r

LOT 8 GROUND & 1ST FLOOR,LOT 7, 1ST & 2ND FLOOR, BLOCK 2 BANDAR INDAH,MILE 4 NORTH ROADW.D.T. NO. 291 90000 SandakanTel No: 089-211054/217197 Fax No: 089-211052 E-Mail: -

Allianz General Insurance Company (Malaysia) Berhad (735426-V)

PRIVATE CAR EXCLUDING GOODS

PERIOD OF INSURANCETEMPOH INSURANS

INSUREDPEMUNYA

ADDRESSALAMAT

OCCUPATION/TYPE OF BUSINESSPERNIAGAAN/PEKERJAAN

HIRE PURCHASE OWNERS/EMPLOYER'S LOANSEWA BELI/PINJAMAN MAJIKAN

PARTICULARS OF VEHICLEBUTIR-BUTIR KENDERAAN

Date of Issue/TimeTarikh Dikeluarkan/Waktu

AESK0066000No. Nota PerlindunganE-Cover Note No.

Make and Type of Body / Buatan dan Jenis Badan

Engine/Motor No.No. Enjin/Motor

Engine C.C/Horse Power/Tonnage/WattCc Enjin/Kuasa Kuda/Tan/Watt

Chassis No.No. Casis

Seating CapacityMuatan Tempat Duduk

Year of ManufactureTahun Dibuat

Regn. Card No.No. Kad Pendaftaran

BABY TEO@TEO TIONG NEN

LOT 4,BLOCK 15TMN TINOSAN,MILE 490000 SANDAKANSABAH

-

LD28-002404

913-095-85B 5 1974

6495423

PremiumLoadingNCD

GROSS PREM

STAMP DUTYTOTAL DUEAMOUNT PAYABLE(ROUNDED)

EXCESSLEBIHAN

Sum InsuredJumlah Diinsuranskan

Type of CoverJenis Perlindungan

10,000.00

250.00 6.00 %10.00

197.09

240.88101.07336.90

218.92

218.90

2765.00 CC

LAND ROVER 109

NA

THIRD PARTY, FIRE AND THEFT

Account No.No. Akaun

NRIC No./Bus. Regn. NoNo. Kad Pengenalan/No. Pendaftaran Perniagaan

Act.Akta

Telephone No.No. Telefon089274048

Registration No./Trailer No. / No. Pendaftaran/No. Treler

This Policy is subject to the following endorsements as printed in this Policy or added thereon or attached thereto:-Polisi ini adalah tertakluk kepada pengendorsan yang telah dicetak atau ditambah atau dimasukkan kedalamnya.

NAMED DRIVERS

LODGING COMPLAINTS & GRIEVANCESIF YOU HAVE ANY COMPLAINTS OF UNFAIR MARKET PRACTICES BY THE COMPANY, YOU MAY CALL OR WRITE TO :

2. 3.

Geographical Area : Malaysia, Republic of Singapore and Negara Brunei Darussalam.Kawasan Geografi : Malaysia, Republik of Singapura dan Negara Brunei Darussalam

Limitations as to Use/ Authorised Driver : As described in the Certificate of Insurance.Had Penggunaan / Pemandu Yang Diberi kuasa : Seperti yang tercatat dalam Sijil Insurans

Issued By / Dikeluarkan oleh

Dikeluarkan Sebagai Pembatalan/Penggantian/No. Nota Perlindungan/ No. Polisi -

Please ensure All accidents are reported to the Police within 24 hours

Issued in lieu of and Cancelling/Replacing Cover Note/Policy No. -Pastikan semua kemalangan hendaklah dilaporkan kepada pihak Polis dalam masa 24 jam.

Tarikh Tandatangan Cadangan dan AkuanDate of Signature of Proposal & Declaration

Kenyataan Penting : Cetakan polisi boleh diperolehi daripada pejabat cawangan kami di seluruh negara ataupun daripada ejen Allianz Anda.Important Notice : Policy print out can be obtained from our branch offices located nationwide or from your servicing agents.

02-11-2015(a)

01-11-2016

(b) Any subsequent period for which the Insured shall payand the Company shall agree to accept a renewalpremium.Sebarang tempoh selanjutnya di mana Anda hendaklahmembayar, dan Kami hendaklah bersetuju menerimapremium pembaharuan.

25.52

SA5983

26-10-2015

RTD CODE : 13

THE SCHEDULEJADUAL

STAMP DUTY PAIDDUTI SETEM DIBAYAR

P O BOX NO.85POST OFFICE JALAN UTARA90307 Sandakan TEL: 089-216713

MARK PUBLIC SERVICES / SK00104-01

26-10-2015

420424045183

SK00104

M.X.1

55.00 %

11.15.35 AM

GST

ALPHA-1500104-001849082-2

(both dates inclusive)From

ToDari

Hingga

(termasuk kedua-dua tarikh) 30.00 %

11.83

ORIGINAL COPY

COMPLAINT UNITALLIANZ GENERAL INSURANCE COMPANY (MALAYSIA)GROUND FLOOR, BLOCK 2A,PLAZA SENTRAL, JALAN STESEN SENTRAL 5,KUALA LUMPUR SENTRAL,50470 KUALA LUMPURTELNO : 03-2264 0520 FAX NO: 03-2264 0602EMAIL: [email protected]

PENGARAHLAMAN INFORMASI NASIHAT DAN KHIDMAT (LINK)BANK NEGARA MALAYSIAGROUND FLOOR BLOCK CJALAN DATO' ONN50480 KUALA LUMPURTOLL FREE : 1-300-88-5465FAX NO: 03-2174 1515EMAIL: [email protected]

1. FINANCIAL MEDIATION BUREAU ("FMB")LEVEL 25, DATARAN KEWANGAN DARUL TAKAFUL,NO. 4 JALAN SULTAN SULAIMAN50000 KUALA LUMPURTELNO: 03-2272 2811FAX NO: 03-2274 5752EMAIL : [email protected]

216216261015I898

ENDT.100 - EXCLUSION OF LEGAL LIABILITY TO PASSENGERS -(Private car only)ENDT.106 - INSURER'S AUTHORISED WORKSHOPENDT.3(q) - THIRD PARTY FIRE AND THEFT

1. ANY AUTHORISED DRIVERS

26-10-2015 11:15:35



PRIVATE CAR EXCLUDING GOODS

PERIOD OF INSURANCETEMPOH INSURANS

INSUREDPEMUNYA

ADDRESSALAMAT

OCCUPATION/TYPE OF BUSINESSPERNIAGAAN/PEKERJAAN

HIRE PURCHASE OWNERS/EMPLOYER'S LOANSEWA BELI/PINJAMAN MAJIKAN

PARTICULARS OF VEHICLEBUTIR-BUTIR KENDERAAN

Date of Issue/TimeTarikh Dikeluarkan/Waktu

AESK0066000No. Nota PerlindunganE-Cover Note No.

Make and Type of Body / Buatan dan Jenis Badan

Engine/Motor No.No. Enjin/Motor

Engine C.C/Horse Power/Tonnage/WattCc Enjin/Kuasa Kuda/Tan/Watt

Chassis No.No. Casis

Seating CapacityMuatan Tempat Duduk

Year of ManufactureTahun Dibuat

Regn. Card No.No. Kad Pendaftaran


LOT 4,BLOCK 15TMN TINOSAN,MILE 490000 SANDAKANSABAH

-

LD28-002404

913-095-85B 5 1974

6495423

PremiumLoadingNCD

GROSS PREM

STAMP DUTYTOTAL DUEAMOUNT PAYABLE(ROUNDED)

EXCESSLEBIHAN

Sum InsuredJumlah Diinsuranskan

Type of CoverJenis Perlindungan

10,000.00

250.00 6.00 %10.00

197.09

240.88101.07336.90

218.92

218.90

2765.00 CC

LAND ROVER 109

NA

THIRD PARTY, FIRE AND THEFT

Account No.No. Akaun

NRIC No./Bus. Regn. NoNo. Kad Pengenalan/No. Pendaftaran Perniagaan

Act.Akta

Telephone No.No. Telefon089274048

Registration No./Trailer No. / No. Pendaftaran/No. Treler

This Policy is subject to the following endorsements as printed in this Policy or added thereon or attached thereto:-Polisi ini adalah tertakluk kepada pengendorsan yang telah dicetak atau ditambah atau dimasukkan kedalamnya.

NAMED DRIVERS

LODGING COMPLAINTS & GRIEVANCESIF YOU HAVE ANY COMPLAINTS OF UNFAIR MARKET PRACTICES BY THE COMPANY, YOU MAY CALL OR WRITE TO :

2. 3.

Geographical Area : Malaysia, Republic of Singapore and Negara Brunei Darussalam.Kawasan Geografi : Malaysia, Republik of Singapura dan Negara Brunei Darussalam

Limitations as to Use/ Authorised Driver : As described in the Certificate of Insurance.Had Penggunaan / Pemandu Yang Diberi kuasa : Seperti yang tercatat dalam Sijil Insurans

Issued By / Dikeluarkan oleh

Dikeluarkan Sebagai Pembatalan/Penggantian/No. Nota Perlindungan/ No. Polisi -

Please ensure All accidents are reported to the Police within 24 hours

Issued in lieu of and Cancelling/Replacing Cover Note/Policy No. -Pastikan semua kemalangan hendaklah dilaporkan kepada pihak Polis dalam masa 24 jam.

Tarikh Tandatangan Cadangan dan AkuanDate of Signature of Proposal & Declaration

Kenyataan Penting : Cetakan polisi boleh diperolehi daripada pejabat cawangan kami di seluruh negara ataupun daripada ejen Allianz Anda.Important Notice : Policy print out can be obtained from our branch offices located nationwide or from your servicing agents.

02-11-2015(a)

01-11-2016

(b) Any subsequent period for which the Insured shall payand the Company shall agree to accept a renewalpremium.Sebarang tempoh selanjutnya di mana Anda hendaklahmembayar, dan Kami hendaklah bersetuju menerimapremium pembaharuan.

25.52

SA5983

26-10-2015

RTD CODE : 13

THE SCHEDULEJADUAL

STAMP DUTY PAIDDUTI SETEM DIBAYAR

P O BOX NO.85POST OFFICE JALAN UTARA90307 Sandakan TEL: 089-216713

MARK PUBLIC SERVICES / SK00104-01

26-10-2015

420424045183

SK00104

M.X.1

55.00 %

11.15.35 AM

GST

ALPHA-1500104-001849082-2

(both dates inclusive)From

ToDari

Hingga

(termasuk kedua-dua tarikh) 30.00 %

11.83

OFFICE COPY

COMPLAINT UNITALLIANZ GENERAL INSURANCE COMPANY (MALAYSIA)GROUND FLOOR, BLOCK 2A,PLAZA SENTRAL, JALAN STESEN SENTRAL 5,KUALA LUMPUR SENTRAL,50470 KUALA LUMPURTELNO : 03-2264 0520 FAX NO: 03-2264 0602EMAIL: [email protected]

PENGARAHLAMAN INFORMASI NASIHAT DAN KHIDMAT (LINK)BANK NEGARA MALAYSIAGROUND FLOOR BLOCK CJALAN DATO' ONN50480 KUALA LUMPURTOLL FREE : 1-300-88-5465FAX NO: 03-2174 1515EMAIL: [email protected]

1. FINANCIAL MEDIATION BUREAU ("FMB")LEVEL 25, DATARAN KEWANGAN DARUL TAKAFUL,NO. 4 JALAN SULTAN SULAIMAN50000 KUALA LUMPURTELNO: 03-2272 2811FAX NO: 03-2274 5752EMAIL : [email protected]

216216261015I898

ENDT.100 - EXCLUSION OF LEGAL LIABILITY TO PASSENGERS -(Private car only)ENDT.106 - INSURER'S AUTHORISED WORKSHOPENDT.3(q) - THIRD PARTY FIRE AND THEFT

1. ANY AUTHORISED DRIVERS

26-10-2015 11:15:35



CERTIFICATE NO.No.Sijil

NCDDiskaun Tanpa Tuntutan

1. Index Mark and Registration Number of VehicleTanda Indeks Dan Nombor Pendaftaran Kenderaan

2. Name of Policyholder :Nama Pemegang PolisiEffective date of the Commencement ofInsurance for the purposes for the Regulations,Ordinance or Enactment

3.

Tarikh efektif permulaan insuran untuk kegunaan OrdinanDate of Expiry of the Insurance4.Tarikh Luput InsuranPersons or Classes of Persons entitled to driveOrang atau Kelas Pihak Yang Dibenarkan Memandu

5.

PROVIDED THAT THE PERSON IS PERMITTED IN ACCORDANCE WITH THE LICENSING OR OTHER LAWS OR REGULATIONS TO DRIVE THE MOTORVEHICLE OR HAS BEEN SO PERMITTED AND IS NOT DISQUALIFIED BY ORDER OF A COURT OF LAW OR BY REASON OF ANY ENACTMENT OFREGULATIONS IN THAT BEHALF FROM DRIVING THE MOTOR VEHICLE.

6. Limitations as to use* Had Penggunaan

This Certificate is not transferable to a new owner of the Vehicle.If for any reason the Insurance is terminated during its currency this Certificate must be returned to the Company or if this Certificate has been lost or destroyed a Statutory Declaration tothat effect must be made. Failure to comply with this obligation is an offence under the compulsory Insurance Legislation.This Certificate must be returned if the insurance is suspended during its currency.

IMPORTANTIf you are involved in an accident causing injury to any person or damage to any property or other vehicle you must :(a) Try to obtain names and address of any witness to the accident.(b) Report to the Company immediately.(c) Refer to the Company immediately all communications received from the Police Authorities.(d) Sent to the Company immediately all letters from Third Parties unanswered.(e) Not pay money to any Party involved in the accident without the Company's written permission.

* Limitations rendered inoperative by Section 95 of the Road Transport Act, 1987 (Malaysia) or Section 8 of the Motor Vehicles (Third Party Risks and Compensation) Act (Cap 189) Republicof Singapore or Section 7 of the Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam are not included under this heading.Had yang tidak beroperasi oleh Seksyen 95 Akta Pengangkutan Jalan 1987 (Malaysia) atau Seksyen 8 Akta Kenderaan Bermotor (Gantirugi dan Risiko Pihak Ketiga) (Cap 189) Republik Singapura atauSeksyen 7 Akta Singapura atau Seksyen 7 Akta Insurans Kenderaan Bermotor (Risiko Pihak Ketiga) (Cap 90) Negara Brunei Darussalam adalah tidak termasuk di bawah tajuk ini.

:

:

:

:

2765.00 CCSA5983 LAND ROVER 109


02-11-2015

01-11-2016

55.00

RTD CODE : 13

ORIGINAL COPY

CERTIFICATE OF INSURANCESIJIL INSURANS

SALINAN ASALROAD TRANSPORT ACT, 1987 (MALAYSIA)

MOTOR VEHICLES (THIRD PARTY RISKS & COMPENSATION) ACT (CAP 189) REPUBLIC OF SINGAPOREMOTOR VEHICLES (THIRD PARTY RISKS) RULES 1959 (MALAYSIA)

MOTOR VEHICLES (THIRD PARTY RISKS AND COMPENSATION) RULES 1960 (REPUBLIC OF SINGAPORE)MOTOR VEHICLES (THIRD PARTY RISKS) ACT (CAP 90) NEGARA BRUNEI DARUSSALAM

AESK0066000

M.X.1

Saya/kami bersetuju bahawa Polisi di mana Sijil ini dikeluarkan tertakluk di bawah proviso Bahagian IV Akta Pengangkutan Jalan 1987. (Malaysia) Akta Kenderaan Bermotor (Risiko Pihak Ketiga &Gantirugi) (Cap 189) Republik Singapura dan Akta Kenderaan Bermotor (Risiko Pihak Ketiga) (Cap 90) Negara Brunei Darussalam.

I/We certify that the Policy to which the Certificate is issued in accordance with the provisions of Part IV of the Road Transport Act, 1987 (Malaysia), Motor Vehicles (Third Party Risks andCompensation) Act (Cap 189) Republic of Singapore and the Motor Vehicles Insurance(Third Party Risks) Act (Cap 90) Negara Brunei Darussalam.

Agent CodeKod Ejen

: SK00104

Use only for social, domestic and pleasure purposes and for the Policyholder's business.The policy does not cover use for hire or reward, racing, pace-making reliability trial, speed testing, the carriage of goods other than samples in connection with any tradeor business or use for any purpose in connection with the motor trade.Digunakan hanya untuk tujuan sosial, domestik dan persiaran dan untuk perniagaan Pemegang Polisi.Polisi ini tidak melindungi kegunaan untuk sewaan atau ganjaran, perlumbaan, mengkadar kelajuan, ujian kebolehpercayaan, ujian kelajuan, membawa barangan selaindaripada sampel yang berkaitan dengan apa-apa pekerjaan atau perniagaan.

%

ALPHA-1500104-001849082-2

(a) The Policyholder.(b) Any other person who is driving on the Policyholder's order or with his permission.

(a) Pemegang Polisi.(b) Sesiapa yang memandu atas arahan Pemegang Polisi atau dengan kebenarannya.

26-10-2015 11:15:35

Allianz General Insurance Company (Malaysia) Berhad (735426-V)LOT 8 GROUND & 1ST FLOOR,LOT 7, 1ST & 2ND FLOOR, BLOCK 2 BANDAR INDAH,MILE 4 NORTH ROADW.D.T. NO. 291 90000 SANDAKANTel No: 089-211054/217197 Fax No: 089-211052Email: -GST Reg. No : 000283779072

ClassPolicy No.

Description

Account No. SK00104

26-10-2015

TAX15112000017099

AESK0066000 MOTOR

BABY TEO@TEO TIONG NENLOT 4,BLOCK 15TMN TINOSAN,MILE 490000 SANDAKANSABAH

TAX INVOICE

Total Amount (RM)

Insured / PolicyHolder

GST Reg. No

Item No.

:

:

:

:

Tax Invoice No

Date

:

:

:

Period ofInsurance

: 01-11-2016From to02-11-2015

197.09 Gross Premium

197.09

10.00Stamp Duty

GST Payable @ 6.00%

218.92

218.90

207.09

11.83

197.09

Premium Payable excluding GST

Premium Subject to GST

Total Premium Payable including GST

Total Amount Payable (including GST and Rounded)

Allianz General Insurance Company (Malaysia) Berhad

This is computer generated. No signature is required.

(Period of Insurance : 02-11-2015 01-11-2016 )-

26-10-2015 11:15:36

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