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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\= 15-53 RHB® 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

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