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    Copyright:

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    Download as PDF, TXT or read online from Scribd
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    43 views1 page

    Bo Rang Taka Ful

    Uploaded by

    aliskkt

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    BORANG PENAMAAN TAKAFUL KEMALANGAN DIRI BERKELOMPOK PELAJAR

    UNIVERSITI UTARA MALAYSIA

    Nama Pelajar: __________________________________ No. Matrik: ____________________


    No. Kad Pengenalan: ____________________________ Program: ______________________
    Alamat Dewan
    Penginapan Pelajar: ____________________________________________________________
    Alamat Tetap: _________________________________________________________________
    _____________________________________________________________________________
    Tel.: (Rumah) _______________________________ Tel. Bimbit:_________________________

    Penama 1: ____________________________________________________________________
    No. Kad Pengenalan: ____________________________ Hubungan: ____________________
    Alamat Tetap: _________________________________________________________________
    _____________________________________________________________________________

    Penama 2: ____________________________________________________________________
    No. Kad Pengenalan: ____________________________ Hubungan: ____________________
    Alamat Tetap: _________________________________________________________________
    _____________________________________________________________________________

    Saya bersetuju menamakan penama-penama di atas untuk diagihkan pampasan Takaful


    sekiranya sesuatu kemalangan berlaku kepada saya.
    Sekian.

    ________________________________
    )

    (Pelajar-pelajar perlu mengisi borang ini bagi memudahkan urusan pembahagian pampasan
    Takaful sekiranya pelajar meninggal dunia akibat kemalangan semasa menuntut di Universiti
    Utara Malaysia

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