Overseas Assurance Corporation (Malaysia) Berhad (102249-P

)
(A member of Great Eastern Holdings Limited)
Level 18, Menara Great Eastern,
303, Jalan Ampang, 50450 Kuala Lumpur.
Telephone: 03-4259 7888 Facsimile: 03-4813 0055
Website: www.oac.com.my

N.MAIALAGAN A/L NARAYANASAMY

KM 2759 JLN DUA,
TMN SUTERA INDAH,
78000 MELAKA.
78000

MOTOR PRIVATE CAR POLICY
Policy No : VPC-V1627590-ML

VHML0457 Original Copy

00 ADD NAMED DRIVER : RM 0.50 Goods and Services Tax (6.MAIALAGAN A/L NARAYANASAMY 02SANTHI A/P VALU Financial Interest / Kepentingan kewangan : AM ISLAMIC BANK BHD Subject to the following endorsements incorporated herein and forming part the policy : Tertakluk kepada Pengendorsan yang dimasukkan dan menjadi sebahagian polisi : E015 HIRE PURCHASE E030 REPLACEMENT PARTS E089 WINDSCREEN WITH TINT OR WITHOUT TINT E106 INSURER'S AUTHORISED WORKSHOP (INCLUDING ANY WINDSCREEN REPLACEMENTS AND REPAIRS) CAP CAR ASSISTANCE PROGRAMME E02F COMPULSORY EXCESS E087 AGREED VALUE Subject also to the Sanction Limitation and Exclusion Clause (SANC) and Goods and Services Tax (GST) stated in the Policy attached hereto.PROTON EXORA 1. / No.00 : RM 1239. Alamat Pos TMN SUTERA INDAH.00%) Stamp Duty / Duti Setem : RM 10. Siri : 1385640 Seating Capacity / Muatan Tempat Duduk : 7 Estimated Value / Nilai Anggaran : RM 30000.C. / No.6 (A) Year of Manufacture / Tahun Diperbuat : 2011 Engine No.00 RM 1200. / Keupayaan Engin : 1597 Make & Body / Buatan & Badan : PROTON . / No.MAIALAGAN A/L NARAYANASAMY Nama Pihak Diinsuranskan Postal Address / : KM 2759 JLN DUA.50 Loading / Tambahan 0. Pendaftaran Kenderaan : MCD1795 C.00 NCD / Diskaun Tanpa Tuntutan 0.37 Perkhidmatan (6. / No. 78000 MELAKA. Sebarang tempoh selanjutnya di mana anda hendaklah membayar dan Syarikat kami hendaklah bersetuju untuk menerima premium pembaharuan PRIVATE CAR / KERETA PERSENDIRIAN Risk / Risiko : 1 Business / Profession / Perniagaan / Perkerjaan : LORRY DRIVER Cover / Perlindungan : COMPREHENSIVE Risk Class / Kelas Risiko : PRIVATE CAR Vehicle Registration No. Polisi : VPC-V1627590-ML Insured Name / : N.Overseas Assurance Corporation (Malaysia) Berhad (102249-P) (A member of Great Eastern Holdings Limited) MOTOR SCHEDULE / JADUAL KENDERAAN BERMOTOR Account No.00% : RM 0. . Akaun : VHML0457 Policy No.00%) / Cukai Barangan dan : RM 74.00 Limits / Had Premium / Premium : RM 1059. 78000 Period of Insurance / : From 27/04/2017 to 26/04/2018 Tempoh Insurans Dari hingga Any subsequent period for which the insurance shall pay and the Corporation may agree to accept a renewal premium.87 Authorised Drivers / Pemandu yang diberi kuasa : 01N. / No.00 (Vehicle / Kenderaan) Excess / Lebihan : RM 0.00 Total Due / Jumlah Perlu Dibayar : RM 1323. / No. Enjin : S4PHRM5721 Chassis No.00% : RM 0. Casis : PL1FZ6YRRCF070971 Log Book No.00 WINDSCREEN WITH TINT : RM 180.

/ No. Signed on behalf of the Corporation Tandatangan bagi Pihak Syarikat Replacing / Penggantian Policy No. Polisi VPC-V1627590-ML Cover Note / Nota Perlindungan J1920412 Issued On / Dikeluarkan Pada 26/04/2017 At / Di MALACCA By / Oleh PRABHA457 _________________________________________ Authorised Signatory / Penandatangan Dibenarkan Important : This Schedule should be read in conjunction with the standard form of policy to which this Schedule is attached. . Penting : Jadual ini hendaklah dibaca bersama dengan format polisi yang dilampirkan bersama Jadual ini.

00 Total : 1. Please write your name and policy number at the back of the cheque.87 Note : Please attach a copy of this Debit Note together with your payment and all cheques should be made payable to Overseas Assurance Corporation (Malaysia) Berhad. TMN SUTERA INDAH. : VPC-V1627590-ML Period of Cover : From 27/04/2017 To 26/04/2018 Insured's Name : N. 78000 MELAKA.00%) : 74. Enclose herewith is : Cheque/Money/Postal Order No.37 Stamp Duty : 10.Overseas Assurance Corporation (Malaysia) Berhad (102249-P) (A member of Great Eastern Holdings Limited) DEBIT NOTE CLIENT'S COPY GST Registration No : 001437466624 Number : J1920412 Trans.239. TMN SUTERA INDAH.MAIALAGAN A/L NARAYANASAMY Address : KM 2759 JLN DUA.87 Total Due : 1.323. : Amount : RM Name of Bank : . 78000 Reason : RENEWAL BUSINESS Type Of Policy : MOTOR PRIVATE CAR / KERETA PERSENDIRIAN Policy No. 78000 Account : VHML0457 MALAYSIAN RINGGIT Premium : 1.50 Goods and Services Tax (6.MAIALAGAN A/L NARAYANASAMY KM 2759 JLN DUA. 78000 MELAKA. Date : 26/04/2017 N.323.

78000 MELAKA. 78000 MELAKA. 78000 Reason : RENEWAL BUSINESS Type Of Policy : MOTOR PRIVATE CAR / KERETA PERSENDIRIAN Policy No. : Date : . TMN SUTERA INDAH.50 Goods and Services Tax (6.323.87 Total Due : 1.87 Note : This section is for the Insured to acknowledge receipt of this policy/endorsement by signing at the indicated space below.00%) : 74.Overseas Assurance Corporation (Malaysia) Berhad (102249-P) (A member of Great Eastern Holdings Limited) DEBIT NOTE AGENT'S COPY GST Registration No : 001437466624 Number : J1920412 Trans. Date : 26/04/2017 N.37 Stamp Duty : 10.MAIALAGAN A/L NARAYANASAMY KM 2759 JLN DUA.323. _________________________________________ Anthorised Signature & company stamp (if any) Name : IC No.00 Total : 1. I/we hereby acknowledge receipt of this policy/endorsement. TMN SUTERA INDAH. : VPC-V1627590-ML Period of Cover : From 27/04/2017 To 26/04/2018 Insured's Name : N. 78000 Account : VHML0457 MALAYSIAN RINGGIT Premium : 1.239.MAIALAGAN A/L NARAYANASAMY Address : KM 2759 JLN DUA.

/ Had yang ditakwilkan tidak berkuatkuasa oleh Seksyen 95 Akta Pengangkutan Jalanraya (Malaysia). Name of Policyholder / Nama Pemegang Polisi N. 1959 (Malaysia) Risk No: 0001 Motor Vehicles (Third Party Risks & Compensation) Act (Cap 189) Republic of Singapore Motor Vehicles (Third Party Risks & Compensation) Rules 1960 (Republic of Singapore) COMPREHENSIVE Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam RM 30000. B) Use for racing pace-making. Index Mark and Registration Number of Vehicle / Tanda Indeks dan No. The policy does not cover A) Use for hire or reward. Effective date of the Commencement of Insurance for the purpose of Regulations. / SAYA/KAMI DENGAN INI MEGESAHKAN bahawa Polisi yang berkaitan dengan Sijil ini dikeluarkan selaras dengan peruntukan Bahagian IV Akta Pengangkutan Jalanraya 1987 (Malaysia). Signed on behalf of the Corporation Tandatangan bagi Pihak Syarikat ___________________________ Authorised Signatory .Overseas Assurance Corporation (Malaysia) Berhad (102249-P) (A member of Great Eastern Holdings Limited) CERTIFICATE OF INSURANCE / SIJIL INSURANS Road trasport Act. reliability trial or speed-testing C) Use for the carriage of goods (other than samples) in connection with any trade or business. Pendaftaran Kenderaan MCD1795 PROTON . D) Use for any purpose in connection with the Motor Trade ISSUED IN LIEU OF AND REPLACING POLICY NO. I/WE HEREBY CERTIFY that the policy to witch this Certificate related is issued in accordance with the provisions of Part IV of the Road Transport Act. Limitation as to use* / Had Penggunaan Use only for social . 6.6 (A) 2. 1987 (Malaysia). V1627590 Limitations rendered inoperation by Section 95 of the Road Transport Act 1987 (Malaysia) or Section 8 of the Motor Vehicles (Third Party Risks and Compensation) Act (Cap 189) Republic of Singapore or Section 7 of the Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam are not included under this heading.PROTON EXORA 1. Persons or Classes of Persons entitled to drive* / Orang atau Kelas Orang yang layak memandu* (a) The Policyholder (b) Any other person who is driving on the Policyholder's order or with his permission. domestic and pleasure purpose and for the Policyholder's business. Motor Vehicles (Third Party Risks & Compensation) Act (Cap 189) Republic of Singapore and the Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam.MAIALAGAN A/L NARAYANASAMY 3. Ordinance or Enactment / Tarikh mula Insurance berkuatkuasa bagi tujuan Peraturan. SIJIL : V1627590 1.00 Akta Pengangkutan Jalan Raya 1987 (Malaysia) Peraturan Kenderaan Bermotor (Risiko Pihak Ketiga) 1959 (Malaysia) Kenderaan Bermotor (Risiko Keatas Pihak Ketiga dan Pampasan) Akta (Kap 189) Republik Singapura Peraturan Kenderaan Bermotor (Risiko Keatas Pihak Ketiga dan Pampasan) 1960 (Republik Singapura) Insurans Insurans Kenderaan Bermotor (Risiko Keatas Pihak Ketiga) Akta (Kap 90) Negara Brunei Darussalam CERTIFICATE NO. Ordinans atau Enakmen 27/04/2017 4. 1987 (Malaysia) PRIVATE CAR Motor Vehicles (Third Party Risks) Rules. 1987 atau Seksyen 8 Kenderaan Bermotor (Risiko Keatas Pihak Ketiga Dan Pampasan) Akta (Kap 189) Republik Singapura atau Seksyen 7 Insurans Kenderaan Bermotor (Risiko Keatas Pihak Ketiga) Akta (Kap 90) Negara Brunei Darussalam tidak termasuk dibawah tajuk ini. / NO. Date of Expiry of Insurance / Tarikh Tamat Insurans 26/04/2018 5. Kenderaan Bermotor (Risiko Keatas Pihak Ketiga Dan Pampasan) Akta (Kap 189) Republik Singapura dan Insurans Kenderaan Bermotor (Risiko Keatas Pihak Ketiga) Akta (Kap 90) Negara Brunei Darussalam.

oac. Address/ Alamat : TMN SUTERA INDAH. Cukai Barangan Dan Perkhidmatan Tax Invoice No.00 Total// Jumlah RM 1.87 This Tax Invoice is issued by Invois Cukai ini dikeluarkan oleh Overseas Assurance Corporation (Malaysia) Berhad (102249-P) Level 18. : 001437466624 No.my Website : www. 303. Tax Invoice/Invois Cukai GST Registration No. Jalan Ampang.50 Goods and Services Tax (6. Menara Great Eastern. 78000 Particulars Of Supply/Butir-butir Pembekalan Type Of Policy/ Jenis Polisi : MOTOR PRIVATE CAR / KERETA PERSENDIRIAN Policy No/ No.00%) / Cukai Barangan RM 74. Polisi : VPC-V1627590-ML From 27/04/2017 To 26/04/2018 Period Of Insurance/ Tempoh Perlindungan : Dari 27/04/2017 Hingga 26/04/2018 Premium/ Premium RM 1./ No.239. 50450 Kuala Lumpur. 78000 MELAKA. Malaysia Tel : (603)4259 7888 Fax : (603)4813 0055 Customer Services Careline : (603)4259 8900 Email : enquiry@oac.MAIALAGAN A/L NARAYANASAMY / Nama Pemegang Polisi Insurans KM 2759 JLN DUA.00%) Stamp Duty// Duti Setem RM 10.37 Dan Perkhidmatan (6. Invois Cukai : FL1700050075 Transaction Date/ Tarikh Transaksi : 26/04/2017 Policyholder Name : N.com.323.my .com.