UW-PW-S009(E)(MT)

REV: B
PRIVATE CAR SCHEDULE / JADUAL KERETA PERSENDIRIAN RTD Code:08
PRIVATE CAR EX GOODS
auto 365 Comprehensive Premier M.X.1

The Insured / Pemegang Polisi Policy No. / No. Polisi

BVB0041154 01-C1
NUR NABILA BINTI SALLEH SAID
Account No. / No . Akaun
12B KAMPUNG BUKIT GUNTONG G59800-00
TEPOH Type of Cover / Jenis Perlindungan
21060 KUALA TERENGGANU COMPREHENSIVE PREMIER
Period of Insurance / Tempoh Insurans
From / Dari 00:00:01 AM 08-03-2019 To / Hingga 07-03-2020
Bus. Regn. No / Premium / Premium RM 1,337.05
Occupation / Pekerjaan No Pendaftaran Perniagaan
OTHERS - 1,337.05
NCD / Diskaun Tanpa Tuntutan 38.33% 512.49
Wef / Berkuatkuasa dari 08-03-2019
I.C. No. / No.Kad Pengenalan 824.56
Optional Cover
910721115362
Windscreen Damage (Tempered/Laminated Glass Inclusive T 105.00
Hire Purchase Owner / Pemilik Sewa Beli Labour Cost) / Kerosakan Cermin Kenderaan (Pengubahan T
Cermin / Cermin Berlapis Termasuk Kos Buruh) RM 700.00T
-
T
Make & Type of Body / Buatan & Jenis Badan Gross Premium / Premium Kasar 929.56
PERODUA MYVI SE / 4D HATCHBACK Rebate / Rebat 10% 92.96
836.60

Registration No. / Excess / Lebihan Regn. Card No. / No.Kad Service Tax / Cukai Perkhidmatan 6.0 % 50.2
No.Pendaftaran Pendaftaran Stamp Duty / Duti Setem 10.00
0.00
WC144Q -

Carrying or Seating Tonnage / C.C./ Watt Sum Insured / Jumlah

Capacity Incl. Driver / Tan / Keupayaan Enjin Diinsuranskan (RM)
Muatan Tempat Duduk 1495.00 CC
Termasuk Pemandu 36,000.00
Year of Manufacture /
5 Tahun Diperbuat (Agreed Value)
2016

Engine /Motor No. / No . Enjin / Motor

R86A93S
Chassis No. / No. Casis Trailer / Treler
PM2M603S002146846 -
Named Driver / Pemandu Yang Dinamakan

ANY AUTHORISED DRIVER

Note : Compulsory excess will be applied for named driver under 21 years old /
Provisional (P) or Learner (L) driver’s licence / unnamed driver. / Ekses wajib
akan dikenakan untuk pemandu yang dinamakan di bawah umur 21 tahun /
pemegang lesen memandu Percubaan (P) atau Pelajar (L) / Pemandu yang
tidak dinamakan.
Subject to IMPORTANT NOTICE: Your duty as the Owner of the vehicle as attached. Total Due / Jumlah Berbayar RM 896.80

Geographical Area : Malaysia , Republic of Singapore and Negara Brunei Darussalam. / Kawasan Geografi : Malaysia, Republik Singapura dan
Negara Brunei Darussalam.
Limitations as to Use / Authorised Driver : As described in the Certificate of Insurance. / Had Penggunaan / Pemandu Yang Diberi Kuasa : Seperti
yang tercatat dalam Sijil Insurans.
Replacing Cover Note No./ - Issued By / Dikeluarkan Oleh : For / untuk
Gantian No. Nota AMGENERAL INSURANCE BERHAD AmGeneral Insurance Berhad
Perlindungan MENARA SHELL,
Renewal of Policy No./ W0887900 NO. 211, JALAN TUN
Pembaharuan No.Polisi SAMBANTHAN
Date of Proposal or 24-01-2019 Tel : 03-22683333
Declaration / Fax : 03-21713030
Tarikh Cadangan atau
Pengisytiharan Authorised Signature /
Date of Issue / Time 24-01-2019 01:38:41 PM Tandatangan Yang Diberi Kuasa
Tarikh Dikeluarkan / Waktu 210210240119K422
Note: / Nota: No refund of premium for any cancellation of policy if premium is charged on minimum premium / Tiada bayaran balik premium bagi sebarang pembatalan polisi sekiranya premium
yang dikenakan adalah premium minima.

0917
Page 1 24-01-2019 01:38:59 PM
 01BVR8PM910150-1

CERTIFICATE OF INSURANCE / SIJIL INSURANS

AKTA PENGANGKUTAN JALAN RAYA 1987 (MALAYSIA) RTD Code :08
PERATURAN KENDERAAN BERMOTOR (RISIKO KEATAS PIHAK KETIGA) 1959 (MALAYSIA)
ORIGINAL COPY / AKTA KENDERAAN BERMOTOR (RISIKO KEATAS PIHAK KETIGA DAN PAMPASAN) (KAP 189) REPUBLIK SINGAPURA
SALINAN ASAL PERATURAN KENDERAAN BERMOTOR (RISIKO KEATAS PIHAK KETIGA DAN PAMPASAN 1960 (REPUBLIK SINGAPURA)
AKTA INSURANS KENDERAAN BERMOTOR (RISIKO KEATAS PIHAK KETIGA) (KAP 90) NEGARA BRUNEI DARUSSALAM

Certificate No. / No. Sijil

BVB0041154 01-C1 Excess : RM 0.00 Sum Insured : RM 36,000.00 (Agreed Value)
1. Index Mark and Registration Number of Vehicle / Tanda Indeks dan No. Pendaftaran Kenderaan
WC144Q NCD : 38.33% Wef : 08-03-2019
2. Name of Insured / Nama Pemegang Polisi
NUR NABILA BINTI SALLEH SAID
3. Period of Insurance / Tarikh Insurans
From / Dari 00:00:01 AM 08-03-2019 To / Hingga 07-03-2020
4. Persons or Classes of Persons entitled to drive / Orang atau kelas orang yang layak memandu:*
a) The Insured.
b) Any other person who is driving on the Insured's order or with his/her permission.
a) Pemegang Polisi.
b) Sesiapa yang memandu atas arahan Pemegang Polisi atau dengan kebenarannya.
Provided that the person driving is permitted in accordance with the licensing or other laws or regulations to drive the Motor Vehicle or has been so permitted and is not
disqualified by order of a Court of Law or by reason of any enactment or regulation in that behalf from driving the Motor Vehicle. / Dengan syarat orang yang dibenarkan
memandu itu menurut perlesenan atau undang-undang atau peraturan lain bagi memandu kenderaan bermotor dan telah dibenarkan dan tidak hilang kelayakan atas perintah
Mahkamah Undang-undang atau atas sebab mana-mana enakmen atau peraturan berkenaan pemanduan kenderaan bermotor.
5. Limitations as to use / Had Penggunaan*
Use only for social, domestic and pleasure purposes and for the insured`s business. The policy does not cover :-
Use for hire or reward, racing, pace-making, reliability trial, speed-testing the carriage of goods other than samples in connection with any trade
or business.
Digunakan hanya untuk tujuan sosial, domestik dan persiaran dan untuk perniagaan Pemegang Polisi.
Polisi ini tidak melindungi kegunaan untuk sewaan atau ganjaran, perlumbaan, mengkadar kelajuan, ujian kebolehpercayaan, ujian kelajuan,
membawa barangan selain daripada sampel yang berkaitan dengan apa-apa pekerjaan atau perniagaan.
* Limitations rendered inoperative 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. /
* Had yang ditakwilkan tidak berkuatkuasa oleh Seksyen 95 Akta Pengangkutan Jalanraya (Malaysia),1987 atau Seksyen 8 Akta Kenderaan Bermotor (Risiko Keatas Pihak
Ketiga Dan Pampasan) (Kap 189) Republik Singapura dan Seksyen 7 Akta Insurans Kenderaan Bermotor (Risiko Keatas Pihak Ketiga) (Kap 90) Negara Brunei Darussalam
tidak termasuk dibawah tajuk ini.

I/WE HEREBY CERTIFY that the policy to which this certificate relates is issued in accordance with the provisions of Part IV of the Road Transport Act,
1987 (Malaysia), Motor Vehicles (Third Party Risks and Compensation) Act (Cap 189) Republic of Singapore and the Motor Vehicles Insurance (Third Party
Risks) Act (Cap 90) Negara Brunei Darussalam. / SAYA / KAMI DENGAN INI MENGESAHKAN bahawa polisi yang melaluinya sijil ini dikeluarkan adalah
selaras dengan peruntukan Bahagian IV Akta Pengangkutan Jalan, 1987 (Malaysia), Akta Kenderaan Bermotor (Risiko Keatas Pihak Ketiga dan
Pampasan) (Kap 189) Republik Singapura dan Akta Insurans Kenderaan Bermotor (Risiko Keatas Pihak Ketiga) (Kap 90) Negara Brunei Darussalam.

IMPORTANT NOTICE: Your duty as the Owner of the vehicle. Failure to comply to the below may result your
claim to be declined.
(1) The insured will have to take all reasonable care to secure the vehicle from loss or damage.
(2) Report to the police for all incidents. For road accident, you have to report to the police within 24 hours. for / untuk AmGeneral Insurance Berhad
(3) Notify us in writing within 7 days after the incident and complete the claim form in full and return it to us (Incorporated in Malaysia / Ditubuhkan di Malaysia)
with the related documents within 21 days from your notification's date. Approved Insurers / Penanggung Insurans Yang Dibenarkan
(4) You must obtain our consent in writing before you repair your vehicle or incur any expenses.
(5) For private car own damage claim - In the event of claim, repairs must be conducted by our
approved repairer.
(6) When incident happen, you need to collect these details :
(a) all drivers e.g full name, residential address and contact number
(b) all vehicles e.g. make and model, registration number, and insurance details
(c) date, time and location of the incident
(d) description of the incident and
(e) report to us immediately
(f) report to us for any claims made by another person against you and send us the notices and Authorised Signature /Tandatangan Yang Diberi Kuasa
letters within 14 days from the receipt of the documents.
(7) Do not negotiate or settle any claims made against you, unless you have our consent in writing.
(8) We will have full discretion in the conduct, defence and/or settlement of any claim.
Agent Code / Kod Ejen: G59800-00
N.B. (i) We have the right to cancel this policy by giving you 14 days’ notice in writing by
registered post to your last known address in our records.
(ii) Betterment – In the event your vehicle is aged above 5 years, this policy is subject to rate of betterment.
(iii) You need to read this policy carefully, and if any error or incorrect description is found herein, or
if the cover is not in accordance with your wishes, you should inform us immediately and return this policy to us for alteration.

Important Notice / Kenyataan Penting :

* For environmental conservation, we have adopted paper less printing concept. Please log on to our website to view the Bahasa Malaysia language policy wordings, terms and conditions and exclusion.
For further enquires, please contact your insurance intermediary or our Customer Contact Centre. /Untuk pemeliharaan alam sekitar, kami telah mengaplikasikan konsep tanpa percetakan. Sila layari laman
web kami untuk rujukan da / atau mencetak kandungan polisi, terma-terma, syarat-syarat dan pengecualian dalam Bahasa Melayu. Untuk pertanyaan lanjut, sila hubungi ejen insurans anda atau Pusat
Khidmat Pelanggan kami.
* You are advised to read and understand the summary of this product as contained in the Product Disclosure Sheet on our website. /Anda dinasihati supaya membaca dan memahami ringkasan produk ini
seperti yang tertera di dalam Lampiran Pemberitahuan Produk yang boleh didapati dilaman web kami.

0917
Page 2 24-01-2019 01:38:59 PM
 Invoice
Invois

Invoice No. : SST-01-19-01131072 Date : 24-01-2019

No. Invois Tarikh

Name : NUR NABILA BINTI SALLEH SAID

Nama

Insurer Address : 12B KAMPUNG BUKIT GUNTONG

Alamat TEPOH
21060 - KUALA TERENGGANU

Agent Name : AMGENERAL INSURANCE BERHAD Account No. : G59800-00

Nama Ejen No. Akaun

Policy/Endorsement No. : W0887900 Cover Note No. : BVB0041154

No. Polisi/Endorsemen No. Nota

Class of Policy : PRIVATE CAR EX GOODS

Jenis Insurans

Period of Insurance : From 08-03-2019 To 07-03-2020

Tempoh Insurans

No. / No Description / Deskripsi Total / Jumlah (RM)

1 Gross Premium / Premium Kasar 929.56
2 Rebate / Rebat 10% 92.96
3 Service Tax / Cukai Perkhidmatan 6% 50.20
4 Stamp Duty / Duti Setem 10.00
5 Total Payable (OTC) / Jumlah Berbayar Di Kaunter 896.80
6 Total Payable / Jumlah Berbayar 896.80

AmGeneral Insurance Berhad

This is computer generated. No signature is required.

Ini adalah cetakan komputer . Tandatangan tidak diperlukan.

0917
Page 3 24-01-2019 01:38:59 PM
INSURED NAME : NUR NABILA BINTI SALLEH SAID
VEHICLE NO : WC144Q
COVER NOTE NO : BVB0041154
PRIVACY CLAUSE

1.0 PRIVACY CLAUSE

1.1 You confirm that you have read, understood and agree to be bound by the Privacy Notice of AmGeneral Insurance
which is available at our website and the clauses herein, as may relate to the processing of your personal
information. For the avoidance of doubt, you agree that the said Privacy Notice shall be deemed to be incorporated
by reference into this policy.
1.2 In the event you provide personal and/or financial information relating to third parties, including information relating
to your next-of-kin and dependents, for the purpose of operating the Insurance Policy with AmGeneral or otherwise
subscribing to AmGeneral's products and services, you:
a. confirm that you have obtained their consent or are otherwise entitled to provide the information to
AmGeneral and for AmGeneral to use it in accordance with this Insurance Policy;
b. agree to ensure that the personal and financial information of the said third parties is accurate and
update AmGeneral in writing in the event of any change to the said personal and financial information;
and
c. agree to AmGeneral's right to terminate the Insurance Policy should such consent be withdrawn by any
of the said third parties
1.3 Even after you have provided AmGeneral with any information, you have the option to withdraw the consent given
earlier. In such instances, AmGeneral will have the right to not provide or discontinue the provision of the Insurance
Policy that is/are linked with such information.
1.4 You agree that the Company and its related companies may contact you about products and services and offers,
which the Company and its related companies believe may be of interest to you, through various channels of
communication.
1.5 In the event you do not wish to consent to use your personal data to receive marketing of products and services by
the Company and its related companies, you may contact AmGeneral as per below details or you may contact
AmGeneral's nearest branch to you:
Customer Service Executive, Customer Contact Centre
Telephone No E-Mail

AmAssurance 1-300-80-3030 customer@amassurance.com.my

Kurnia Insurans 1-800-88-6333 customer@kurnia.com

1.6 AmGeneral reserves the right to amend this Section from time to time at AmGeneral's sole discretion by providing
notice to you.
VEHICLE INSURED VALUE
1.0 IF YOU HAVE SELECTED THE AGREED VALUE OPTION
1.1 Your vehicle is insured based on an agreed value.
1.2 In the event of total loss, the maximum amount that we will pay is up to the sum insured as shown in the schedule.
2.0 IF YOU HAVE SELECTED THE MARKET VALUE OPTION
2.1 Your vehicle is insured based on market value.
2.2 In the event of total loss, the maximum amount that we will pay is up to the market value of the vehicle which will
be determined at the time of loss or the sum insured as shown in the schedule; whichever is lesser. You may refer
to Section 10 : 'Definitions' or Endorsement 113 of the policy wording for the detailed definition of market value.
2.3 It is important to insure your vehicle with the appropriate market value. Below are the effects of over-insurance and
under-insurance when an incident happens and giving rise to a claim:
a. Over-insurance : When a claim arises, the maximum amount that we will pay you is up to the market
value of your vehicle even if your vehicle's sum insured is higher than the market value.
b. Under-insurance : When claim arises, we will only bear part of the loss in proportion to the difference
between the market value and the sum insured. The balance has to be borne by you if
the under-insured amount is more than 10% of the market value.

0917
Page 4 24-01-2019 01:38:59 PM
AmGeneral Insurance Berhad (44191-P)
A member of the AmBank Group

Reference No. / No. Rujukan 2203636

Name / Nama NUR NABILA BINTI SALLEH SAID

Vehicle No. / Motor policy period of cover /

No. kenderaan WC144Q Tempoh perlindungan polisi motor 08-03-2019 to 07-03-2020

No. of seats (motor). / Total premium (motor) /

5 Jumlah Premium (motor) (RM) RM 896.80
No. tempat duduk (motor)

Motor policy no. / Auto Shield policy period of cover /

BVB0041154 Tempoh perlindungan polisi Auto Shield (RM) -
No. polisi motor

No. of seats (Auto Shield) / Total premium (Auto Shield) /

No. tempat duduk (Auto Shield) Jumlah premium (Auto Shield) (RM) -

Auto Shield Policy no. / Perfect Rider Plus period of cover /

- Tempoh perlindungan Perfect Rider Plus -
No. polisi Auto Shield

Perfect Rider Plus Plan / Total premium (Perfect Rider Plus) /

- Jumlah premium (Perfect Rider Plus) (RM) -
Pelan Perfect Rider Plus

Perfect Rider Plus Policy No. / Total premium /

- RM 896.80
No. polisi Perfect Rider Plus Jumlah premium (RM)

Bank approval code / Kod kelulusan bank 379153

THANK YOU
Thank You for insuring with us. For any enquiries, please contact your agent. AMGENERAL INSURANCE BERHAD / Terima
kasih kerana melanggan bersama kami. Untuk sebarang pertanyaan, sila hubungi ejen anda. AMGENERAL INSURANCE BERHAD

Address / MENARA SHELL,

Alamat NO. 211, JALAN TUN SAMBANTHAN

Tel / Tel 03-22683333

Fax / Fax 03-21713030

Email / E-mel digital@amgeneralinsurance.com