TAKAFUL IKHLAS BERHAD (593075 U) A whaly-oved suber of MN Hots Bara IKHLAS Point, Tower 11A, Avenue 5, ‘Bangsar South, No 8, Jalan Kerinch, 69200 Kua Lumpur Takata tel 03-2723 9909 fax: 03-2723 6986 call centre: 08-2729 0596 TKHLAS website: nv takati-itias commy Forel Ted casa enter Ne TUE Ue AUT UCL Pe tea re en ae eee ee Ue ee ‘Nola Borang kabenaran ni hanya dipelukenjka Pemegang Akaun bagi akan bank (yang sibsnarkan sahaja) yang digunaken bagi pemotongan sumbangan buken merupakan Pesertaauatu Orang Yang Dilndung| bag il ersebut Note This form is only required ifthe accounthlder ofthe bank account (enly those alloned) used fer contribution deduction i nt the Partipant ortho Perean Covered ofthe carfeat, Et unieacne euimeneed Saami wee fbb} bl- Gobble LL Telephone no 4 x lel o - a HP ] ] eal all alll alls [a1 emt eee Bank Account No [7 || 4] 714] 9} 6] 3] 1]5 F Name ofBank CIMB Bank Eton ‘ontribution Pa No. Borang Fubungen dengan Permeonani No. Sit | Nama Pesarta /Orang Yang Olindung) | Pemegang Aksun ‘Proposal Form No | —Name-ofPantojant/ Person Covared Relatoranp io | Contution (Carcate No Accounhalser ‘Amount | “Payment 202110481305 |MUHAMMAD FARIZBINMOHO NAZIR | __ ANAK RM 147.00 | BULANAN ‘Gaya dengan ri bersetuju dan memenarkan Takal Ixhlas Berhed mendebitan akaun bank saye untuk pembayaren bag) taruman bagi permohonaa/ sists Tabaful sepert siyatakan cata, dan seterusnya, berdasarkan kepada jumian caruman yang berkatan hereby egree and euthorise Tekafu ikhiae Borhed fo debit my bank aocount to pay the contbution(s) for tho Takstul ‘pplcaton()/ Certest(s) 98 stated above, and ubsequeily in accordance tothe respective contrbuiion schedules, Ss poy ‘Tandatangan Pemegang Akaun ae angan Peserta / Orang Yang ‘Tandatangan Saks! eee ees wan ce = ‘Signature of Participant / Person = yo a ron, OAfef 28 rei: | fone. bere dae "t/q /ae3 RIC No ia PSD POM PCA FRMOODTETATAKAFUL IKHLAS BERHAD (593075 U) A ahaly-owned ebuclary of NNR Hols Bord IKHLAS Point, Tower 114, Avenue 5, Bangser South, No.8, Jalan Kern, $9200 Kusle Lumpur aati MM fot 03-2723 0000 fax: 03-2723 9008 call conte: 03-2723 9608 TK HLAS® website: vn takats-ioves commy er eh caer Waal eee Ete ECU Ue at Lauer} aside eae a aco a Lea ule lad Nota Borang kebenaran in hanya cpertakan ka Pemegang Akaun bagi akaun bank (yang dibanarkan sahaja) yang aigunakan bagh ppemotongan sumbangan Duken merupakan Pesertaauatu Orang Yang Diindung! bagi si tersebut Note This formis only required if the eccounthlder ofthe bank account (only those allowed) used fer contibuion deduction is not tho Partcipant or the Person Covered ofthe cortioae Et tuna hict hen een NamePemegaraAroun Ay TolHo| Infalz] ‘1A lele[s| [mjalx] mi ulo ] T T = 1 | | | No. K.P. T,] Nok PLama 1 NRIC No. 6 jo [o}3|2}6}-[o}2|-| 5] 9} 2] 8] cana no | No. Telefon ] Telephone No 4 lz | on - I we lolijo 4}4 4 ene jikaun azir@vahoo.com No. Ataun Bank ‘Nama Bank Bank Account No |7 | 0 41 9}6/3/ 5 Name of Bank — CIMB Bank Butir-Butir Arahan Bayaran Caruman / Particulars Of Contribution Payment Instruction ‘No. Borang Tubungan dengan] Jumian | Kekerapan |] Permohonan’ No. Si | Nama Peserta/Crang Yang Diindung! | Pamegang Akaun | Catuman | Bayaran Proposal Fom No! | Nemecof Partapent/Person Covered | Ralatimahipto” | Conhbution | Fraquancy of (Gerateste No Aecountholser ‘mount | Payment 202110459592 [MOHD ARIFNAJMIBIN MOHD NAZIR | ANAK Rw 142.00 | BULANAN ‘Saya dengan ini borsetuju dan rembenarkan Takatu Iles Berhed mendeblian okaun bank saya unlk pembayaran bagi ‘caruman bagi dermohenary sji-ai Tekatul tepert dnyatakan a alas, dan setorusnye, berdaserkan kepada [mah caruman yang beratan. "hereby agree and authorise Tokafu Ikhlas Borhad to debit my bank account to pay the contibubion() for the Takafu! ‘ppllcaton(sV Certeat(s) a5 slated above, and subsequent in accordance tothe respective covtnbuton schedties Trndetngan Feregangmin —TatcaaGEPanTSTO=NG Yar Tanctangen Sac Snare aroun Bia opt nance Strourer vires eorored Nana | ame Trin Fee [22 rem: 2] nee, Date Date M4 leery Marat | Ts | Dae | J PSD-POW PCR FRMOODTETA