COVER NOTE

STAMP DUTY PAID

Participant SHAMSUL ARIF BIN HARUNA

PERODUA SALE NO.21 BLOCK C ADIKA COMMERCIAL CENTRE JALAN MASAK KENINGAU 89007 SABAH

Cover Note No. : K5046611 Account No. : V0004964 Agent Name : ABDUL RAHMAN BIN MUNUR Product Type : PRIVATE CAR - PRIVATE USE Period of Takaful from 04/07/2013 To 03/07/2014 (both Dates Inclusive). Any subsequent period for which the Participant shall pay and the Takaful Operator shall agree to accept a renewal contribution..

NRIC No Business/Occupation Vehicle Information JPJ Document No Vehicle Reg No Make Model Engine No Chassis No

: 711008-12-5547 Business Reg No : : Businessman/Busin Other ID No : esswomen : : : : : :

Year of Manufacture : : Normal Vehicle Cubic Capacity : : Private Use Seating Capacity : Financial Interest : Authorised Driver 1 SHAMSUL ARIF BIN HARUNA 711008-12-5547 2 SYAHRIL BIN HARUNA 770413-12-5751 Subject to the following warranties, endorsements and clauses incorporated herein and forming part of the Policy. Clause Code Clause Name

QTE9286 Log Book No FORD Ranger Pickup Double Cab WLAT755213 Cover Type PR8UACCAM7CZ Vehicle Type 00006 2007 License Type 2499 Use For 5 NIL

: A4637556

Vehicle Estimated Value Gross Contribution Add: Loading 0.00% Less: No Claim Discount 55.00% Named Driver

RM RM RM RM RM RM RM RM RM

40000.00 1041.40 0.00 572.77 0.00 ______ 468.63 0.00 0.00 10.00 478.63

: Comprehensive : Private Car

Less : Discount/Rebate 0.00% Add : Service Tax Stamp Duty

TOTAL AMOUNT DUE RM

Excess All Claims

RM

0.00

IMPORTANT NOTICE This Takaful Certificate (including this schedule) is issued to you based on the information transmitted to us/our agents/representatives by you. If you find any of the information stated herein is inconsistent with your disclosure, kindly provide us with the correct information for revision, and if we do not hear from you within fourteen (14) days from the commencement date of your certificate, we shall deem that the information is correct. In line with the provisions of S.28 of the Takaful Act 1984, we shall have the right to invalidate your certificate and/or deny your claim should we later discover that your disclosure was not made in good faith and/or was fraudulently and/or falsely and/or deceivingly made.

Issue Date Issue At Issue By

: 04-07-2013 : F2 : v0004964

For and on behalf of Etiqa Takaful Berhad

Visit www.etiqa.com.my or our nearest branch to obtain the full policy wordings. Help preserve the countrys natural resources.