RHB® RHB INSURANCE BHD (38000-U)
E-Payment Registration Form
TF New Regetation F crange of Daas
Pavan er BAMEL
‘OB a1 = 1S BSC
Tot ISH, LERONG SUREA Sk, TAME SuRNA, SOL FANAN
Sie PETRA SAYA, AB0S0_FACHING, SARABAK =
ore FOBNID em [Oe
aaRINAH eT RAWACT Tay we
rae 7a FSSC ST ~
ay pole-BQeRUAD
FES ae lac RECUR CI ES
== Ea
roi, WOR, Kampung Kemgaieng Tene, Saeee Rachi
Faia f-1inG=e039180— 8 Tewrean [8S
1999 Cae aspen) a
eros pi eh se Pr Ge nt
Urecoats ames yay ek Gre
‘Savoury resort econ ROR my an ews ican te ean oma
hermosa
‘Pesan sonst dene pra wos danas aan aig tomy atria rh
‘ceases os nnn mrt eae pope an
‘Somme bootable
ie
fore Bathe Ot Rowe! —
Pee Ep eee = Fame open
pao
‘ene stacey oi Pap ues Raparton farm otc plete an" poo stereo
[njuruettna bat none beer aneonaoot mr) esol ost usm ste
‘uhastsn others eainar tony compar bn a“Aut: CRC
Fone 002160277
DATE (rath): >2\10|2090 —
sina,
(@erminiaan Und Penbatalen Pel isurans)
[hereby would lke to request to cane the below insurance pla with immediate effect.
(Sane dengan in ingin merohon sak enotallan pela insur sapert dt bawal int dengan seta ert)
INSURANCE PLAN NAME:
(Waa Pela tsuvans)
‘STORM PERSONAL ACCIDENT MAX PERSONAL ACCIDENT.
‘MY CRITICAL SHIELD Cash Back Personal Acident
PERSONAL DETAILS (Buti-butir pecibal):
1) POLICY NO CREDITCARD NO. (Name Pela Insns¥o, Kad Kre):
law Pevsanal BeclaeTt
iy NAME OF INSURED MEMBER (Ai Vang Dwar
Wet Poets
ft) ARLE one fd Penge
Yee
in) CONTACT NO. Telefon
CONTACTS iar Ten
”
Ope
(andetangon dst Yor Dincrancton)
Name: Haiciooh BC Caxmicus
TeNe:_QOeD\= 15-53RHB® PENYATA KAUN
RHB® | eae
opened lone Protected by PION wp to R¥250,000 for each iter
aE 268 *
fact Ber eae
tor es Lande UA 2K
‘iw S098 S00 ka
rem Sava
53050 sucwone sama
+*Statement Message+*
cram up tS UE ME mare os
SR Ry eae a a TSS
ieee mnie Sewer ans
meatimnecua sass ee
Sara
Account Activity
3m at Te tht eo 1 10.00
Seu Pony Tranter
V0 FER cen ta "
ery ore
ili 2 1,310.0 01.99
Sr Foey rotor
ne Boe
oo EET oe ao
wa 20
550.90 ag
#
2
us 24 2 1,350.00 sos
Srattore transfor
fon 25 ny ok 1 5.00 ses.as
Bra Prey Tra
Sraparty roster
so 25 ob 1 1915.40 1918.88
28
Be
enero POR ANU OM POHL
Eee ee tat a tamnts emer eee