MASTER CERTIFICATE FOR Takaful myelite PA

Transcription

1 STAMP DUTY PAID MASTER CERTIFICATE FOR Takaful myelite PA CERTIFICATE NO. PMB-P BRO-15

2 This Master Certificate is issued to cover customers of the Master Certificate Owner with Our invitation to participate in Takaful myelite PA managed by Us, in consideration of payment of the necessary contributions and shall take effect on the Commencement Date as stated in the Master Certificate Information Page ( MCIP ). The terms and conditions on this page and the subsequent pages, any amendment or endorsement or annexure included at issue or at a later date will form part of this Master Certificate. 1. GENERAL DEFINITIONS In this Master Certificate where the context states the masculine gender shall be deemed to include the feminine, and likewise, singular word shall be deemed to include the plural and vice versa, and the following words and expressions shall be deemed to have the following meanings: 1.1 ACCIDENT means a sudden, unintentional, unexpected, unusual and specific event that occurs at an identifiable time and place which will, independently of all other causes, be the sole cause of bodily injury. 1.2 ACCIDENTAL BODILY INJURY means a bodily injury occurring during the Period of Takaful which is the direct result of accidental, external, violent and visible means and which solely and independently of any other cause results in a claim for death or disablement or losses. This is extended to bodily injury as a result of exposure to the elements of natural perils. This does not include any sickness, disease, bacterial or viral infection, (unless this is the direct result of an Accidental Bodily Injury) naturally occurring condition or degenerative process or the result of any gradually operating cause. 1.3 ACT OF TERRORISM means an act, including but not limited to the use of force or violence, by any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization or government(s) which is committed for political, religious, ideological, or ethnic purposes or reasons including the intention to influence any government and/or to put the public, or any section of the public, in fear. 1.4 CHILD refers to an unmarried biological/legally adopted/step child of the Participant who has attained the age of thirty (30) days but not exceeding nineteen (19) years next birthday. He is financially dependent upon the Participant. For child who is registered as full-time student at a recognized educational institution and is not gainfully employed, the maximum allowable age will be twenty-three (23) years next birthday. 1.5 CONTRIBUTION refers to the amount payable as stated in the Certificate Information Page (hereinafter referred to as CIP ) or in a subsequent endorsement issued by Us. 1.6 DEPENDANT means any of the following persons: (a) Spouse of the Participant; (b) Child of the Participant. 1.7 EFFECTIVE DATE refers to the first day of a Period of Takaful on which coverage of the Person Covered under this Master Certificate has become effective as stated in the CIP or in a subsequent endorsement issued by Us. 1.8 GENERAL TAKAFUL FUND or GTF means the Participants holding account into which the Contribution after the deduction of any Wakalah Fee under this Master Certificate shall be credited. All benefits as specified in this Master Certificate and the cancellation proceeds shall be payable from this account. If GTF is insufficient for benefits payment, We will arrange for Qardh. The Qardh will be repaid when GTF returns to surplus position and before any surplus is distributed. Page 1 of 10

3 1.9 HOSPITAL means only an establishment duly constituted and registered as a Hospital for the care and treatment of sick and injured person as paying bed-patients, and which: (a) has facilities for diagnosis and major surgery; (b) provides 24-hour a day nursing services by registered and graduate nurses; (c) is under the supervision of a Physician; and (d) is not primarily a Clinic; a place for alcoholics or drug addicts a nursing, rest or convalescent home or a home for the aged or similar establishment INDIVIDUAL CERTIFICATE means the document which contains details of the Takaful coverage provided to the Person Covered under this Master Certificate MASTER CERTIFICATE OWNER refers to Bank Islam Malaysia Berhad MEDICAL PRACTITIONER means a person who is qualified and licensed to practice western medicine and who, in rendering such treatment, is practicing within the scope of his licensing and training in the geographical area of practice, but excluding a doctor, physician or surgeon who is the Person Covered himself PARTICIPANT means the eligible customer of the Master Certificate Owner as named in the CIP who has accepted Our invitation to participate in this Master Certificate PERIOD OF TAKAFUL in respect of any Persons Covered means the one (1) calendar year commencing on the Effective Date as stated in the CIP. Each succeeding Period of Takaful is the one (1) year period from the certificate anniversary to the next certificate anniversary PERMANENT DISABILITY refers to a n y o f the l i s t e d conditions i n the S c h e d u l e of Benefits. Such condition must continue uninterrupted for a period of six (6) months and verified by Our appointed Medical Practitioner to be beyond hope of recovery PERSON COVERED means the person who is covered under this Master Certificate. Beside the Participant, other Person Covered in any one Individual Certificate should not exceed one (1) Spouse and three (3) children QARDH means a loan provided by Us if the amount in GTF has been fully utilized. The loan will be granted without interest SPOUSE means a legally married spouse of the Participant and who has a t t a i n e d t h e age between eighteen (18) years next birthday and seventy (70) years next birthday, both ages inclusive on the Effective Date SUM COVERED means the amount of coverage in respect of the benefits provided in the CIP TABARRU means a donation for the purpose of which is not commercial and is used to help other person covered in times of misfortune for the purpose of solidarity, brotherhood and cooperation among the person covered TAKAFUL refers to a mutual assistance scheme for all participants which is based on the principles of brotherhood, solidarity and cooperation where each participant agrees to contribute a sum(s) on the basis of Tabarru into a risk fund for providing financial aid and assistance to the person covered, the participant or the beneficiary on the occurrence of pre-defined events WAKALAH refers to a Shariah contract where You appoint Us to invest and manage Contribution in the GTF on Your behalf. As a return, You allow Us to deduct certain amount of Contribution as Wakalah Fee for the services rendered. Page 2 of 10

4 1.23 WE, US or OUR refers to Syarikat Takaful Malaysia Am Berhad. 2. GENERAL PROVISIONS 2.1 THE CONTRACT This Master Certificate, MCIP, Individual Certificate, CIP and all relevant documentary declarations and/or statements that make up this Master Certificate together with any endorsement made by Us, will form the entire contract between the Master Certificate Owner, the Participant, the Person Covered and Us. All statements made will be representations and not warranties. In the case it is evidenced that the statements made by the Master Certificate Owner, the Participant or the Person Covered are fraudulent, We can declare that the contract is void. If there is any further change made to the contract, it has to be in writing, approved and signed by Our authorised officer. 2.2 PARTICIPATION AND ELIGIBILITY REQUIREMENTS The eligible persons covered for Takaful coverage under this Master Certificate are the Master Certificate Owner s present and future customers and their Dependant as invited by Us to participate in this Master Certificate. 2.3 GEOGRAPHICAL TERRITORY All benefits provided in this Master Certificate are applicable worldwide, twenty-four (24) hours a day. 2.4 MISREPRESENTATION/FRAUD Takaful coverage to any Person Covered will be void if information provided is untrue in any respect or if any material fact affecting the risk be incorrectly stated or omitted, or if the coverage has been accepted through any misstatement, misrepresentation or suppression, or any fraudulent or exaggerated claim, or any false declaration or statement been made. 2.5 PROOF OF AGE Proof of age of the Person Covered will be required by Us before any benefit is payable under this Master Certificate unless this information has been previously verified and confirmed by Us to be correct. 2.6 MISSTATEMENT OF AGE If at the true age, the Person Covered is not eligible to be covered under this Master Certificate, his coverage will be treated as void and Our liability will be limited to the refund of Contribution paid without profit. 2.7 DISTRIBUTION OF SURPLUS We will invest and manage the GTF in accordance with the Shariah. Any surplus arising from GTF as determined by Us will apply to settle any Qardh owing to Us. Any residual of the calculated surplus after making all the above payments will then be kept in GTF to prepare and provide for any unfavourable claims experience. Page 3 of 10

5 2.8 TREATMENT OF SMALL PAYMENT AMOUNTS For any amount due and payable to the Participant including but not limited to the amount arising from claim which is less than Ringgit Malaysia Twenty Five (RM25.00), We will exercise Our rights to donate such amount of money to charity as approved by Our Shariah Advisory Body. However, if the Participant decides otherwise, the Participant is required to submit a formal request to Us. 2.9 FREE LOOK PERIOD If the Participant is not satisfied with his Individual Certificate for any reason, the Participant may return it to Us within fifteen (15) days from the date of receipt of the Individual Certificate. We will cancel the coverage of the Person Covered and refund to the Participant all Contribution paid in his Individual Certificate CONTRIBUTION AND GRACE PERIOD The Contribution rates are not guaranteed. We may revise the Contribution rates in the future in the event of adverse claims experience. The rates revision will apply to all Person Covered regardless of their claims experience. If there is any rate revision, the Master Certificate Owner will be notified by Us at least sixty (60) days before it takes effect. The revised Contribution rates will only apply at the next Certificate Anniversary. The Certificate Anniversary of any CIP means one (1) year after the Effective Date and annually thereafter. The Participant must pay Contribution within sixty (60) days Grace Period from each of the Contribution due dates. If the Contribution remains unpaid after the Grace Period, his Individual Certificate will lapse without having any further Takaful cover, benefit or value NOTICE Any correspondence, notice, request, instruction required by Us must be in writing CHANGE IN RISK The Participant or the Person Covered must immediately inform Us in writing if there is any material change in the occupation, business or duties of the Person Covered and pay any additional Contribution CANCELLATION OF THIS MASTER CERTIFICATE This Master Certificate either in its entirety or in respect of any Person Covered may be cancelled by Us at any time by giving fourteen (14) days notice by registered letter sent to the last known address of the Master Certificate Owner provided that such cancellation shall be without prejudice to the rights in respect of prior injury to any Person Covered. Likewise, the Master Certificate Owner may cancel this Master Certificate at anytime by giving Us fourteen (14) days notice. Under such circumstances, there is no refund of any contribution to the Participant NOMINATION The Participant who is sixteen (16) years and above may nominate any natural person to receive benefits payable in the event of death of the Person Covered, either as an executor or as a beneficiary under a conditional Hibah. Such nomination shall be witnessed by a person other than the nominee himself and who is of sound mind and has attained the age of eighteen (18) years The Participant may from time to time revoke any such nomination and/or to name another nominee(s) with written notification duly received and registered by Us. Page 4 of 10

6 If the Participant has nominated more than one nominee, the benefits payable, if any, shall be paid to the surviving nominees at the time of the Person Covered s death in equal shares unless otherwise specified by the Participant; and such payment shall be deemed as a valid discharge of Our liability with respect to the Person Covered under this Master Certificate Upon death of any nominee after the Person Covered s death but prior to any payment of the benefits, We shall pay the benefits to: (i) the estate of the Participant if the nominee is an executor; or (ii) the estate of the deceased nominee if the nominee is a beneficiary under conditional Hibah If there is no effective nomination in force upon the death of the Person Covered, the benefits payable may be paid to the lawful executor or administrator of the Participant s estate. If there is no lawful executor or administrator of the Participant s estate at the time of payment of the benefits, We may pay to a proper claimant up to the maximum amount allowable under the Laws of Malaysia, and the balance, if any, will be paid to the person named as the lawful executor or administrator of the Participant s estate in accordance with the court order received by Us subsequently ALTERATIONS We reserve the right to vary the terms and provisions of this Master Certificate on any Certificate Anniversary. No changes to this Master Certificate or CIP will be valid unless approved, endorsed and signed by Our authorized officer INCONTESTABILITY We will not dispute the validity of any claim under this Master Certificate after one (1) year from the Effective Date of the first Period of Takaful, unless there is fraud CLAIMS NOTIFICATION, PROCEDURE AND SETTLEMENT Written notice of any event likely to give rise to a claim should be submitted to Us as soon as reasonably possible and in any case (except for Daily Hospital Income Benefit) not later than fourteen (14) days of the Accident causing such injury or loss. For Daily Hospital Income Benefit, written notice of any Hospital confinement that incurs claimable expenses must be submitted together with supporting documents to Us within thirty (30) days from the date of commencement of such Hospital confinement The Participant shall procure and act upon medical or surgical advice as soon as practicable The Person Covered may be required, at Our expense to undergo further medical examination We will only pay the benefits if any medical certificates and other evidence which We may require are provided on request at the Participant s expenses We shall deduct any amount owed to Us before making any benefit payment. Such payment, if any, will be payable to the named nominee according to the terms and conditions of this Master Certificate On payment of the benefits under Accidental Permanent Disability Benefit, for which once the Participant gives Us a receipt or discharge, Our liability in that respect will reduce by the sum paid or cease if full benefits have been paid We reserve the right to repudiate a claim where We are not satisfied with the evidence available to validate either: (i) Identity of the Person Covered; or (ii) The circumstance of the loss In the event of Accidental Bodily Injury resulting in death, We shall be entitled to have a post-mortem examination at Our expenses. Page 5 of 10

7 2.18 CERTIFICATE, INFORMATION AND EVIDENCE All certificates, information, medical reports and evidence as required by Us shall be furnished at the Participant s expense, and in such a form that We may require. In any event, all notices, which We shall require the Participant or the Person Covered to give, must be in writing and addressed to Us. A Person Covered shall, at Our request and expense, submit to Us a medical examination whenever such is deemed necessary DISAPPEARANCE Upon Our satisfaction to the disappearance of the Person Covered and sufficient evidence is produced which leads to Us to the inevitable presumption that the Person Covered has sustained Accidental Bodily Injury which has resulted in death, We will pay claims under Accidental Death Benefit and Funeral Expenses Benefit. If however, at any time after We have paid the benefits and the Person Covered is subsequently found to be living, payment of the said benefits must be refunded to Us TERMINATION OF THE COVERAGE The coverage on any Person Covered under this Master Certificate will automatically terminate when any one (1) of the following events occurs: upon cancellation of coverage as provided under clause CANCELLATION OF THIS MASTER CERTIFICATE above ; or upon death of the Person Covered; or upon claim admission of the Accidental Permanent Disability Benefit where the aggregate amount of benefits payable under this and all other claims paid is equal to the Sum Covered on Accidental Permanent Disability Benefit; or when the Person Covered attains the age of seventy five (75) years next birthday on any Certificate Anniversary; or for the Child of a Participant, when he attains the age of nineteen (19) years next birthday or twenty four (24) years next birthday if in full-time tertiary institution, on any Certificate Anniversary; or when the Individual Certificate is lapsed or terminated in any other manner. For events and above, when the coverage of any Person Covered is terminated, coverage to all other Person Covered issued under the same Individual Certificate will also be terminated automatically on the same date. Any Contribution paid or accepted after the termination of this Master Certificate or the termination of the coverage on any Person Covered will not create any liability but We will refund such Contribution without profit ARBITRATION CLAUSE All differences arising out of this Master Certificate shall be referred to the decision of a Arbitrator to be appointed in writing by the parties in difference or if they cannot agree upon a single Arbitrator to the decision of two Arbitrators one to be appointed in writing by each of the parties within one calendar month after having been required to do so by either of the parties or in case the Arbitrators do not agree of an Umpire appointed in writing by the Arbitrators before entering upon the reference. The Umpire shall sit with the Arbitrators and preside at their meeting and the making of an Award shall be a condition precedent to any right of action against Us. If We shall disclaim liability to the Master Certificate Owner or the Participant for any claim hereunder and such claim shall not within twelve (12) months from the date of such disclaimer have been referred to arbitration under the provisions herein contained then the claim for all intents and purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder. Page 6 of 10

8 2.22 RETAKAFUL We have the discretion to secure adequate retakaful (reinsurance) from any source We consider fit for the Person Covered s benefit SANCTIONS EXCLUSION CLAUSE We shall not be deemed to provide cover nor be liable to pay any claim or any benefit as contained in this Master Certificate to the extent that the provision of such cover, payment of such claim or such benefit would expose Us to: any sanction, prohibition or restriction under United Nations resolutions; or the trade or economic sanctions, laws or regulations of the: European Union; or United Kingdom; or United States of America; or any of the states to the above countries; or any other locally applicable laws or regulations APPLICABLE LAW This Master Certificate, and all rights, obligations and liabilities arising under this Master Certificate, shall be construed, determined and enforced in accordance with the Laws of Malaysia. 3. BENEFITS While this Master Certificate is in force, and subject to its terms and conditions, We will provide the following benefits to the Person Covered as stated in the CIP: 3.1. ACCIDENTAL DEATH BENEFIT Upon receipt and approval of due proof on the death of the Person Covered as a result of Accident, We will pay the Sum Covered on Accidental Death Benefit in one lump sum. Provided that: Death of the Person Covered must be incurred within twelve (12) months from the event date; and If the Person Covered is a Child on the date of death, the Sum Covered on Accidental Death Benefit shall be reduced to 50% of the amount shown in CIP. Upon the full payment of the revised amount of Sum Covered on Accidental Death Benefit, the Individual Certificate will be terminated automatically We receive the notification of death accompanied by the documentary evidence of death; and The aggregate amount of benefits payable to any Person Covered under Accidental Death Benefit and Accidental Permanent Disability Benefit taken together should not exceed a total of one hundred percent (100%) of the Sum Covered on Accidental Death Benefit FUNERAL EXPENSES BENEFIT Upon death of the Person Covered as a result of Accident, We will pay the Sum Covered on Funeral Expenses Benefit in respect of the Person Covered as shown in the CIP, in addition to the Accidental Death Benefit. Page 7 of 10

9 Provided that We receive the notification of the relevant death accompanied by the documentary evidence of death of the Person Covered ACCIDENTAL PERMANENT DISABILITY BENEFIT Upon receipt and approval of due proof that the Person Covered suffers any of the Permanent Disability as a result of Accident and prior to the Certificate Anniversary on which he attains the age of seventy five (75) years next birthday, We will pay a benefit or benefits correspond to the said Permanent Disability in accordance with the Schedule of Benefits below SCHEDULE OF BENEFITS Item PERMANENT DISABILITY CLAIM PAYMENTS AS % OF SUM COVERED ON ACCIDENTAL PERMANENT DISABILITY BENEFIT 1. Loss of two limbs Loss of both hands, or of all fingers and both thumbs Total loss of sight of both eyes Total paralysis Injuries resulting in being permanently bedridden Loss of arm at shoulder Loss of arm between shoulder and elbow Loss of arm at elbow Loss of arm between elbow and wrist Loss of hand at wrist Loss of leg (a) at hip 100 (b) between knee and hip 100 (c) below knee Eye: Loss of (a) Whole eye 100 (b) Sight of one eye except perception of light 50 (c) Lens of one eye Loss of four fingers and thumb of one hand Loss of four fingers Loss of thumb (a) both phalanges 25 (b) one phalanx Loss of index finger (a) three phalanges 10 (b) two phalanges 8 (c) one phalanx Loss of middle finger (a) three phalanges 6 (b) two phalanges 4 (c) one phalanx Loss of ring finger (a) three phalanges 5 (b) two phalanges 3 Page 8 of 10

10 (c) one phalanx Loss of little finger (a) three phalanges 4 (b) two phalanges 3 (c) one phalanx Loss of metacarpals (a) first or second (additional) 3 (b) third, fourth or fifth (additional) Loss of toes (a) all toes 15 (b) great toes, both phalanges 5 (c) great toes, one phalanx 2 (d) other than great toe and if more than one toe lost, each Loss of hearing: (a) both ears 75 (b) one ear Loss of speech 50 Any other form of permanent disability not stated in the Schedule of Benefits will be assessed at Our sole and absolute discretion, and any proportion of the Sum Covered on Accidental Permanent Disability Benefit payable will be in accordance with such rates of compensation which in Our opinion is consistent with the provisions of the Schedule of Benefits CONDITION FOR PAYMENT OF BENEFITS Sustaining of a Permanent Disability must be incurred within twelve (12) months from the event date If the Person Covered is a Child on the date of claim, the Sum Covered on Accidental Permanent Disability Benefit shall be reduced to 50% of the amount shown in CIP. Upon the full payment of the revised amount of Sum Covered on Accidental Permanent Disability Benefit, the Individual Certificate will be terminated automatically A claim made under Accidental Permanent Disability Benefit will result in the same amount of reduction in the Sum Covered on Accidental Death Benefit The aggregate amount of benefits payable to any Person Covered under Accidental Permanent Disability Benefit and Accidental Death Benefit taken together should not exceed a total of one hundred percent (100%) of the Sum Covered on Accidental Permanent Disability Benefit SNATCH INJURY BENEFIT Upon receipt and approval of due proof that the Person Covered suffers injury caused by snatch thief, We will pay the Sum Covered on Snatch Injury Benefit as shown in the CIP in one lump sum. No further payment will be made in respect of this covered benefit for any subsequent claim incurred within the same Period of Takaful DAILY HOSPITAL INCOME BENEFIT Upon receipt and approval of due proof that the Person Covered is confined to a Hospital as a result of Accident and on the recommendation of a registered Medical Practitioner, We will pay Sum Covered on Daily Hospital Income Benefit as shown in the CIP on each day of confinement. The aggregate amount of Daily Hospital Income Benefit payable to each Person Covered shall be limited to a maximum of thirty (30) days within the same Period of Takaful. Page 9 of 10

11 4. EXCLUSIONS We shall not pay for any consequence whatsoever which is the direct or indirect result of any of the following: 4.1. war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, mutiny or usurped power, strike, riot, civil commotion, military or popular uprising, when the Person Covered is taking part therein an Act of Terrorism solely resulting from the utilization of nuclear, chemical or biological weapons, devices or substances as a means of force, violence or mass destruction or howsoever distributed or combined, when the Person Covered is taking part therein insanity, suicide (whether sane or insane), intentional self inflicted injuries or any attempt thereat effect or influence of drugs or alcohol pre existing physical or mental defect or infirmity provoked murder or assault while travelling in an aircraft as a member of the crew, except only as a fare paying passenger in an aircraft licensed for passenger service while committing or attempting to commit any unlawful or criminal act, participation in, attempt at, or acting as an accessory to, any crime which involves deliberate criminal intent or action Whilst participating in professional sports and/or hazardous activities including but not limited to hunting, mountaineering, ice hockey, polo playing, steeple chasing, winter sports, yachting, caving, potholing white water rafting, sky diving, cliff diving, bungee jumping, water ski jumping, under water activities involving the use of breathing apparatus, martial arts or boxing, aerial activities such as parachuting, paragliding and hang gliding or participation in any form of race or competition other than on foot Individuals such as pilots, aviation crews and firemen during the course of their work or whilst on duty, fishermen, professional motor racers, professional sportsmen, stevedores, building demolition workers, divers, jockeys, logging workers, miners, marine salvage crew, individuals directly involved in making or handling explosives, personnel in the armed forces, tree fellers, window cleaners of high rise buildings and other hazardous and dangerous occupations The Person Covered whilst using machinery driven by mechanical power as a tool of trade Nuclear energy or radioactivity of any kind including but not limited to ionising radiations from or contamination by radioactivity from any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel or nuclear weapons material. Page 10 of 10

12 GOODS AND SERVICES TAX CLAUSE The amount of contribution payable by the Participant under this Master Certificate includes an amount on account of the GST on the contribution. When We pay a claim, GST status of the Participant will determine the amount We pay. When the Participant is: (a) a non-gst registered person, We will pay in full (including GST) up to Sum Covered/limit of liability or the other limits of takaful cover. (b) a GST registered person, We will pay (excluding GST) up to Sum Covered/limit of liability or the other limits of takaful cover. The Participant is to claim his Input Tax Credit entitlement from the Royal Malaysian Customs Department directly. The Participant must advise Us of his correct entitlement to an Input Tax Credit on his Contribution. Takaful myelite PA /V01(E)/ Page 1 of 1

13 PERSONAL DATA PROTECTION ACT 2010 You may make inquiries or request for access to or correction of Your Personal Data or limit the processing of Your Personal Data at any time by submitting such inquiry or request to Us via to We will retain Your personal information only for as long as necessary to fulfill the purpose for which it was collected or to comply with legal, regulatory or internal policy requirements. Page 1 of 1

14 COMPLAINT PROCEDURES We believe the Participant deserves a courteous, fair and prompt service. If there is any circumstance when Our service does not meet expectations of the Participant, please contact Us using the appropriate contact details below and provide the Certificate Number/Claim Number and Person Covered s Name: 1. Firstly with the department or person the Participant dealt with Us on how the Participant would like the problem to be solved. 2. Secondly if the problem is not solved to the Participant s satisfaction, then make a formal written complaint to: Customer Service Unit (CSU) Suite 1B-3A, Level 3A, Block 1B, Plaza Sentral Jalan Stesen Sentral Kuala Lumpur Operating hours: Monday to Friday 9:00am 5:30pm Tel: myelitepa@takaful-malaysia.com.my 3. Thirdly, if the Participant is not satisfied with Our decision, he can refer the matter to Ombudsman for Financial Services (OFS) or BANK NEGARA MALAYSIA through BNMTELELINK or BNMLINK, at the following addresses: Ombudsman for Financial Services (664393P) Level 14, Main Block, Menara Takaful Malaysia No. 4, Jalan Sultan Sulaiman Kuala Lumpur Tel: Fax : enquiry@ofs.org.my Website: BNM Laman Informasi Nasihat dan Khidmat (LINK) Ground Floor, Blok D, Bank Negara Malaysia Jalan Dato Onn Kuala Lumpur Tel: (LINK) Fax : bnmtelelink@bnm.gov.my Page 1 of 1

15 CLAIM FORM AND SUPPORTING DOCUMENTS (COPIES MUST BE CERTIFIED) The claimant is responsible to ensure that the claim is for the benefits under this Master Certificate. Any difference in definition of scope of cover will strictly follow those as stated in this Master Certificate. Listed below are some documents to support the proof of claim: Accidental Death Claim (including Funeral Expenses) (a) Claim form (b) Copy of death certificate of deceased (c) Copy of burial permit (d) Copy of identity card of claimant (e) Police report (f) Attending Physician Statement (optional unless requested by Us) (g) Original certificate of Takaful Plan (if any) (h) Copy of proof of relationship Accidental Permanent Disability Claim (a) Claim form (b) Copy of identity card of claimant (c) Copy of termination letter from the employer (optional unless requested by Us) (d) Medical Board Panel Report (e) Police report (f) Medical Report from the attending specialist doctor Snatch Injury Benefit Claim (a) Claim form (b) Copy of identity card of claimant (c) Police report Daily Hospital Income Benefit Claim (a) Claim form (b) Copy of identity card of claimant (c) Discharge note or ward chit or any statement/bills produced by the hospital (d) Police report if hospitalization is due to Accident (e) Medical report from the hospital if above RM500 The claimant must submit the duly completed claim forms together with the relevant supporting documents to Customer Service Unit (CSU) Suite 1B-3A, Level 3A, Block 1B, Plaza Sentral Jalan Stesen Sentral Kuala Lumpur Operating hours: Monday to Friday 9:00am 5:30pm Tel: myelitepa@takaful-malaysia.com.my for Our claims processing. Page 1 of 1