Date : 23 Jun 2020

PUSPAVALLI A/P KUPPAN

NO. 3009 BLOCK C
TAMAN TAHA
28400 MENTAKAB

Dear Sir/Madam

RE: APPLICATION NO. : Z205639641

PERSON COVERED'S NAME : KOMALA A/P MARUTHAMUTHU
PARTICIPANT'S NAME : PUSPAVALLI A/P KUPPAN

We thank you for your application for a family Takaful Coverage with our Company. For the consideration of issuing
you a certificate, we require additional tests/reports/investigations/forms as indicated in the attached Outstanding
Requirement Advice.

Please be advised that any initial/subsequent contribution paid shall be deemed invalid null and void and the
Company shall not be liable in any manner whatsoever for any claims made there from unless and until the
requirements indicate in the attached Outstanding Requirement Advice have been attended to, application has been
duly approved and certificate contract has been duly issued.

By copy of this letter, we are also requesting our agent to assist you in this matter.

Thank you.

ZURICH TAKAFUL MALAYSIA BERHAD

ztmb.underwriting@zurich.com.my

From Family Underwriting

(Computer generated advice - no signature is required)
cc - CONSULTANT : JB01-24-T09361J RAMAN A/L PONNUSAMY
C.M.C : C101-01-T66048W KUANTAN BRANCH

eCOPY
 Outstanding Requirement Advice

Application No. : Z205639641 Date :23 Jun 2020

Person Covered's Name : KOMALA A/P MARUTHAMUTHU
Applicant's Name : PUSPAVALLI A/P KUPPAN

Please accomplish the requirement(s) indicated below for assessment of the above numbered application:

1)Replacement of certificate

2)A copy of Person Covered's NRIC.

3)Completed Original Signature Page duly signed and dated by Participant.

4)A copy of Participant's NRIC.

5)Incomplete Nominee - Applicant/ insured can't be appointed as nominee, please

submit new nomination else please confirm via AA form to delete the nomination

Remarks :

eCOPY
 23 JUN 2020

Application /Certificate No : Z205639641 (TSG02)

Existing /Old Certificate No : Z173383071 (TSG02)

We noticed that your customer have replaced an existing Family Takaful certificate /Rider within 12 months from the
purchase of a new Family Takaful certificate/rider.

IMPORTANT NOTICE TO CMC/MC/CONSULTANT

1. IF THE CERTIFICATE IS REPLACED WITHIN 12 MONTHS AFTER THE PURCHASE OF THE NEW
CERTIFICATE, TAKAFUL OPERATOR IS REQUIRED TO CLAW BACK IN FULL, THE COMMISSION AND
OVER-RIDING COMMISSIONS ON THE CERTIFICATE FROM THE CONSULTANT AND AGENCY LEADER
RESPECTIVELY.

2. ON THE OTHER HAND, IF THE CERTIFICATE IS REPLACED WITHIN 12 MONTHS PRIOR TO THE NEW
CERTIFICATE BEING PURCHASED, THE TAKAFUL OPERATOR SHOULD NOT PAY ANY COMMISSION
TO THE NEW CERTIFICATE.

3. THE DISCIPLINARY ACTIONS WILL BE TAKEN BY COMPANY FOR CONSULTANT THAT HAS BEEN
FOUND GUILTY ON SPECIFIES NUMBER OF REPEATED FOR ROC OFFENSES.

As a general rule, it is often not advantageous to replace an existing Family Takaful certificate /rider with a new
Family Takaful certificate/rider whether issued by the same Takaful operator or a different Takaful Operator. Some of
the reasons it may be of disadvantages to your client certificate(s). Please refer to letter as attached.

Please conserve your client and return the ROC confirmation slip (duly signed) to company before 20 DEC 2020.

Your failthfully,

ZURICH TAKAFUL MALAYSIA BERHAD

FAMILY CERTIFICATE SERVICES DEPARTMENT
CONSERVATION UNIT

This is a computer generated document and it does not require a signature.

This document shall not be invalidated solely on the ground that it is not signed.

eCOPY
PUSPAVALLI A/P KUPPAN
NO. 3009 BLOCK C
TAMAN TAHA
28400 MENTAKAB

Dear Sir/Madam 23 Jun 2020

Application /Certificate No : Z205639641 (TSG02)

Existing /Old Certificate No : Z173383071 (TSG02)

We noticed that you intend to replace an existing Family Takaful certificate /rider within 12 months from the
purchase of a new Family Takaful certificate/rider.

IMPORTANT NOTICE TO CERTIFICATE OWNER

IT MAY NOT BE IN YOUR BEST INTEREST TO SURRENDER, LAPSE, CHANGE OR BORROW FROM EXISTING
FAMILY
1. CAREFULLY STUDY THE SUMMARY RESULT COMPARISON UNTIL YOU ARE SURE YOU
UNDERSTAND FULLY THE EFFECT OF THE TRANSACTION.
2. CONSULT THE COMPANY OR AGENT FROM WHOM YOU BOUGHT THE EXISTING FAMILY TAKAKFUL
CERTIFICATE TO REVIEW WITH YOU THE TRANSACTION BEFORE MAKING A FINAL DECISION.

As a general rule, it is often not advantageous to replace an existing Family Takaful certificate /rider with a new
Family Takaful certificate/rider whether issued by the same Takaful operator or a different Takaful operator. Some of
the reasons it may be of disadvantage to you are:

i. The amount of annual contribution under and existing Family Takaful ceritficate may be lower than a new
Family Takaful certificate with similar coverage or benefits. Any replacement or the same type of certificate
will normally be at a higher contribution \rate based on person covered's attained age.

ii. Replacement of an existing Family Takaful Certificate with a new one will result in the certificate owner
incurring the initial costs twice.

iii. The incontestable and suicide clauses begin in a new Family Takaful certificate, This may result in a claim
being denied under the new Family Takaful certificate that would have been paid under the Family Takaful
certificate that was replaced.

iv. There may have been changes in your health since the purchase of the existing coverage.

Your failthfully,
FAMILY CERTIFICATE SERVICES DEPARTMENT
CONSERVATION UNIT

This is a computer generated document and it does not require a signature.

This document shall not be invalidated solely on the ground that it is not signed.

cc. Consultant :
C.M.C :

eCOPY
Summary Result Comparison

1. Types of Replacement (TOR) TOR Code

Lapsed [ 04 ]

2. Description of Existing and New Certificate

(Existing Certificate)

Appl/ TOR Plan(P) Type Sum Assured Annualised Contestable Suicide

Certificate No Code Rider(R) (P/R) Contribution Expiry Expiry
(RM) (RM) Date Date
Z173383071 04 TSG02 P 22238.00 1200.00 28-03-19 28-03-18
TSGAD R 111190.00 0.00
TSGRB R 3000.00 0.00
------------
Total 1200.00
------------

(New Application/Certificate)

Appl/ TOR Plan(P) Type Sum Assured Annualised Contestable Suicide

Certificate No Code Rider(R) (P/R) Contribution Expiry Expiry
(RM) (RM) Date Date
Z205639641 TSG02 P 18100.00 1200.00 12-06-22 12-06-21
TSGAD R 90500.00 0.00
TSGRB R 3000.00 0.00
------------
Total 1200.00
------------

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 Confirmation by Participant

In your own interest, we would advise you to reconsider your decision. You may consult our Customer Care Officer
at 03-62876666 for further advice.

We wish to offer you the options shown below in the event that you were not aware of the consequences of replacing
one certificate with another.

Please indicate your choice below and return this letter to us within 180 days from the date of this letter. If we fail to
receive your response, we will automatically maintain the new certificate and old certificate will remain as status
quo.

Note: Participant to complete this section

Replacement of Certificate/Rider - Confirmation by Participant

Date : 23 Jun 2020

New Application /Certificate No : Z205639641 (TSG02)

Existing Certificate No : Z173383071 (TSG02)

I confirm that I am aware of the consequences of replacing my existing /old certificate/rider with a new one and I
have decided to:

(Tick ( / ) one of the boxes below)

Purchase/Maintain the new certificate. { }

Reinstate the old certificate/rider and obtain a full refund of the { }

contributions paid under the new certificate.

Signature of Participant

I.C No :

Date :

eCOPY
 PINDAAN KE ATAS PERMOHONAN SIJIL TAKAFUL
KEPADA ZURICH TAKAFUL MALAYSIA BERHAD

AMENDMENT TO APPLICATION FOR TAKAFUL CERTIFICATE

MADE TO ZURICH TAKAFUL MALAYSIA BERHAD

No. Permohonan
Application No.
Pejabat
Office

Saya dengan ini meminta bahawa permohonan saya bertarikh 20 dipinda seperti berikut :
hereby request that my application dated 20 be amended as follows :

dan saya mengesahkan bahawa tiada perubahan tahap kesihatan, dan saya tidak menerima sebarang rawatan
perubatan, nasihat perubatan atau pemeriksaan, dari tarikh lengkapnya permohonan tersebut; selanjutnya, bahawa
semua jawapan yang dinyatakan dalam permohonan saya, termasuk yang berkenaan dengan pekerjaan saya, adalah
benar.
and I certify that there has been no change in my condition of health, and that I have received no medical attention,
consultation or examination whatsoever, since the date of completion of said application; further, that all my answers as
written in the course of said application, including those relating to my occupation, are still true.

Ditandatangani di pada hari 20

Signed at this day of 20

Disaksi oleh / Witnessed by Tandatangan Penuh Pemohon

Tandatangan Pengantara Signature of Applicant in Full
Signature of Intermediary

Nama
Name

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