BORANG CADANGAN IKHLAS MACHINERY BREAKDOWN TAKAFUL IKHLAS MACHINERY BREAKDOWN TAKAFUL PROPOSAL FORM

Size: px
Start display at page:

Download "BORANG CADANGAN IKHLAS MACHINERY BREAKDOWN TAKAFUL IKHLAS MACHINERY BREAKDOWN TAKAFUL PROPOSAL FORM"

Transcription

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. A. BUTIRAN PENCADANG / PARTICULARS OF PROPOSER 1. a. Nama Penuh Pencadang / Full name of Proposer : BORANG CADANGAN IKHLAS MACHINERY BREAKDOWN TAKAFUL IKHLAS MACHINERY BREAKDOWN TAKAFUL PROPOSAL FORM b. Alamat Pencadang : Proposer Address : Poskod / Postcode Negeri / State Bandar / Town c. Lokasi Loji : Plant Location : Poskod / Postcode Negeri / State Bandar / Town d. Jenis Perniagaan : Nature of Business : e. Nama Ketua Jurutera Pengurus Loji : Name of Chief Engineer of Plant Manager : f. Stesen Keretapi / Lapangan Terbang Terdekat : Nearest Railway Station / Airport : 2. Pernahkah mana-mana mesin yang akan dilindungi diberikan perlindungan oleh syarikat lain terhadap sebarang kerosakan? Has any of the machinery to be covered previously been covered by other companies against breakdown? Jika ya, sila nyatakan spesifikasi butiran dan syarikat If so, which item of the specification and by what companies Nyatakan bila perlindungan bermula State when the coverage is to commence HH/DD BB/MM TTTT/YYYY Masa/Time (AM/PM) Tempoh Takaful tamat pada tarikh dan masa yang sama tahun depan Period of Takaful to expire at the same date and time next year 3. Adakah perlindungan ke atas asas mesin diperlukan? Do you wish to cover the foundation of machinery? Jika ya, nyatakan spesifikasi butiran berkaitan. / If so, please state the relevant item of the specification. 4. Adakah spesifikasi merangkumi semua mesin yang dilindungi dalam Kerosakan Mesin? Does the specification include all the machinery coverable under Machinery breakdown? Jika tidak, adakah mesin yang akan dilindungi mewakili semua mesin yang dilindungi dalam satu bahagian loji? If not, does the machinery to be covered represent all machinery coverable in one plant section?

2 5. Adakah anda juga ingin perlindungan ke atas caj tambahan (jika berlaku kerugian) untuk : Do you wish the cover to include extra charges (in case of loss) for : a. Pengangkutan ekspres, lebih masa, tugas malam, bertugas semasa cuti am? Express freight, overtime, night work, work on public holidays? b. Pengangkutan Udara? Air freight? c. Had tanggungan pengangkutan udara Limit of indemnity for air freight 6. Berikan maklumat perlindungan tambahan yang diperlukan. Give details of any special extension of cover required. 7. Spesifikasi Butiran yang ingin dilindungi Specification of Items to be Covered No. No. Senarai butiran 1 Description of items 1 Tahun dibuat Pernyataan 2 Year of manufacture Remarks 2 Amaun Perlindungan 3 Sum Covered 3 RM Sila nyatakan secara penuh dan butiran lengkap semua mesin termasuk nama pembuat, jenis, pengeluar, kemampuan, kelajuan, kemampatan, berat, voltan, aliran elektrik, pusingan, minyak, tekanan, suhu dan lain-lain. Please give full and exact description of all machines, including name of manufacture, type, output, capacity, speed, load, weight, voltage, amperage, cycles, fuel, pressure, temperature, etc. Sila nyatakan mana-mana bahagian mesin yang dilindungi pernah mengalami kerosakan atau kegagalan berfungsi dalam masa 3 tahun yang menunjukkan tanda baik pulih atau terdedah kepada risiko baru. Give particulars of any part of the machinery to be covered which had a breakdown or failure during the last 3 years, which shows any signs of repair or which is exposed to any special risk. Sila nyatakan kos terkini penggantian mesin yang mana jenis dan kemampuan (termasuk pelincir untuk transformer dan suis) serta caj muatan, duti kastam, kos pembinaan dan juga nilai asas, jika perlindungan diperlukan. Please state current cost of replacing the machine by new machinery of the same kind and capacity (including in the case of transformers and switchers) plus freight charges, custom duties, cost of erection and also value of foundations, if the latter are to be covered. Jika perlu, sila lampirkan di atas kertas yang berasingan. If necessary, attached a separate sheet.

3 B. 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 perjanjian Takaful antara Saya / Kami dan Takaful Ikhlas Berhad (selepas ini dirujuk sebagai "pihak Syarikat") dan ianya disifatkan sebagai termaktub dalam perjanjian ini. 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 30% 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 contract between Me / Us and Takaful Ikhlas Berhad (herein referred as "the Company") and they are deemed to be incorporated in the contract. 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 30% of the Contribution as Wakalah Fee. I/ WefurtheragreethatthebalanceofMy/ OurContributionshallbeallocatedinto 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 / We also understand 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 manamana 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/Signature of Proposer : Cop Syarikat/Company's Stamp: Tarikh/Date :

4 C. PERLINDUNGAN MAKLUMAT PERIBADI / PERSONAL DATA PROTECTION 1. 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. 2. 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 manamana 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) 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 c) 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.

5 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. NOTA PENTING / IMPORTANT NOTES 1. Sila ambil perhatian pada tempoh 60 hari waranti sumbangan yang tercatat pada sijil ini. Dengan waranti ini, Sijil Takaful dibatalkan secara automatik kecuali sumbangan penuh di bayar kepada Takaful IKHLAS dalam tempoh 60 hari dari tarikh permulaan perlindungan. Sekiranya urusan takaful ini melalui broker, broker ini bertindak bagi pihak anda atau untuk tujuan pembentukkan kontrak takaful ini. Adalah penting anda membuat bayaran penuh sumbangan kepada broker anda secepat mungkin dan pada bilabila masa dalam tempoh 60 hari waranti sumbangan untuk membolehkan broker anda mengirim sumbangan awal kepada Takaful IKHLAS. Anda dinasihatkan untuk meminta broker anda memberi anda resit broker dan Takaful IKHLAS untuk sumbangan yang telah anda bayar. Your attention is drawn to the 60 days contribution warraty attached to the certificate. By this warranty, the Takaful certificate is automatically cancelled unless the full contribution is paid to Takaful IKHLAS within 60 days from the commencement date of cover. Please note that if this Takaful is transacted through broker, the broker is acting on your behalf for the purpose of formation of this contract of Takaful. It is important that you make the full payment of the contribution to your broker as soon as possible and in any case within 60 days period of the contribution warranty so as to enable your broker to remit the contribution early to Takaful IKHLAS. You are advised to request your broker to furnish you with the broker's and Takaful IKHLAS's receipt on the contribution that you paid Segala terma dan syarat-syarat perlindungan adalah termaktub kepada persetujuan dari TAKAFUL IKHLAS BERHAD Unless otherwise agreed upon, TAKAFUL IKHLAS BERHAD 's standard terms and conditions of the certificate applies. Perlindungan ini tidak akan berkuatkuasa selagi Borang Cadangan ini belum diterima oleh Syarikat. No Cover is in force until this Proposal has been accepted by the Company. Sebarang perubahan kepada maklumat yang diberikan hendaklah dimaklumkan kepada Syarikat dengan segera. Kegagalan melaporkannya, menyebabkan pihak syarikat berhak untuk menolak semua tuntutan. Any changes in the information given must be reported to the Company immediately, otherwise the Company will reserve the right to decline all liabilities. 5. 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. 6. 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 7. 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 the government and/or the authority in the future (including Goods and Services Tax (GST)). Upon implementation of the GST, we shall be entitled to recover the GST from you in respect of this Takaful Certificate that is required under the law.

6 UNTUK KEGUNAAN EJEN ATAU PEJABAT / FOR AGENT'S 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

BORANG CADANGAN IKHLAS EQUIPMENT COMPREHENSIVE PERILS TAKAFUL IKHLAS EQUIPMENT COMPREHENSIVE PERILS TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS EQUIPMENT COMPREHENSIVE PERILS TAKAFUL IKHLAS EQUIPMENT COMPREHENSIVE PERILS TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

BORANG CADANGAN IKHLAS COMPUTER COMPREHENSIVE PERILS TAKAFUL IKHLAS COMPUTER COMPREHENSIVE PERILS TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS COMPUTER COMPREHENSIVE PERILS TAKAFUL IKHLAS COMPUTER COMPREHENSIVE PERILS TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

BORANG CADANGAN IKHLAS COMPREHENSIVE PERILS TAKAFUL IKHLAS COMPREHENSIVE PERILS TAKAFUL PROPOSAL FORM. Bandar / Town

BORANG CADANGAN IKHLAS COMPREHENSIVE PERILS TAKAFUL IKHLAS COMPREHENSIVE PERILS TAKAFUL PROPOSAL FORM. Bandar / Town A. BUTIRAN PENCADANG / THE PROPOSER 1. Nama Pencadang Name of Proposer 2. Alamat Surat Menyurat Correspondence Address TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South,

More information

BORANG CADANGAN IKHLAS MACHINERY BREAKDOWN TAKAFUL IKHLAS MACHINERY BREAKDOWN TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS MACHINERY BREAKDOWN TAKAFUL IKHLAS MACHINERY BREAKDOWN TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9696 (General Line) Fax : 03-2723 9998 (General Fax Line) Website

More information

BORANG CADANGAN IKHLAS PERDANA PERSONAL ACCIDENT TAKAFUL PROPOSAL FORM IKHLAS PERDANA PERSONAL ACCIDENT TAKAFUL

BORANG CADANGAN IKHLAS PERDANA PERSONAL ACCIDENT TAKAFUL PROPOSAL FORM IKHLAS PERDANA PERSONAL ACCIDENT TAKAFUL TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

BORANG CADANGAN IKHLAS ELECTRONIC EQUIPMENT TAKAFUL IKHLAS ELECTRONIC EQUIPMENT TAKAFUL PROPOSAL FORM. Bandar / Town

BORANG CADANGAN IKHLAS ELECTRONIC EQUIPMENT TAKAFUL IKHLAS ELECTRONIC EQUIPMENT TAKAFUL PROPOSAL FORM. Bandar / Town TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

BORANG CADANGAN IKHLAS PERSONAL ACCIDENT TAKAFUL IKHLAS PERSONAL ACCIDENT TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS PERSONAL ACCIDENT TAKAFUL IKHLAS PERSONAL ACCIDENT TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

Title Dato Datin Mr Ms Mr Mrs Dr Others

Title Dato Datin Mr Ms Mr Mrs Dr Others TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

BORANG CADANGAN IKHLAS PUBLIC LIABILITY TAKAFUL IKHLAS PUBLIC LIABILITY TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS PUBLIC LIABILITY TAKAFUL IKHLAS PUBLIC LIABILITY TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

BORANG CADANGAN IKHLAS PLATE GLASS TAKAFUL IKHLAS PLATE GLASS TAKAFUL PROPOSAL FORM. Bandar / Town

BORANG CADANGAN IKHLAS PLATE GLASS TAKAFUL IKHLAS PLATE GLASS TAKAFUL PROPOSAL FORM. Bandar / Town TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

BORANG CADANGAN TAKAFUL KEBAKARAN - BUKAN KEDIAMAN FIRE TAKAFUL PROPOSAL FORM - NON-RESIDENTIAL

BORANG CADANGAN TAKAFUL KEBAKARAN - BUKAN KEDIAMAN FIRE TAKAFUL PROPOSAL FORM - NON-RESIDENTIAL TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

BORANG CADANGAN IKHLAS MONEY TAKAFUL IKHLAS MONEY TAKAFUL PROPOSAL FORM. Bandar / Town

BORANG CADANGAN IKHLAS MONEY TAKAFUL IKHLAS MONEY TAKAFUL PROPOSAL FORM. Bandar / Town TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

PACIFIC MUTUAL FUND BHD IMPORTANT NOTICE ON PERSONAL DETAILS NOTIS PENTING BERKENAAN MAKLUMAT PERIBADI

PACIFIC MUTUAL FUND BHD IMPORTANT NOTICE ON PERSONAL DETAILS NOTIS PENTING BERKENAAN MAKLUMAT PERIBADI PACIFIC MUTUAL FUND BHD IMPORTANT NOTICE ON PERSONAL DETAILS NOTIS PENTING BERKENAAN MAKLUMAT PERIBADI The Personal Data Protection Act 2010 (hereinafter referred to as the Act ) came into effect on 15

More information

GUW-PFR029/00 Permata (01/12/11)

GUW-PFR029/00 Permata (01/12/11) TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

BORANG CADANGAN IKHLAS NIAGA TAKAFUL ( OFFICE NIAGA) IKHLAS NIAGA TAKAFUL (OFFICE NIAGA) PROPOSAL FORM

BORANG CADANGAN IKHLAS NIAGA TAKAFUL ( OFFICE NIAGA) IKHLAS NIAGA TAKAFUL (OFFICE NIAGA) PROPOSAL FORM A. IKHLAS Point, Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 Fax : 03-2723 9998 Call Centre No : 03-2723 9696 Website : www.takaful-ikhlas.com.my PENCADANG

More information

TAKAFUL IKHLAS BERHAD ( U) IKHLAS POINT Corporate Head Office Tower 11A,Avenue 5, Bangsar South, No. 8, JalanKerinchi, Kuala Lumpur.

TAKAFUL IKHLAS BERHAD ( U) IKHLAS POINT Corporate Head Office Tower 11A,Avenue 5, Bangsar South, No. 8, JalanKerinchi, Kuala Lumpur. TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS POINT Corporate Head Office Tower 11A,Avenue 5, Bangsar South, No. 8, JalanKerinchi, 59200 Kuala Lumpur. Tel: 03-2723 9999 Fax: 03-2723 9998 Website: www.takaful-ikhlas.com.my

More information

BORANG CADANGAN IKHLAS PLATE GLASS TAKAFUL IKHLAS PLATE GLASS TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS PLATE GLASS TAKAFUL IKHLAS PLATE GLASS TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS SDN BHD. (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

APPLICATION FOR A PERFORMANCE BOND / ADVANCE PAYMENT BOND

APPLICATION FOR A PERFORMANCE BOND / ADVANCE PAYMENT BOND APPLICATION FOR A PERFORMANCE BOND / ADVANCE PAYMENT BOND Pursuant to Paragraph 4(1) of Schedule 9 of the Financial Services Act 2013, if you are applying for this Insurance for a purpose related to your

More information

BORANG CADANGAN IKHLAS PUBLIC LIABILITY TAKAFUL IKHLAS PUBLIC LIABILITY TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS PUBLIC LIABILITY TAKAFUL IKHLAS PUBLIC LIABILITY TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

BORANG CADANGAN IKHLAS FIDELITY GUARANTEE TAKAFUL IKHLAS FIDELITY GUARANTEE TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS FIDELITY GUARANTEE TAKAFUL IKHLAS FIDELITY GUARANTEE TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

School Children Personal Accident Insurance Plan - List Of Insured Persons

School Children Personal Accident Insurance Plan - List Of Insured Persons School Children Personal Accident Insurance Plan - List Of Insured Persons IMPORTANT NOTE Pursuant to Paragraph 5 of Schedule 9 of the Financial Services Act 2013, if you are applying for this Insurance

More information

BORANG CADANGAN IKHLAS MONEY TAKAFUL IKHLAS MONEY TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS MONEY TAKAFUL IKHLAS MONEY TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS BERHAD. (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9696 (General Line) Fax : 03-2723 9998 (General Fax Line) Website

More information

BORANG CADANGAN TAKAFUL KEDIAMAN SAHAJA TAKAFUL PROPOSAL FORM - RESIDENTIAL ONLY

BORANG CADANGAN TAKAFUL KEDIAMAN SAHAJA TAKAFUL PROPOSAL FORM - RESIDENTIAL ONLY TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

M A X I S M O B I L E S E R V I C E S S D N B H D T 1 C P

M A X I S M O B I L E S E R V I C E S S D N B H D T 1 C P M A X I S M O B I L E S E R V I C E S S D N B H D 7 3 3 1 5 - T 1 C P - 8 1 6 7 0 6 ACE Jerneh Insurance Berhad (9827-A) Wisma ACE Jerneh, 38 Jalan Sultan Ismail 50250 Kuala Lumpur Malaysia Tel 03 2058

More information

BORANG CADANGAN IKHLAS PERDANA PERSONAL ACCIDENT TAKAFUL PROPOSAL FORM IKHLAS PERDANA PERSONAL ACCIDENT TAKAFUL

BORANG CADANGAN IKHLAS PERDANA PERSONAL ACCIDENT TAKAFUL PROPOSAL FORM IKHLAS PERDANA PERSONAL ACCIDENT TAKAFUL TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9696 (General Line) Fax : 03-2723 9998 (General Fax Line) Website

More information

BORANG CADANGAN IKHLAS NIAGA TAKAFUL ( OFFICE NIAGA) IKHLAS NIAGA TAKAFUL (OFFICE NIAGA) PROPOSAL FORM

BORANG CADANGAN IKHLAS NIAGA TAKAFUL ( OFFICE NIAGA) IKHLAS NIAGA TAKAFUL (OFFICE NIAGA) PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point, Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9696 Fax : 03-2723 9998 Website : www.takaful-ikhlas.com.my (Anak

More information

BORANG CADANGAN IKHLAS BURGLARY TAKAFUL IKHLAS BURGLARY TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS BURGLARY TAKAFUL IKHLAS BURGLARY TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS SDN BHD. (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

This Policy reflects the terms and conditions of the contract of insurance as agreed between you and the Company.

This Policy reflects the terms and conditions of the contract of insurance as agreed between you and the Company. (62605-U) This Policy is issued in consideration of the payment of premium as specified in the Policy Schedule and pursuant to the answers given in your Proposal Form (or when you applied for this insurance)

More information

BORANG CADANGAN IKHLAS ERECTION ALL RISKS TAKAFUL IKHLAS ERECTION ALL RISKS TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS ERECTION ALL RISKS TAKAFUL IKHLAS ERECTION ALL RISKS TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9696 (General Line) Fax : 03-2723 9998 (General Fax Line) Website

More information

Alamat Surat Menyurat : Poskod : No. telefon : Emel : RM 100 PELAN B RM 80,000 RM 80,000 RM 1,000

Alamat Surat Menyurat : Poskod : No. telefon : Emel : RM 100 PELAN B RM 80,000 RM 80,000 RM 1,000 BORANG CADANGAN TAKAFUL AMANI (PELAN TAKAFUL KEMALANGAN DIRI BERKELOMPOK) NOTA PENTING : MENURUT SEKSYEN 28 AKTA TAKAFUL 1984, ANDA DIKEHENDAKI MENYATAKAN DI DALAM BORANG CADANGAN INI DENGAN BENAR DAN

More information

Machinery Insurance Proposal Form

Machinery Insurance Proposal Form Machinery Insurance Proposal Form SCHEDULE 9 OF THE FINANCIAL SERVICES ACT 2013 (FSA) Pursuant to Paragraph 4(1) of Schedule 9 of the Financial Services Act 2013, if you are applying for this Insurance

More information

LIVING CARE. Critical Illness Insurance

LIVING CARE. Critical Illness Insurance LIVING CARE Critical Illness Insurance PREMIUM TABLE ANNUAL PREMIUM (RM) (excluding Service Tax and Stamp Duty)/ SUM INSURED (RM) Attained Age 50,000 100,000 150,000 200,000 250,000 (Next Birthday) Male

More information

PERSONAL ACCIDENT CLAIM FORM BORANG TUNTUTAN KEMALANGAN DIRI

PERSONAL ACCIDENT CLAIM FORM BORANG TUNTUTAN KEMALANGAN DIRI PERSONAL ACCIDENT CLAIM FORM BORANG TUNTUTAN KEMALANGAN DIRI The issuance of this form is not an admission of liability on the part of the Takaful Operator and if false statement or declaration be made

More information

GST 01 PERMOHONAN PENDAFTARAN CUKAI BARANG DAN PERKHIDMATAN APPLICATION FOR GOODS AND SERVICES TAX REGISTRATION

GST 01 PERMOHONAN PENDAFTARAN CUKAI BARANG DAN PERKHIDMATAN APPLICATION FOR GOODS AND SERVICES TAX REGISTRATION Panduan di bawah akan membantu anda mengisi borang yang berkaitan dengan permohonan anda. The guideline below will assist you in filling in the form relating to your application. GST 01 PERMOHONAN PENDAFTARAN

More information

BORANG CADANGAN IKHLAS (RETAIL NIAGA) IKHLAS NIAGA TAKAFUL (RETAIL NIAGA) PROPOSAL FORM

BORANG CADANGAN IKHLAS (RETAIL NIAGA) IKHLAS NIAGA TAKAFUL (RETAIL NIAGA) PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point, Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9696 Fax : 03-2723 9998 Website : www.takaful-ikhlas.com.my (Anak

More information

YAYASAN BURSA MALAYSIA SCHOLARSHIP PROGRAMME Scholarship Application Form 2018/2019

YAYASAN BURSA MALAYSIA SCHOLARSHIP PROGRAMME Scholarship Application Form 2018/2019 YAYASAN BURSA MALAYSIA SCHOLARSHIP PROGRAMME Scholarship Application Form 2018/2019 Paste a recent passport-sized photograph here. A. Personal Particulars Date of birth: Place of birth: Age: Citizenship:

More information

BORANG CADANGAN "IKHLAS FIRE TAKAFUL - NON-RESIDENTIAL" PROPOSAL FORM FOR "IKHLAS FIRE TAKAFUL - NON-RESIDENTIAL"

BORANG CADANGAN IKHLAS FIRE TAKAFUL - NON-RESIDENTIAL PROPOSAL FORM FOR IKHLAS FIRE TAKAFUL - NON-RESIDENTIAL TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9696 (Call Centre) Fax : 03-2723 9998 (General Fax Line) Website

More information

KRITERIA BORANG NYATA CUKAI PENDAPATAN (BNCP) TIDAK LENGKAP PEMBERITAHUAN

KRITERIA BORANG NYATA CUKAI PENDAPATAN (BNCP) TIDAK LENGKAP PEMBERITAHUAN KRITERIA BORANG NYATA CUKAI PENDAPATAN (BNCP) TIDAK LENGKAP CRITERIA ON INCOMPLETE INCOME TAX RETURN FORM (ITRF) PEMBERITAHUAN MULAI 1 JANUARI 2012, BNCP YANG TIDAK LENGKAP AKAN DIPULANGKAN KEPADA PEMBAYAR

More information

WIN CASH- REMITTANCE TO CHINA CONTEST TERMS & CONDITIONS

WIN CASH- REMITTANCE TO CHINA CONTEST TERMS & CONDITIONS WIN CASH- REMITTANCE TO CHINA CONTEST TERMS & CONDITIONS Contest Period Malayan Banking Berhad ( Maybank ) is organizing this Win Cash- Remittance To China Contest ( Contest ) that will commence on 12

More information

PEMBERITAHUAN CATATAN NOTES. Hanya BNCP ASAL yang ditetapkan oleh LHDNM akan diterima. Menggunakan salinan fotostat BNCP adalah tidak dibenarkan.

PEMBERITAHUAN CATATAN NOTES. Hanya BNCP ASAL yang ditetapkan oleh LHDNM akan diterima. Menggunakan salinan fotostat BNCP adalah tidak dibenarkan. KRITERIA BORANG NYATA CUKAI PENDAPATAN (BNCP) TIDAK LENGKAP YANG TIDAK BOLEH DITERIMA CRITERIA ON INCOMPLETE INCOME TAX RETURN FORM (ITRF) WHICH IS UNACCEPTABLE PEMBERITAHUAN BNCP TIDAK LENGKAP YANG TIDAK

More information

INDUSTRY TRANSFORMATION INITIATIVE REGISTRATION FORM

INDUSTRY TRANSFORMATION INITIATIVE REGISTRATION FORM Local (KL and Selangor): RM180 per participant Please register me for: INDUSTRY TRANSFORMATION INITIATIVE REGISTRATION FORM Outstation (other states including East Malaysia): RM220 per participant Please

More information

BORANG CADANGAN IKHLAS NIAGA TAKAFUL (CLINIC NIAGA) IKHLAS NIAGA TAKAFUL (CLINIC NIAGA) PROPOSAL FORM

BORANG CADANGAN IKHLAS NIAGA TAKAFUL (CLINIC NIAGA) IKHLAS NIAGA TAKAFUL (CLINIC NIAGA) PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point, Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9696 Fax : 03-2723 9998 Website : www.takaful-ikhlas.com.my (Anak

More information

BORANG CADANGAN IKHLAS RETAIL NIAGA IKHLAS NIAGA TAKAFUL (RETAIL NIAGA) PROPOSAL FORM

BORANG CADANGAN IKHLAS RETAIL NIAGA IKHLAS NIAGA TAKAFUL (RETAIL NIAGA) PROPOSAL FORM A. IKHLAS Point, Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 Fax : 03-2723 9998 Call Centre No : 03-2723 9696 Website : www.takaful-ikhlas.com.my PENCADANG

More information

JABATAN KASTAM DIRAJA MALAYSIA ROYAL MALAYSIAN CUSTOMS DEPARTMENT

JABATAN KASTAM DIRAJA MALAYSIA ROYAL MALAYSIAN CUSTOMS DEPARTMENT JABATAN KASTAM DIRAJA MALAYSIA ROYAL MALAYSIAN CUSTOMS DEPARTMENT GST - 01 PERMOHONAN PENDAFTARAN CUKAI BARANG DAN PERKHIDMATAN APPLICATION FOR GOODS AND SERVICES TAX REGISTRATION Nota Penting (Important

More information

Course Title Date Venue. Name (as in NRIC/Passport) NRIC/Passport No. Designation Company & Address

Course Title Date Venue. Name (as in NRIC/Passport) NRIC/Passport No.  Designation Company & Address Capital Market Director Programme (CMDP) REGISTRATION FORM A. PROGRAMME MODULES Please tick ( ) Course Title Date Venue Fee (RM) GST (6%) Total Fee (RM) Module 1: Directors as gatekeepers of market participants

More information

Date: 07/05/2014. This product provides Takaful protection against incidents of theft to your property.

Date: 07/05/2014. This product provides Takaful protection against incidents of theft to your property. PRODUCT DISCLOSURE SHEET (Read this Product Disclosure Sheet before you decide to participate in the IKHLAS Burglary Takaful. Be sure to also read the general terms and conditions.) 1) What is this product

More information

BORANG CADANGAN UNTUK IKHLAS FLEXI-EB TAKAFUL / PROPOSAL FORM FOR IKHLAS FLEXI-EB TAKAFUL

BORANG CADANGAN UNTUK IKHLAS FLEXI-EB TAKAFUL / PROPOSAL FORM FOR IKHLAS FLEXI-EB TAKAFUL TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS POINT,Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Telephone No : 03-2723 9999 Fax No : 03-2723 9998 Website : www.takaful-ikhlas.com.my

More information

BORANG CADANGAN TAKAFUL SEMUA RISIKO (HARTA BENDA PERIBADI) ALL RISKS TAKAFUL PROPOSAL FORM (PERSONAL EFFECTS)

BORANG CADANGAN TAKAFUL SEMUA RISIKO (HARTA BENDA PERIBADI) ALL RISKS TAKAFUL PROPOSAL FORM (PERSONAL EFFECTS) BORANG CADANGAN TAKAFUL SEMUA RISIKO (HARTA BENDA PERIBADI) ALL RISKS TAKAFUL PROPOSAL FORM (PERSONAL EFFECTS) NOTIS PENTING Kontrak Takaful Pengguna Menurut Perenggan 5 dari Jadual 9 Akta Perkhidmatan

More information

Borang Cadangan Liability Awam Public Liability Proposal Form

Borang Cadangan Liability Awam Public Liability Proposal Form Borang Cadangan Liability Awam Public Liability Proposal Form NOTIS PENTING Kontrak Takaful Pengguna Menurut Perenggan 5 dari Jadual 9 Akta Perkhidmatan Kewangan Islam 2013, jika anda memohon takaful ini

More information

EQUIPMENT ALL RISKS TAKAFUL PROPOSAL FORM / BORANG CADANGAN TAKAFUL PERALATAN SEMUA RISIKO

EQUIPMENT ALL RISKS TAKAFUL PROPOSAL FORM / BORANG CADANGAN TAKAFUL PERALATAN SEMUA RISIKO HEAD OFFICE/ IBU PEJABAT: SYARIKAT TAKAFUL MALAYSIA BERHAD(131646-K) 26th Floor, Annexe Block, Menara Takaful Malaysia, No 4. Jalan Sultan Sulaiman, 50000 Kuala Lumpur, P.O Box 11483, 50746 Kuala Lumpur

More information

BORANG CADANGAN IKHLAS MOTORIST PA TAKAFUL IKHLAS MOTORIST PA TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS MOTORIST PA TAKAFUL IKHLAS MOTORIST PA TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9696 (General Line) Fax : 03-2723 9998 (General Fax Line) Website

More information

NO. RUJUKAN CUKAI PENDAPATAN: INCOME TAX REFERENCE NO. :... CAWANGAN LEMBAGA HASIL DALAM NEGERI: BRANCH OF INLAND REVENUE BOARD :...

NO. RUJUKAN CUKAI PENDAPATAN: INCOME TAX REFERENCE NO. :... CAWANGAN LEMBAGA HASIL DALAM NEGERI: BRANCH OF INLAND REVENUE BOARD :... JABATAN DASAR PERCUKAIAN, IBU PEJABAT LEMBAGA HASIL DALAM NEGERI MALAYSIA, MENARA HASIL, ARAS 17, PERSIARAN RIMBA PERMAI, CYBER 8, 63000 CYBERJAYA, SELANGOR. ---------------------------------------------------------------------------------------------------------

More information

Contractors Plant and Machinery (CPM) Insurance Proposal Form

Contractors Plant and Machinery (CPM) Insurance Proposal Form Contractors Plant and Machinery (CPM) Insurance Proposal Form SCHEDULE 9 OF THE FINANCIAL SERVICES ACT 2013 (FSA) Pursuant to Paragraph 4(1) of Schedule 9 of the Financial Services Act 2013, if you are

More information

GUW-PFR002/00 Individual PA (01/06/11) A.BUTIRAN PENCADANG / THE PROPOSER. 1. Nama Name. Encik Mr. 2. Gelaran Title. Cik Ms. Dr Dr. Tuan Mr.

GUW-PFR002/00 Individual PA (01/06/11) A.BUTIRAN PENCADANG / THE PROPOSER. 1. Nama Name. Encik Mr. 2. Gelaran Title. Cik Ms. Dr Dr. Tuan Mr. TAKAFUL IKHLAS SDN BHD (593075 u) IKHLAS Point Tower 11A, Avenue 5 Bangsar South No. 8 Jalan Kerinchi 59200 Kuala Lumpur Telephone No: 03-2723 9999 Fax No: 03-2723 9998 Website: www.takaful-ikhlas.com.my

More information

TAX INVOICE / INVOIS CUKAI INVOICE NO. NO. INVOIS DATE TARIKH GST REGISTRATION NO. NO. PENDAFTARAN GST : POLITEKNIK KUCHING SARAWAK

TAX INVOICE / INVOIS CUKAI INVOICE NO. NO. INVOIS DATE TARIKH GST REGISTRATION NO. NO. PENDAFTARAN GST : POLITEKNIK KUCHING SARAWAK POLITEKNIK SARAWAK KM. 22 JALAN MATANG TAX INVOICE / INVOIS CUKAI INVOICE NO. NO. INVOIS DATE TARIKH GST REGISTRATION NO. NO. PENDAFTARAN GST : TI-GEN-2018-07-00094836 : 24/07/2018 : 000082276352 06-103-GCA02264

More information

ALL RISKS TAKAFUL PROPOSAL FORM / BORANG CADANGAN TAKAFUL SEMUA RISIKO

ALL RISKS TAKAFUL PROPOSAL FORM / BORANG CADANGAN TAKAFUL SEMUA RISIKO HEAD OFFICE/ IBU PEJABAT: Syarikat Takaful Malaysia Am Berhad (1246486-D) 26th Floor, Annexe Block, Menara Takaful Malaysia No. 4, Jalan Sultan Sulaiman, 50000 Kuala Lumpur P.O. Box 11483, 50746 Kuala

More information

NO. RUJUKAN CUKAI PENDAPATAN: INCOME TAX REFERENCE NO. :... CAWANGAN LEMBAGA HASIL DALAM NEGERI: BRANCH OF INLAND REVENUE BOARD :...

NO. RUJUKAN CUKAI PENDAPATAN: INCOME TAX REFERENCE NO. :... CAWANGAN LEMBAGA HASIL DALAM NEGERI: BRANCH OF INLAND REVENUE BOARD :... JABATAN DASAR PERCUKAIAN, IBU PEJABAT LEMBAGA HASIL DALAM NEGERI MALAYSIA, MENARA HASIL, ARAS 17, PERSIARAN RIMBA PERMAI, CYBER 8, 63000 CYBERJAYA, SELANGOR. ---------------------------------------------------------------------------------------------------------------------------

More information

TAX CLEARANCE LETTER APPLICATION FOR COMPANIES, LIMITED LIABILITY PARTNERSHIPS (LLP) AND LABUAN ENTITIES (LABUAN COMPANIES & LABUAN LLP)

TAX CLEARANCE LETTER APPLICATION FOR COMPANIES, LIMITED LIABILITY PARTNERSHIPS (LLP) AND LABUAN ENTITIES (LABUAN COMPANIES & LABUAN LLP) OPERATIONAL GUIDELINE NO. 3 OF YEAR 2016 LEMBAGA HASIL DALAM NEGERI MALAYSIA TAX CLEARANCE LETTER APPLICATION FOR COMPANIES, LIMITED LIABILITY PARTNERSHIPS (LLP) AND LABUAN ENTITIES (LABUAN COMPANIES &

More information

BORANG CADANGAN IKHLAS GROUP PERSONAL ACCIDENT TAKAFUL IKHLAS GROUP PERSONAL ACCIDENT TAKAFUL PROPOSAL FORM

BORANG CADANGAN IKHLAS GROUP PERSONAL ACCIDENT TAKAFUL IKHLAS GROUP PERSONAL ACCIDENT TAKAFUL PROPOSAL FORM TAKAFUL IKHLAS BERHAD (593075 U) IKHLAS Point Tower 11A, Avenue 5, Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur Tel : 03-2723 9999 (General Line) Fax : 03-2723 9998 (General Fax Line) Call

More information

Please refer to the Takaful Certificate contract for more information.

Please refer to the Takaful Certificate contract for more information. PRODUCT DISCLOSURE SHEET (Read this Product Disclosure Sheet before you decide to take out the IKHLAS Foreign Worker Compensation Scheme Takaful. Be sure to also read the general terms and conditions.)

More information

Date: 07/05/2014. Please refer to the Takaful Certificate contract for more information.

Date: 07/05/2014. Please refer to the Takaful Certificate contract for more information. PRODUCT DISCLOSURE SHEET (Read this Product Disclosure Sheet before you decide to participate in the IKHLAS Fidelity Guarantee Takaful. Be sure to also read the general terms and conditions.) 1) What is

More information

BURGLARY TAKAFUL PROPOSAL FORM / BORANG CADANGAN TAKAFUL KECURIAN

BURGLARY TAKAFUL PROPOSAL FORM / BORANG CADANGAN TAKAFUL KECURIAN HEAD OFFICE/ IBU PEJABAT: SYARIKAT TAKAFUL MALAYSIA BERHAD(131646-K) 26th Floor, Annexe Block, Menara Takaful Malaysia, No 4. Jalan Sultan Sulaiman, 50000 Kuala Lumpur, P.O Box 11483, 50746 Kuala Lumpur

More information

KRITERIA BORANG NYATA CUKAI PENDAPATAN (BNCP) TIDAK LENGKAP CRITERIA ON INCOMPLETE INCOME TAX RETURN FORM (ITRF) PEMBERITAHUAN

KRITERIA BORANG NYATA CUKAI PENDAPATAN (BNCP) TIDAK LENGKAP CRITERIA ON INCOMPLETE INCOME TAX RETURN FORM (ITRF) PEMBERITAHUAN KRITERIA BORANG NYATA CUKAI PENDAPATAN (BNCP) TIDAK LENGKAP CRITERIA ON INCOMPLETE INCOME TAX RETURN FORM (ITRF) PEMBERITAHUAN (Pin. 1/2014) MULAI 1 JANUARI 2012, BNCP YANG TIDAK LENGKAP AKAN DIPULANGKAN

More information

GROUP TERM LIFE ASSURANCE SCHEME (CELCOM-BIMA) - ANNEXURE

GROUP TERM LIFE ASSURANCE SCHEME (CELCOM-BIMA) - ANNEXURE GROUP TERM LIFE ASSURANCE SCHEME (CELCOM-BIMA) - ANNEXURE This Annexure forms part of the Group Term Life Assurance Scheme certificate of insurance ( Certificate of Insurance ) to which it is attached

More information

AmBank Credit Card Fee & Charges

AmBank Credit Card Fee & Charges AmBank Credit Card Fee & Charges Annual Fee Minimum Monthly Payment Finance Charges Cash Advance Fee Late Payment Interest Free Period Excess Limit Fee Credit Balance Refund Fee Free For Life 5% of the

More information

(Mandatory / Mandatori)

(Mandatory / Mandatori) RM120,000 (Mandatory / Mandatori) All statements will be sent via e-mail/semua penyata bulanan akan dihantar melalui e-mel ** ** I hereby confirm that this is my valid e-mail for statement delivery / Dengan

More information

TAKAFUL myhome CONTENT PROPOSAL FORM / BORANG CADANGAN TAKAFUL myhome CONTENT

TAKAFUL myhome CONTENT PROPOSAL FORM / BORANG CADANGAN TAKAFUL myhome CONTENT HEAD OFFICE/ IBU PEJABAT: Syarikat Takaful Malaysia Am Berhad (1246486-D) 26th Floor, Annexe Block, Menara Takaful Malaysia No. 4, Jalan Sultan Sulaiman, 50000 Kuala Lumpur P.O. Box 11483, 50746 Kuala

More information

Death Claim Form (by Claimant) / Borang Tuntutan Kematian (oleh Penuntut)

Death Claim Form (by Claimant) / Borang Tuntutan Kematian (oleh Penuntut) Policy No. / Polisi No. Death Claim Form (by Claimant) / Borang Tuntutan Kematian (oleh Penuntut) Important Note / Nota Penting: This form is to be completed by the claimant. Please do not sign on a blank

More information

PRODUCT DISCLOSURE SHEET

PRODUCT DISCLOSURE SHEET PRODUCT DISCLOSURE SHEET Read this Product Disclosure Sheet before you decide to apply for the Trade Services Facility. Please be sure to also read the Terms and Conditions as stated in the Letter of Offer.

More information

Foreign Workers Compensation Scheme (FWCS) Proposal Form

Foreign Workers Compensation Scheme (FWCS) Proposal Form Foreign Workers Compensation Scheme (FWCS) Proposal Form SCHEDULE 9 OF THE FINANCIAL SERVICES ACT 2013 (FSA) Pursuant to Paragraph 4(1) of Schedule 9 of the Financial Services Act 2013, if you are applying

More information

Applicable for AmBank Credit Card b) 1.42% per month or 17% p.a. if you have promptly settled your minimum payment due for 10 consecutive months

Applicable for AmBank Credit Card b) 1.42% per month or 17% p.a. if you have promptly settled your minimum payment due for 10 consecutive months AmBank Credit Cards: Fees & Charges (Effective 1 June 2018) (Fees stated below are applicable for these cards unless stated otherwise, AmBank SIGNATURE Priority Banking World Mastercard, AmBank SIGNATURE

More information

- - No. icert / icert No.

- - No. icert / icert No. BORANG PERMOHONAN PENAMAAN BARU / PENUKARAN PENAMAAN (HIBAH TAKAFUL / WASI TAKAFUL) REQUEST FOR NEW NOMINATION / CHANGE OF NOMINATION FORM (TAKAFUL HIBAH / TAKAFUL WASI) No. icert / icert No. Nombor Sijil/Certificate

More information

BIMB HOLDINGS BERHAD (Company No X) (Incorporated in Malaysia under the Companies Act, 1965)

BIMB HOLDINGS BERHAD (Company No X) (Incorporated in Malaysia under the Companies Act, 1965) NOTICE OF ELECTION THIS NOTICE OF ELECTION IS IMPORTANT AND REQUIRES YOUR IMMEDIATE ATTENTION AND IS TO BE READ IN CONJUNCTION WITH THE DIVIDEND REINVESTMENT PLAN ( DRP ) STATEMENT ( DRP STATEMENT ). TERMS

More information

Apartment and Condominium Insurance Package

Apartment and Condominium Insurance Package Apartment and Condominium Insurance Package APARTMENT AND CONDOMINIUM INSURANCE PACKAGE Anything can happen at any time. Protect the property under your management and get covered with our Apartment and

More information

LONG TERM HOUSEOWNER S TAKAFUL PROPOSAL FORM / BORANG CADANGAN TAKAFUL PEMILIK RUMAH KEDIAMAN JANGKA PANJANG

LONG TERM HOUSEOWNER S TAKAFUL PROPOSAL FORM / BORANG CADANGAN TAKAFUL PEMILIK RUMAH KEDIAMAN JANGKA PANJANG HEAD OFFICE/ IBU PEJABAT: SYARIKAT TAKAFUL MALAYSIA BERHAD(131646-K) 26th Floor, Annexe Block, Menara Takaful Malaysia, No 4. Jalan Sultan Sulaiman, 50000 Kuala Lumpur, P.O Box 11483, 50746 Kuala Lumpur

More information

Borang Cadangan Takaful Liabiliti Pekerja Employer s Liability Takaful Proposal Form

Borang Cadangan Takaful Liabiliti Pekerja Employer s Liability Takaful Proposal Form Borang Cadangan Takaful Liabiliti Pekerja Employer s Liability Takaful Proposal Form NOTIS PENTING: Kontrak Takaful Pengguna Menurut Perenggan 5 dari Jadual 9 Akta Perkhidmatan Kewangan Islam 2013, jika

More information

Polisi Pemain Golf. Golfer s Policy

Polisi Pemain Golf. Golfer s Policy Polisi Pemain Golf Golfer s Policy Bahawasanya Pemegang Insurans (seterusnya dirujuk sebagai Majikan) yang dinyatakan di dalam Jadual ini, menerusi Cadangan dan Perakuan bersama surat-menyurat yang berkaitan

More information

ABSOLUTE DEED OF ASSIGNMENT

ABSOLUTE DEED OF ASSIGNMENT ABSOLUTE DEED OF ASSIGNMENT RM10.00 Stamping Fee I, whose name and particulars are set out in Part 1 of the Schedule, (hereinafter called the Participant) for the consideration set out in Part 2 of the

More information

PRODUCT DISCLOSURE SHEET

PRODUCT DISCLOSURE SHEET PRODUCT DISCLOSURE SHEET Read this Product Disclosure Sheet before you decide to apply for the Trade Services Facility. Please be sure to also read the Terms and Conditions as stated in the Agreement.

More information

PDPA Form for Individual Customers (Borang PDPA Untuk Pelanggan-Pelanggan Individu) Please complete in BLOCK LETTERS (Sila lengkapkan dengan HURUF BESAR) Name: (Nama) Identification Card Number : (Nombor

More information

4. Shell reserves the right at its absolute discretion to vary, delete or add to any of these Terms and Conditions without prior notice.

4. Shell reserves the right at its absolute discretion to vary, delete or add to any of these Terms and Conditions without prior notice. SHELL HELIX MEKANIK SENANG MENANG 2016 Terms and Conditions 1. This Shell Helix Mekanik Senang Menang 2016 ( Programme ) is jointly organised by Shell Malaysia Trading Sdn Bhd (6087-M) ( SMTSB ) and Shell

More information

PRODUCT DISCLOSURE SHEET

PRODUCT DISCLOSURE SHEET PRODUCT DISCLOSURE SHEET (Read this product Disclosure Sheet before you decide to sign up the KFH SURE SAVINGS ACCOUNT-i. Be sure you also read the general terms and conditions) KFH SURE SAVINGS ACCOUNT-i

More information

TAKAFUL AMANI. Date: 07/05/2014

TAKAFUL AMANI. Date: 07/05/2014 PRODUCT DISCLOSURE SHEET (Read this Product Disclosure Sheet before you decide to participate in the Takaful Amani. Be sure to also read the general terms and conditions.) 1) What is this product about?

More information

BALANCE TRANSFER TERMS & CONDITIONS

BALANCE TRANSFER TERMS & CONDITIONS BALANCE TRANSFER TERMS & CONDITIONS 1. Holders of any Maybank Credit Card Card(s) ( Cardmember ) may apply to transfer outstanding balances [ including principal, accrued profit, profit and other charges

More information

Shell Advance Advance2Langkawi Contest

Shell Advance Advance2Langkawi Contest Shell Advance Advance2Langkawi Contest Organiser: Shell Malaysia Trading Sdn Bhd ( SMTSB ) 1. The Shell Advance Advance2Langkawi ( Contest ) period runs from 23 October 2015 till 31 December 2015 (11:59

More information

Foreign Workers Compensation Scheme (FWCS) Proposal Form

Foreign Workers Compensation Scheme (FWCS) Proposal Form Foreign Workers Compensation Scheme (FWCS) Proposal Form SCHEDULE 9 OF THE FINANCIAL SERVICES ACT 2013 (FSA) Pursuant to Paragraph 4(1) of Schedule 9 of the Financial Services Act 2013, if you are applying

More information

TAKAFUL IKHLAS BERHAD HELAIAN PENERANGAN PRODUK. Skim Takaful Kemasukan Hospital dan Pembedahan Pekerja Asing (SKHPPA)

TAKAFUL IKHLAS BERHAD HELAIAN PENERANGAN PRODUK. Skim Takaful Kemasukan Hospital dan Pembedahan Pekerja Asing (SKHPPA) HELAIAN PENERANGAN PRODUK Sila baca Helaian Keterangan Produk ini sebelum membuat keputusan untuk mengambil Skim Takaful Kemasukan Hospital dan Pembedahan Pekerja Asing (SKHPPA). Sila pastikan juga bahawa

More information

MAYBANK ISLAMIC IKHWAN BALANCE TRANSFER. Declaration/ Pengakuan Terms and Conditions/Terma. Date: Declaration/ Pengakuan

MAYBANK ISLAMIC IKHWAN BALANCE TRANSFER. Declaration/ Pengakuan Terms and Conditions/Terma. Date: Declaration/ Pengakuan Declaration/ Pengakuan I shall comply with the Bank's requirements in respect of my application and I understand that the Bank's offer of the financing shall be subject to the Bank performing the necessary

More information

Date : 07/05/2014. This product will compensate you in the event of permanent disability or death caused by Accident.

Date : 07/05/2014. This product will compensate you in the event of permanent disability or death caused by Accident. PRODUCT DISCLOSURE SHEET (Read this Product Disclosure Sheet before you decide to participate in the IKHLAS Perdana P.A. Takaful. Be sure to also read the general terms and conditions.) 1) What is this

More information

Agent s Tel No. / No. Tel Ejen : Agent s / Emel Ejen : Branch Code / Kod Cawangan :

Agent s Tel No. / No. Tel Ejen : Agent s  / Emel Ejen : Branch Code / Kod Cawangan : HEAD OFFICE/ IBU PEJABAT: Syarikat Takaful Malaysia Am Berhad (1246486-D) 26th Floor, Annexe Block, Menara Takaful Malaysia No. 4, Jalan Sultan Sulaiman, 50000 Kuala Lumpur P.O. Box 11483, 50746 Kuala

More information

ING INSURANCE SCHOLARSHIP APPLICATION CHECKLIST

ING INSURANCE SCHOLARSHIP APPLICATION CHECKLIST ING INSURANCE SCHOLARSHIP APPLICATION CHECKLIST Students are required to enclose copies of the following documents together with the ING Insurance Scholarship Application form: 1. Identity card 2. Diploma,

More information

Personal Accident (General) Application Form

Personal Accident (General) Application Form Personal Accident (General) Application Form IMPORTANT NOTE Pursuant to Paragraph 5 of Schedule 9 of the Financial Services Act 2013, if you are applying for this Insurance wholly for purposes unrelated

More information

THE PORTABLE & PERSONAL MEDICAL PLAN

THE PORTABLE & PERSONAL MEDICAL PLAN A-Health Maximiser THE PORTABLE & PERSONAL MEDICAL HEALTH PLAN Maximising your protection to meet your changing needs Purchase with AIA PRS to fund your retirement years aia.com.my A-Health Maximiser Maximising

More information

Cash Credit Redemption Program. Terms and Conditions

Cash Credit Redemption Program. Terms and Conditions Cash Credit Redemption Program Terms and Conditions The Terms and Conditions herein are to be read together with and are supplementary to the standard Terms and Conditions of the Credit Card Agreement

More information

Cash Credit Redemption Programme. Terms and Conditions

Cash Credit Redemption Programme. Terms and Conditions Cash Credit Redemption Programme Terms and Conditions The Terms and Conditions herein are to be read together with and are supplementary to the standard Terms and Conditions of the Credit Card Agreement

More information

PERFECT RIDER 24hr PROPOSAL FORM / BORANG CADANGAN PERFECT RIDER 24hr Cover Note No. No. Nota Perlindungan Name of Proposer Nama Pencadang NRIC / Passport No. No. Kad Pengenalan / Pasport Business Registration

More information

Global Fly Season Exclusive UnionPay Privileges Not To Be Missed ( Promotion )

Global Fly Season Exclusive UnionPay Privileges Not To Be Missed ( Promotion ) Global Fly Season Exclusive UnionPay Privileges Not To Be Missed ( Promotion ) Terms and Conditions ERAMAN MALAYSIA 1. The promotion is valid from 1 May 31 October 2018 ( Promotion Period ). 2. This promotion

More information

Equipment All Risks Insurance Policy

Equipment All Risks Insurance Policy Equipment All Risks Insurance Policy PRODUCT DISCLOSURE SHEET (Read this Product Disclosure Sheet before you decide to take out the Equipment All Risks Insurance Policy. Be sure to also read the general

More information

AmBank WeChat Tipi Tap Raya Contest Terms and Conditions

AmBank WeChat Tipi Tap Raya Contest Terms and Conditions AmBank WeChat Tipi Tap Raya Contest Terms and Conditions 1.0 Definitions 1.1 For the purposes of this Terms and Conditions, the following words and expressions shall have the meanings assigned to them

More information

BORANG CADANGAN TAKAFUL PERALATAN (BERGERAK DAN TETAP) EQUIPMENT TAKAFUL PROPOSAL FORM (MOBILE AND IMMOBILE)

BORANG CADANGAN TAKAFUL PERALATAN (BERGERAK DAN TETAP) EQUIPMENT TAKAFUL PROPOSAL FORM (MOBILE AND IMMOBILE) BORANG CADANGAN TAKAFUL PERALATAN (BERGERAK DAN TETAP) EQUIPMENT TAKAFUL PROPOSAL FORM (MOBILE AND IMMOBILE) NOTIS PENTING: Kontrak Takaful Pengguna Menurut Perenggan 5 dari Jadual 9 Akta Perkhidmatan

More information