OFFICIAL RECEIPT

Date : 16/08/2021
O1542535-RECEIPT-0000001

MISS MENU A/P MOHAN

PT, 4044 TAMAN LABU
INDAH
71900 LABU Receipt No : O1542535-01
NEGERI SEMBILAN

POL NO. STATUS MODE PREMIUM DESCRIPTION AMOUNT(RM)

30649763 In Force Monthly 200.00 ATM/Internet 200.00

Banking Upload
Total Paid 200.00

Coverage up to 13th September 2021.

FINRPA PRINTED ON 2021-08-17-10.11.49.

The Premium amount is inclusive of consumption tax (if applicable).

Cashier/Agent No: FINRPA / 729666

Please keep the receipts as proof of payment.

This is a computer printout, no signature is required.

 INTERIM COVER

Tokio Marine Life Insurance Malaysia Bhd.(“the Company”) shall provide Interim Cover on the death of
the Life Assured whereby the Interim Cover shall commerce on the date of receipt of full payment for
the first modal premium required, evidenced by the official receipt issued by the Company or any other
form of statement based on the payment method used. This Interim Cover shall cease on:
i. the date of commencement of policy or rejection of the proposal; or
ii. the date when the premium paid is refunded by the Company due to whatsoever reason; or
iii. the ninetieth (90th) day following the date of receipt of the first modal premium payment.
whichever is earliest.

This Interim Cover provided shall be subject to the following terms & conditions:

1. This Interim Cover is only applicable for death caused directly and solely by “Accident”.
“Accident” means a sudden, unintentional, unexpected, unusual and specific event that occurs at
an identifiable time and place which shall, independently of any other cause, be the sole cause of
the death.

2. The amount payable under this Interim Cover will be the basic sum assured as applied for
excluding all riders and supplementary benefits, subject to a maximum of RM500,000 on
the same Life Assured.

3. This Interim Cover shall not be payable for death resulting from:
i. any Accident occurring before the Company receive first full modal premium required; or
ii. any form of illness or disease of whatever nature and however caused; or
iii. attempted suicide (whether sane or insane); or
iv. self-inflicted injury or injury sustained while under the influence of drugs or intoxicating
alcohol; or
v. injury sustained while engaging in hazardous speed or endurance contest; or
vi. any airborne activities (except when travelling as a fare paying passenger or a crew member
of an aircraft operated by an international airline and licensed for passenger service over a
regular scheduled commercial route); or
vii. submarine voyage; or
viii. military, police, naval or aeronautical service; or
ix. violation of law or resistance to arrest.

PAYMENT OTHER THAN CASH

When a payment is made other than in cash, this receipt will only be valid after the payment is
successfully credited to the Company.

PAYMENT FOR NEW APPLICATION AND LAPSED POLICY

The issuance of this receipt for the premium payment stated overleaf shall not constitute an
acceptance on the part of the Company for the application of new insurance cover or
reinstatement of a lapsed insurance cover. The new insurance cover or reinstatement of a lapsed
insurance cover shall only be effective upon the approval of the Company with the issuance of the
Policy, endorsement or reinstatement documents.