THE PACIFIC INSURANCE BERHAD (Company. No.

91603-K)
40-01, Q-Sentral, 2A Jalan Stesen Sentral 2,
Kuala Lumpur Sentral, 50470 Kuala Lumpur.
P.O. Box 12490, 50780 Kuala Lumpur
Tel : 03 - 2633 8999 Fax : 03 - 2633 8998
Website: www.pacificinsurance.com.my
Toll-free: 1-800-88-1629

MOTOR QUOTATION SLIP FOR NEW BUSINESS

Name BESTARI OTOMASI SDN BHD
Address LOT 31208&417 JALAN AWAN MAKMUR OFF JALAN KLANG
IC/Business Registration 735172P
Passport No
Telephone Number
Agent Code V0009839
SCHEDULE
Make & Model of TOYOTA ESTIMA DBA-GSR55W(A) Cubic Capacity H.P. of 3456.0CC
Vehicle Tonnage
Vehicle Body SEDAN Sum Insured 65,500.00
Registration No WYX3003 Excess 0.00
Vehicle Registration NIL Use of Vehicle PRIVATE CAR
Card No
Year of Manufacture 2009 Cover Type Private Car - Third
Party Fire And Theft
Engine No 2GR0713046 Vehicle Type Private Car
Chassis No GSR557007729 Premium(RM) 1,625.71
Seat Capacity 7 Stamp Duty 10.00
Effective Date 23/12/2020 to 22/12/2021 Service Tax 97.54
Extra Benefit specified Total Due 1,733.25
Additional Named NA Vehicle Color
Driver

QUOTATION
Premium Pricing RM
Basic Premium 1,625.71
All Rider Premium 0.00
-NCD (0.00%) 0.00

Gross Premium 1,625.71

-Discount(0.00%) 0.00
Premium After Discount 1,625.71
+Service Tax (6.00 %) 97.54
+Stamp Duty 10.00
Gross Due 1,733.25

ENDORSEMENTS AND CLAUSES:-

B03Q ENDORSEMENT 3(Q) - THIRD PARTY FIRE AND THEFT