July 4, 2012

Wisma AIA,
103 Jalan Tun Ismail
25000 KUANTAN
Pahang D.M
(ATT: Cancellation Dept)
Tel No: 09-5178795
Faks: 09-5157151
RE: POLICY NUMBER MCCL 929741 CANCELLATION
I am sending you this written notice to request cancellation of my insurance policy
effective 01st August 2012. I would appreciate you sending me written confirmation
within 30 days that the cancellation has been put into effect. Please refund the unused
portion of my policy premium and cease charging my credit card account for payment of
monthly premiums.
Thank you for your prompt attention to this matter.
Sincerely,

ROZALINA MOHAMAD (790804-06-5280)

NO 27, JALAN SEBERANG BALOK 3,
PERUMAHAN BALOK PUTRA,
26100 KUANTAN PAHANG.