RESTRICTED

MOTOR TAKAFUL QUOTATION SLIP

Agency Code : V0026538 - AGENSI AN NAJAH PUJ
Quotation No : FL22021M-01723817-001
Quotation Date : 08/31/2021
Applicant : ASMA JUWINA BINTI MOHAMAD
Insured's ID : 790518-10-5632/
Period of Insurance : 31/08/2021 until 30/08/2022
Occupation : 1st Class : Others
Marital Status : Married

VEHICLE INFORMATION
Vehicle Registration Number : WKX4049
Vehicle Make : PROTON
Vehicle Model : WIRA A/B GLi
NVIC : GO603A
Chassis Number : PL1C96LNR3B878296
Cubic Capacity : 1298
Year of Manufactured : 2003
Seating Capacity/Tonnage/Horse Power : 5
Vehicle Use : Private Use
Vehicle location postcode : 42700

COVERAGE INFORMATION
Product Type : Private Car
Use of Vehicle : Private Car - Private Use
Sum Covered : RM 6000.00 (Market Value)
Cover Type : Comprehensive
Named Drivers : 1) ANY AUTHORISED DRIVER
2) ASMA JUWINA BINTI MOHAMAD
Excess All Claims : RM 0.00

CONTRIBUTION SUMMARY

Basic Contribution RM 454.28

NCD (55.00%) RM 249.85
RM 204.43
Windscreen (RM500.00) RM 75.00
Gross Contribution RM 279.43
SST ( 6.00%) RM 16.77
Stamp Duty RM 10.00
Total Contribution Payable RM 306.20

Validity Period : Until 29/11/2021

Please note that this slip is not the actual Certificate document and is only intended as a summary of terms and conditions under the Certificate

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 Important Notice

1. Etiqa General Takaful Berhad (Etiqa General Takaful) is licensed under the Islamic Financial Services
Act 2013 to transact both family and general takaful business in Malaysia and is regulated by Bank
Negara Malaysia (BNM).

2. Pursuant to Paragraph 5 of Schedule 9 of the Islamic Financial Services Act 2013, if you are applying for
this Takaful wholly for the purposes unrelated to your trade, business or profession, you have a duty to
take reasonable care not to make a misrepresentation in answering the questions when you applied for
this Takaful. You must answer all questions as fully and accurately.

Failure to take reasonable care in answering the questions may result in avoidance of your Certificate of
Takaful, refusal or reduction of your claim(s), change of terms or termination of your Certificate of
Takaful.

The above duty of disclosure shall continue until the time your Certificate of Takaful is entered into,
varied or renewed with us.

In addition to answering the when you applied for this Takaful, you are required to disclose any other
matter that you know to be relevant to our decision in accepting the risks and determining the rates and
terms to be applied.

You also have a duty to tell us immediately if at any time after your Certificate of Takaful has been
entered into, varied or renewed with us any of the information given is inaccurate or has changed.

3. Please note that it is an offence under the law of the Republic of Singapore to enter the country without
extending passenger liability cover to your motor takaful. Please ensure your passenger liability cover is
sufficient if you intend to travel to Singapore with your vehicle.

4. Please cover your vehicle for a sum not less that its market value as you are liable to bear a ratable
proportion of the loss in the event that the sum covered at the time of the loss is less than the market
value by 10%.

5. Please note that under Section 96(1) of the Islamic Financial Services Act 2013 (IFSA), the Takaful
Certificate of this type requires contribution due to be paid and received by Etiqa General Takaful before
the takaful cover under the takaful contract commences. If this condition is not complied with, then the
takaful Certificate shall not be effective and shall become void.

6. All contribution (if applicable) will be subjected to relevant charges or taxes as deemed necessary by the
Malaysian tax authorities. It is important to keep any receipt that you receive as proof of payment of
contribution.

Please note that this slip is not the actual Certificate document and is only intended as a summary of terms and conditions under the Certificate

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