10th August 2016

30021696-GACCEPT3 -0000001

MR. ABDUL LATIF BIN ABDUL AZIZ

NO 29
JALAN HARMONI 8
TAMAN DESA SKUDAI
81300 SKUDAI
JOHOR

Dear Sir/Madam,

PROPOSAL FOR INVESTMENT LINK INSURANCE

PROPOSAL NUMBER : 30021696
NAME OF LIFE ASSURED : MR. ABDUL LATIF BIN ABDUL AZIZ

We are pleased to inform you that your Proposal For Life Insurance has been accepted by the Company on revised
terms and conditions. The particulars of the revised terms and conditions are stated overleaf.

If you wish to take up this offer, please sign and return the attached copy of Declaration of Acceptance of our counter
offer within fourteen (14) days from the date of this offer. Your insurance cover will commence upon receipt of your
confirmation of acceptance, provided there is no material change in your eligibility for insurance based on your
declaration in Proposal For Life Insurance, questionnaires, written amendments or any other documents completed in
connection with Proposal For Life Insurance and statement or answers given to the Medical Examiner. We shall be
entitled to accept or reject the proposal on receiving such information.

By effecting an insurance with the Company, you have made a select choice of not only the numerous ways of having
family protection and investment, but also of the institutions which are best able to ensure the fulfillment of your
needs.

Thank you.

This is a computer generated letter and no signature is required.

cc. Branch : Johor Bahru

Agent : RAMES A/L PARAMASIVAM 726484
Unit Head: VALAYUTHAM S/O PONNUSAMY

N
Proposal Number : 30021696

DECLARATION OF ACCEPTANCE

Plan type : TokioMarine-iLifeSecure Mode : Monthly

1st Life : MR. ABDUL LATIF BIN ABDUL AZIZ

Coverage Sum Assured Loadings

(RM) Age % Loaded Rate/1000 Duration
Loaded
TokioMarine-iLifeSecure 12,000.00
Total and Permanent Disability Benefit 12,000.00
iHealth+ 100.00 25.00 38
iHealth Income 100.00
iLife Waiver Plus 400.00

The following exclusion(s) also apply:

Life Assured :
IHEALTH+ AND IHEALTH INCOME:
EXCLUDE DISEASE/DISORDER OF SINUS, AND/OR THEIR COMPLICATIONS.

I hereby agree to accept the above revised terms and conditions of the offer stated on this letter and certify that all
information provided in my application are still true and remain unchanged.

Signature of *Life Assured/Proposer Signature of Witness

Date: Name :
NRIC :
Date :