SCHEDULE / JADUAL MX1

CLASS OF CERTIFICATE : PRIVATE CAR COVER TYPE : MOTOR-COMPREHENSIVE

JENIS SIJIL JENIS PERLINDUNGAN
CERTIFICATE NO. : VPP-V0361120-80-DIR-18 AGENCY CODE : 80-104-0070195A
NOMBOR SIJIL KOD AGENSI
PARTICIPANT NAME : MAZIAH BINTI JUSOH NRIC : 730502-11-5188
NAMA PESERTA
ADDRESS : NO 1721 KAMPUNG KUBUR KECIL COMPANY REG. NO. :
ALAMAT JALAN PANJI ALAM NO. PENDAFTARAN
KUALA TERENGGANU SYARIKAT
21100 TERENGGANU
REPLACING CERT.NO. : REFERENCE NO. :
NOMBOR SIJIL ASAL NOMBOR RUJUKAN
BUSINESS / OCCUPATION :
PERNIAGAAN /
KEGUNAAN

ISSUED & SIGNED AT : CAWANGAN KUALA TERENGGANU

DIKELUARKAN DAN
DITANDATANGANI DI
PERIOD OF TAKAFUL (BOTH DATE INCLUSIVE) DATE OF SIGNATURE OF
TEMPOH PERLINDUNGAN (TERMASUK KEDUA-DUA TARIKH) PROPOSAL & DECLARATION
FORM
TARIKH TANDATANGAN BORANG
CADANGAN & AKUAN
a.) FROM : 01/02/2018 TO : 31/01/2019 24/01/2018
MULA TAMAT
b.) ANY SUBSEQUENT PERIOD FOR WHICH THE PARTICIPANT SHALL PAY AND THE COMPANY SHALL AGREE TO ACCEPT A RENEWAL
CONTRIBUTION
MANA-MANA TEMPOH SELANJUTNYA DI MANA PESERTA MEMBAYAR DAN SYARIKAT BERSETUJU MENERIMA SUMBANGAN
PEMBAHARUAN

DETAILS OF VEHICLE THE CERTIFICATE'S CONTRIBUTION (RM)

BUTIR KENDERAAN SUMBANGAN SIJIL (RM)
REGISTRATION NO. WQY5188 BASIC CONTRIBUTION 833.62
NO. PENDAFTARAN SUMBANGAN ASAS
MAKE & MODEL SUZUKI SWIFT
BUATAN & MODEL
CUBIC CAPACITY 1,490
KEUPAYAAN PADU

TONNAGE / KG
TON / KG
SEATING CAPACITY INCLUDING 5
DRIVER
RUANG DUDUK TERMASUK
PEMANDU
YEAR OF MANUFACTURE 2008 NCD ENTITLEMENT 55.00 % 458.49
TAHUN DI BUAT KELAYAKAN NCD

ADDITIONAL COVERAGE
PERLINDUNGAN TAMBAHAN
ENGINE NO. M15A-1279897 BREAKAGE OF GLASS IN WINDSCREE 800.00 120.00
NO. ENJIN NAMED DRIVERS 10.00

CHASSIS NO. PPPEZC21S00101755

NO. CASIS
SUM COVERED RM 23,000
JUMLAH PERLINDUNGAN
EXCESS / AKSES RM 0.00 SUB TOTAL / JUMLAH KECIL 505.13

REBATE / REBAT 50.52

USE OF VEHICLE PRIVATE CAR-PRIVATE USE GST / CUKAI BARANG dan PERKHIDMATAN 6.00% 27.26
KEGUNAAN KENDERAAN
STAMP DUTY / DUTI SETEM 10.00
REPLACING COVER NOTE NO. TOTAL AMOUNT PAYABLE / JUMLAH 491.87
NO. PENGGANTIAN / PEMBAYARAN
PEMBATALAN NOTA LINDUNG
PREVIOUS CERTIFICATE NO. ACT CONTRIBUTION 54.68
NO. SIJIL TERDAHULU SUMBANGAN AKTA

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HIRE PURCHASE/LEASING COMPANY/EMPLOYER :
SEWA BELI/SYARIKAT MENYEWA/MAJIKAN
NAMED DRIVERS : AHMAD ZUBIR BIN JUSOH
PEMANDU YANG DINAMAKAN MAZIAH BINTI JUSOH
KU ANIZA BINTI KU IBRAHIM

SUBJECT TO FOLLOWING OPERATIVE ENDORSEMENTS ATTACHED : C089, C113

TERTAKLUK KEPADA ENDOSMEN-ENDOSMEN BERIKUT YANG DISERTAKAN

PERSONS OR CLASSES OF PERSONS ENTITLED TO DRIVE AND LIMITATIONS AS TO USE AS SPECIFIED IN THE CERTIFICATE OF TAKAFUL
ISSUED IN RELATION TO THIS SCHEDULE.
MANA-MANA ORANG YANG DIBENARKAN MEMANDU DAN HAD ATAS KEGUNAAN ADALAH TERMAKTUB DALAM SIJIL TAKAFUL YANG
DIKELUARKAN SEHUBUNGAN DENGAN JADUAL INI.

SUBJECT TO THE FOLLOWING WARRANTIES/CLAUSES/ENDORSEMENTS AS PRINTED HEREIN OR ATTACHED HERETO:

TERTAKLUK KEPADA WARANTI/KLAUSA/ENDOSMEN YANG DICETAK ATAU DILAMPIRKAN SEPERTI BERIKUT :

C089 COVER FOR WINDSCREENS, WINDOWS AND SUNROOF

C113 REFERENCE TO MOTOR VEHICLE MARKET VALUATION SYSTEM

IN WITNESS WHEREOF THIS CERTIFICATE HAS BEEN SIGNED ON BEHALF AND WITH THE AUTHORITY OF THE COMPANY.
BAHAWASANYA SIJIL INI TELAH DITANDATANGANI DENGAN KEBENARAN DAN BAGI PIHAK SYARIKAT.

DATE : 24/01/2018
TARIKH
SIGNED AT : CAWANGAN KUALA TERENGGANU
LOKASI

SYARIKAT TAKAFUL MALAYSIA AM BERHAD (1246486-D)

AUTHORISED SIGNATORY
PENANDATANGAN YANG SAH

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