealsounderstand that the net distributable surplus arising from the Risk Fund, if any, shall be managed by the Company according to the method and allocation in accordance to the Shariah principle that will benefit the Participant." (For further details, please refer to the respective Takaful Certificates). KEBENARAN Saya dengan ini membenarkan pihak Syarikat untuk memperolehi sebarang maklumat tentang saya dan/atau syarikat saya dari mana-mana organisasi yang mempunyai pengetahuan tentang saya/syarikat saya dan memberi kebenaran kepada pihak Syarikat untuk menggunakan dan/atau berkongsi sebarang maklumat yang diproses tentang saya/syarikat saya bagi tujuan penyediaan perlindungan Takaful dan pengendalian tuntutan kepada pihak ketiga jika pihak Syarikat anggap ianya perlu. Saya juga faham bahawa pihak Syarikat akan memberikan sesalinan maklumat tentang saya yang diperolehi oleh pihak Syarikat kepada saya jika diminta. CONSENT I hereby consent and authorise the Company to seek any information related to me and/or my company from any organisation that has records or knowledge of me/my company and hereby consent that the Company may use/or share any information that the Company may have about me/my company being currently processed by the Company for the purpose of providing Takaful coverage and claims handling, to such third parties as the Company deems necessary. I hereby acknowledge that the Company will provide a copy of my personal information upon request. Tandatangan Pencadang: Tarikh : Signature of Proposer : Date :
6 J. PERLINDUNGAN MAKLUMAT PERIBADI / PERSONAL DATA PROTECTION Saya memberi izin dan kuasa kepada: (a) Takaful Ikhlas Berhad (bermaksud mana-mana anak-anak syarikat milik penuh dan berkaitan dengan MNRB Holdings Berhad atau Takaful Ikhlas Berhad atau mana-mana penyedia perkhidmatan yang dilantik) (selepas ini dirujuk sebagai Takaful IKHLAS) untuk memperolehi dan memproses; dan (b) mana-mana pengamal perubatan, hospital atau institusi perubatan (sama ada diperbadankan atau tidak) yang pernah merawat saya atau memiliki rekod mengenai saya atau kesihatan saya untuk menyediakan maklumat yang relevan dan dokumen-dokumen yang diperlukan oleh Takaful IKHLAS untuk menentukan sama ada untuk menerima permohonan saya atau meluluskan sebarang tuntutan yang dibuat ke atas Sijil Takaful yang dikeluarkan kepada saya. Saya juga bersetuju bahawa Salinan pemberian kuasa ini adalah berkuatkuasa dan sah seperti salinan asal. I hereby consent and authorize: (a) Takaful Ikhlas Berhad (means any of MNRB Holdings Berhad or Takaful Ikhlas Berhad owned subsidiaries and associate companies or Takaful IKHLAS or any of its appointed service providers) (hereinafter defined as Takaful IKHLAS) to obtain and process; and (b) any medical practitioner, hospital, medical institution or any person (whether incorporated or not) who has ever attended to me or has records on me or my health to provide relevant information and documents required by Takaful IKHLAS to determine whether to accept my proposal or approve any claim arising from the Takaful Certificate issued to me. I further agree that a photocopy of this authorization will be as effective and valid as the original. Saya dengan ini memberi kebenaran secara mutlak dan bersetuju bahawa Takaful IKHLAS boleh memproses, mengguna, menyimpan, mendedahkan, memindahkan, menyusun, memadankan, mendapatkan dan/atau menukar (semuanya sama ada di dalam atau di luar Malaysia) semua maklumat peribadi saya yang diberikan kepada dan/atau diperolehi oleh Takaful IKHLAS serta sebarang maklumat yang diperolehi daripada atau berkaitan dengan Sijil Takaful yang dikeluarkan berasaskan borang permohonan ini (secara kolektif dirujuk sebagai Maklumat Peribadi ) kepada, daripada atau dengan sesiapa sahaja yang dianggap perlu oleh Takaful IKHLAS termasuk dan tidak terhad kepada mana-mana ejen, kontraktor, pembekal perkhidmatan atau pihak ketiga yang dipilih untuk memberi perkhidmatan kepada Takaful IKHLAS dan/atau Bank Negara Malaysia atau mana-mana pihak berkuasa yang berkaitan yang mana Takaful IKHLAS berkewajiban untuk membuat pendedahan di bawah keperluan undang-undang atau mahkamah untuk sebarang atau semua tujuan dan tidak terhad: I hereby irrevocably consent and agree that Takaful IKHLAS may process, use, store, disclose, transfer, compile, match, obtain and/or exchange (all whether within or outside Malaysia) all my personal information provided to and/or obtained by Takaful IKHLAS as well as any information derived from or relating to my Takaful Certificate issued based on this Takaful application (collectively referred to as Personal Data ), to, from or with any person as Takaful IKHLAS may consider necessary including without limitation any agent, contractor, service provider or selected third party that provide services to Takaful IKHLAS and/or Bank Negara Malaysia or any other relevant authorities that Takaful IKHLAS is under obligation to make disclosure to, under the requirements of any law or court for any and all purposes including without limitation to: a) Berhubung dengan produk-produk dan/atau perkhidmatan-perkhidmatan yang ditawarkan oleh Takaful IKHLAS kepada saya dan/atau berkaitan dengan pemadanan bagi sebarang tujuan mana-mana Maklumat Peribadi saya di dalam simpanan Takaful IKHLAS; dan/atau In connection with the products and/or services offered by Takaful IKHLAS to me and/or in connection to matching for whatever purpose of any of my Personal Data under the possession of Takaful IKHLAS; and/or b) c) Untuk memudahkan pengendalian perniagaan Takaful IKHLAS atau operasi prosedur-prosedur dalaman Takaful IKHLAS; dan/atau To facilitate the conduct of Takaful IKHLAS s business or the operations of the Takaful IKHLAS s internal procedures; and/or Bagi tujuan mempromosi produk-produk lain dan/atau perkhidmatan oleh Takaful IKHLAS dan/atau mana-mana rakan strategiknya secara amnya kepada saya. Sekiranya saya tidak ingin menerima sebarang maklumat promosi daripada atau mana-mana rakan strategiknya, saya akan memaklumkan secara bertulis ke alamat Takaful IKHLAS yang disediakan di dalam borang ini. For the purpose of promoting other products and/or services by Takaful IKHLAS and/or its strategic partners, generally to me. If I do not wish to receive any promotional information from any of its strategic partners, I will notify by writing to Takaful IKHLAS s address provided in this form. d) e) Untuk menambahbaik produk dan/atau perkhidmatan yang disediakan oleh Takaful IKHLAS; To improve the products and/or services provided by Takaful IKHLAS; Untuk tujuan menyiasat, melaporkan dan pencegahan atau sebaliknya aktiviti-aktiviti yang berkaitan dengan pengubahan wang haram, pembiayaan keganasan, penyelewengan, pengelakan cukai dan aktiviti-aktiviti jenayah secara amnya, penyenggaraan pangkalan data, analisa statistik, pengesahan tuntutan, audit, pengendalian dan penyelesaian aduan pelanggan, dan hal-hal operasi seperti yang diperuntukkan oleh undang-undang; dan /atau For purposes of investigating, reporting and preventing or otherwise in relation to money laundering, terrorist financing, fraud, tax evasion and criminal activities generally, maintenance of databases, statistical analysis, claim verification, audit, customer complaints handling and resolution, and operational matters as required by the law; and/or f) Untuk sebarang tujuan proses undang-undang atau mahkamah yang dimulakan oleh atau diserahkan terhadap saya atau Takaful IKHLAS, sama ada Takaful IKHLAS adalah pihak yang terlibat atau tidak. For purposes of any legal or court process initiated by or served on me or Takaful IKHLAS, whether or not Takaful IKHLAS is a party. 3. Saya faham bahawa saya boleh meminta akses kepada dan akan memaklumkan Takaful IKHLAS jika terdapat perubahan kepada Maklumat Peribadi saya secepat yang mungkin dan bersetuju bahawa Takaful IKHLAS tidak akan dipertanggungjawabkan atas sebarang kerugian sama ada secara langsung atau tidak, atau lain-lain liability sama ada sivil atau jenayah disebabkan kesalahnyataan fakta sebenar atau penyembunyian tentang sesuatu fakta material untuk mempengaruhi orang lain untuk melakukan perbuatan yang merugikannya, serta Maklumat Peribadi yang tidak tepat atau tidak lengkap yang diberikan oleh saya. I understand that I can request access to and will keep Takaful IKHLAS updated of any change to my Personal Data as soon as practicable and agree that Takaful IKHLAS shall not be liable for any direct or indirect loss or other liabilities under civil or criminal due to misrepresentation of the truth or concealment of a material fact to induce another to act to its detriment, inaccurate or incomplete Personal Data provided by me.
7 K. UNTUK KEGUNAAN EJEN ATAU PEJABAT/FOR AGENTS OR OFFICE USE ONLY PENGESAHAN IDENTITI PELANGGAN / VERIFICATION OF CUSTOMER S IDENTITY (Seperti di dalam Peruntukan Akta Pencegahan Pengubahan Wang Haram & Pencegahan Pembiayaan Keganasan 2001) (As per requirement on Anti-Money Laundering & Anti-Terrorism Financing Act 2001) (Untuk Kegunaan Kakitangan Syarikat atau Perantara Sahaja) / (For Use by a Company Staff or Intermediary only) Saya dengan ini mengaku bahawa saya telah melihat Kad Pengenalan / Sijil Kelahiran / Pasport / dokumen pendaftaran syarikat yang berkaitan / surat / dokumen pengesahan individu yang mewakili syarikat dan mengesahkan pengenalan/ identiti Pencadang / Peserta dengan menggunakan dokumen-dokumen tersebut. I hereby declare that I have sighted the original NRIC / Birth Certificate / Passport / company-related registration document / authorization letter/documents for any person authorized to represent the company and verified the identity of the Proposer / Participant through these documents. Signature NRIC No. Name Designation
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