TAKAFUL IKHLAS BERHAD

Tower 11A, Avenue 5, Bangsar South

No.8, Jalan Kerinchi
59200 Kuala Lumpur

REQUEST FOR ENDORSEMENT

To

Date

TAKAFUL IKHLAS BERHAD

General Underwriting Dept
3rd Floor, Tower 11A, Avenue 5, Bangsar South
No.8, Jalan Kerinchi
59200 Kuala Lumpur
Tel No. : 03-27239999 Fax No. : 03-27118229

PARTICIPANTS NAME
CERTIFICATE NO.
EXPIRY DATE

:
:
:

We refer to the above matter, please take note that the following are to be amended as stated below;
[

Loan is fully settled. Delete Chargee/Mortgagee Clause w.e.f _________ and kindly
correspond directly with the Participant.

The certificate is to be cancelled w.e.f ____________ . Due to property sold/master

certificate/loan is fully settle.

The occupancy of the property should read as_____________________________.

Name of Participant read as ___________________________________________.

Correspondence address changed to _______________________________________

_________________________________________________________________

Location of Risk changed to ___________________________________________.

__________________________________________________________________

Period of Takaful changed to __________________________________________.

Extension of Period of Takaful from ________________ to __________________

Sum Covered *Increase/Decrease to RM ______________ w.e.f ______________.

Others (Please specify)_______________________________________________

__________________________________________________________________

Yours faithfully,

NoNnoO

_______________________________
Name and I/C no./Companys chop

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