eTiQa ‘General Takaful Date: 09 Jun 2021 MR MUHAMAD NURAFIQ BIN RUSLAN NO 16,LORONG SRI SEMENTA 128, TAMAN SRI SEMENTA BATU 7, JALAN KAPAR, KLANG 42100 SELANGOR: WELCOME TO THE ETIQA FAMILY Certificate No. : TDA-J2123472-W1 Plan Name : Takaful PA Plus Monthly Period of Takaful : 22/04/2021 - 21/04/2022 We are pleased to extend our warmest welcome to you for being a part of our family. We enclose herewith the following document for your action:- Certificate Schedule This important document summarizes the details of your certificate and we suggest that you keep this document for reference. Kindly be informed that the details stated in the certificate schedule is based on the information you have declared to us at the time of application. We advise that you check the document carefully and if there is any discrepancy, please inform us immediately. Our consultant will be glad to serve you For any enquiries on the above or any of our products, feel free to call Etiga Oneline at 1 300 13 8888 or e-mail us at info@etiga.com.my. In case of any claim, you may call our Claim Assist at 1 300 88 1007 for fast and efficient claim service. Again, we welcome you to the Etiqa Family. Thank you Yours sincerely, Etiqa General Takaful Berhad Dalaran Mayank, Hos, jalan Maarot, 59000 Kuala Lumpur T +603 2297 3888 F803 2297 3600 € info@etiga.commy —_wwrwtiga.com.my figs Oneine 3300.9 6888 senempsin @ MaybankeTiQa ‘General Takaful Date: 09 Jun 2021 MR MUHAMAD NURAFIQ BIN RUSLAN NO 16,LORONG SRI SEMENTA 128, ‘TAMAN SRI SEMENTA BATU 7, JALAN KAPAR, KLANG 42100 SELANGOR SELAMAT MENYERTAI KELUARGA ETIQA No Si : TDAJ2123472-W1 Nama Pelan Takaful PA Plus Monthly Tempoh Takaful + 22/04/2024 - 21/04/2022 Dengan sukacitanya kami mengalu-alukan penyertaan ke dalam keluarga Etiqa Kami sertakan dokumen berikut untuk tindakan anda yang selanjutnya:- Jadual Sij Dokumen penting ini adalah rumusan bagi maklumat-maklumat sijil anda dan hendakiah disimpan sebagai rujukan. Harap maklum bahawa maklumat-maklumat yang terdapat dalam jadual sijil ini adalah berdasarkan maklumat-maklumat yang telah anda isytiharkan kepada kami sewaktu permohonan. Anda dinasihatkan untuk memeriksa dokumen ini dengan tel dan sekiranya terdapat sebarang percanggahan, sila maklumkan kepada kami dengan segera. Para penasihat kami bersedia untuk membantu anda. Untuk sebarang pertanyaan mengenai perihal yang di atas atau berkenaan produk-produk kami yang lain, sila hubungi Etiqa Oneline di talian 1 300 13 8888 atau emelkan kepada kami di alamat info@etiqa.com.my. Untuk sebarang urusan tuntutan, anda boleh menghubungi Claim Assist kami di talian 1 300 88 1007 bagi perkhidmatan tuntutan yang cepat dan efisyen. Kami sekali lagi mengucapkan selamat datang ke Etiga. Terima kasih. Yang bener, Etiqa General Takaful Berhad ign Genera Tahal Bathad on liga Onetine 300 13 2888 Betaranivaybanie No. lan Mara 9000 Kola Lumpur “souepn 7 1"6032297 3888 F' 26032297 3800 E lnogetiqa.com.my —_warwatiga.com.my wn @MaybankeTiga (sa our | “General Takaful bors SeTEM ADORE /SCHEDULE DIJELASKAK Rapid-Takaful PA Plus (Monthly rang Yang Oilindungi /Covered Person (=) Woabor SIz17 ‘MUAAKAD NURAFIO BIN RUSLAN Certificate No AMY SYAIDA ANTRA BINTT RAZA "TOR-J2123472-"1 SEMUA ANAK YANG LAYAK / ALL ELIGIBLE CHILDREN Skim Yang Dipilin ‘arikh Berkuatkuasa/ Schene Selected Effective Date 22/04/2021 SKIM KELUARGA / FAMILY SCHEME Sunbangan Bulanan/ Peserta/Participant Monthly Contribution MR MUHAMAD NORAFIO BIN RUSLAN RM 43.46 ‘BAYARAN PAMPASAN/ PAMPASAN/BENEFIT BENEFIT PAYMENT (Setsap orang/Each Person) con 02 Pampasan Lumpsh / 200000 Total Paralysis Benefit 02 Pampasan tain Untuk Hilang Upaya Kekal s0000 sehingga/ Other Permanent Disablerent up to 03 Panpasen Kemalangan Maut/ 100000 Accidental Death Benefit 04 Papasan Pengkebumian/ 2000 Compassionate Cash Benefit 05 Pampasan Tanai Penghantaren 3000 Pulang Jenazah / Repatriation Cash Benefit, 06 fanpasan Tanai Pesakit Luar / 200 outpatient Cash Benefit 07 Pampasan Kecederaan atas Kejadion 350 Ragut / Snatch Thief Injury Benefit 08 Penbayaran Balik Panpasan Fesakit 1000 Dalam sehingga / IncHospital Medical Expenses Reimbursement up to cel BR recreate arm igs Gnmat seeuane "apertures Beene eee igniter Sens econ Bn pea s%erain @ Maybank Dataran Maybank, os, Jalon Maro, 59000 Kuala Lumpur [74603 22973888 F +603 2297 3600 E info@etiqa.commy _wwrwtiga.com.nyeTiQa “General Takaful LTADURL /SCHEDULE ‘TDR-32123472-41 Rapid-Takaful PA Plus Monthly BAYARAN PRMPASAN/ PAMPASAN/BENEFIT BENEFIT PAYMENT (Setiap orang/Each Person) fam) 09 Pampasan Tunas Hospital sehari. 100 (sehingga 100 hari) / Hospital Cash Benefit per day (up to 100 days) 10 Yuran Anbulans sehingga / 200 Anbulance Fees up to CHANGES IN TAXATION, REGULATIONS AND LEGISLATION lie may vary the terns of the Certificate As We consider appropriate and equitable, if there are changes in taxation, regulations oF legislation that affect this Certificate.We will notify You in weiting ‘three (3) months prior when terns in this Certificate need to be changed. If such tax applice, it shall be Your obligation to pay such chargeable tax (where applicable) Im the event You do not pay such all value added tax, goods and services tax or any other tax of a similar nature, We may, but is hot obliged to pay such tax on Your behalf, and You shall reimburse or Indemnity Us for all of auch tax upon demand by Us. PERSONAL DATA PROTECTION Act Personal Data shall have the sane meaning 22 described to it as under Section ¢ of the Personal Data Protection Act 2020, Personal Rata refers to the personal data furnished by the Person Covered, the Participant , or an authorized thizd party related to che Certificate of Takatul. Personal Data does not include information on an individual which is in the public domain. ‘Your and Our Data Protection obligations and Rights We shall be able to process Personal Data according to the Section 4 Of the Personal Data Protection Act 2010, We shall be able to disclose Personal Data provided by You, as the context nay require, to 1, Btiga General Insurance serhad, Etiga General Takaful Berhad Etiga Life Intemational (i) Ltd or Etiga Offshore Insurance (i) Ltd; 2. Other entities within the Maybank Group; 31 our. authorized’ agents and. service providers with whom We have contractual agreenents for sone of Our functions, services and eee Dl tiga General Takafl Bathe ovo) "pena econ ga Onetne 30013 8888 Meera reer tay token sind hitenan @Maybere Dataran Maybank, Ne, s,lalan Maar, s9c00 Kuala Lumpur +603 2297 3888 F +603 2297 3800 E info@etiza.commy _ wwwetga.com.myeTiga General Takaful \JADUAL,/ SCHEDULE pon -2123472-#1 Rapid-Takaful PA Plus Monthly activities. Other Insurance or Takaful companies and distribution partners (such se banks , islanic banks , inourance brokers , Takaful brokers, reinsurance companies, Retekaful coupanies) ? Industry trade association such ag Life Insurance Aasociation of Malaysian (LIAM) , Persatuan Insurans Am Malaysia (PIAM) and Malaysian Takaful' Association (MTA); 6. Our merchants and strategic partners; 7. any parties authorised by You (from time to time); oF 8. Enforcement regulatory and governmental agencies as permitted or required by law, authorized by any order of court or to meet, obligations to regulatory authorities You will keep Us updated in respect of all such Personal Data as soon as 19 practicable ie shall not be liable for any direct or indirect loss or damage due to any inaccuracy or incompleteness in the Personal Data provided to us. We may from time to tine request that You provide other Personal data Eequited for the purposes of this Certificate: Prior to providing Us with the Personal Data of a Ferson Covered , or another individual, you must inform that individual of Our privacy notice. Por the detailed privacy noticed on how We collect, use, process, protect and disclose Personal Data, please visit Our branches, contact Btiga Oneline at 1300 13 8888 , or refer to Our website at wiw.etiga com. IMPORTANT NOTICE - applicable to ALL CONSUMER Products (Takafwl wholly for purposes unrelated to your trade, business or profession: elated Where You have applied for this Takaful wholly for purposes un to Your trade, business or profession, You had a duty to take Feagonable care not to make 2 misrepresentation in answering the Guestions in the Application Form (or when You applied for this akafvl} i.e. You should have answered the questions fully and accurately, Pailuge to have taken reasonable care in answering the Guections may result in avoidance of Your contract of Takaful, refusal Or reduction of Your Claim(s), change of terme or termination of Your Contract of Takaful in accordance with the remedies in Schedule 9 of the Zelanic Financial Services Act 2013. You were also required to disclose any other matter that You knew to be relevant to our Gecision in accepting the risks and determining the rates and terms to be applied. You also have a duty to sell Us inmediately if at any tine after Your contract of Takaful has been entered into, varied or renewed with Us any of the information given in the Application Form (or 3. cee fh orem stncgnnyr au mneninnno cane pte ean Etiga General Takafl Berhad oye) a tiga Onetine 300 33 8888 sagem alah tet gig ahem soni Maybank Dataran Maybank, No. 1, Jalan Maarof, 59000 Kuale Lumpur * Pee en, Mar ee°e elaceetonny _wometnconsyeTiQa “General Takaful JRDUAL/SCHEDULE 0A-32123472-W1 Rapid-Takaful PA Plus (Monthly when You applied for this Takaful) is inaccurate or has changed. IMPORTANT NOTICE - applicable to ALL NON CONSUMER Products (Takaful wholly for purposes related to your trade, business or profession) This Certificate ie issued in consideration of the payment of contribution as specified in the Certificate Schedule and pursuant to the answer given in Your Proposal Form (or when you applied for this Takaful) and any other disclosures made by you between the tine of submission of Your Proposal Form (or when you applied for this Takaful) and the tine this contract is entered into, The answers and any other disclosures given by you shall form part of this contract Of between you and us. In the event of any prevcontractilal misrepresentation made in relation to your answers or in any disclosures made by you, it may result in avoidance of your contract of takaful, refusal or reduction of your claim(s), change of terms or termination of your contract of takaful, This Certificate reflects the terms and conditions of the contract of takaful as agreed between you and us. (COMMUNICABLE DISEASE EXCLUSTON 1, Notwithstanding any provision to the contrary within this takaful agreement this takatul agreenent excludes 211 actual or alleged loss, Liability, denage, compensation, injury, sickness, disease, death, medical payment, defense cost, cost, expense or any other amount incurred by of accruing to the Participant, directly or indirectly and regardiess of any other cause contributing concurrently or in any Sequence, originating fron, caused by, arising out of, contributed to by, resulting fron, or otherwise in connection with @ Communicable Disease or the fear ot threat (whether actual or perceived) of a Communicsbie Disease. 2. As used herein, a Conmunicsle Disease means any disease which can be transmitted by meens of any substance or agent from any organism to another organism where + 2.1 the substance or agent includes, but is not laited to, 2 virus, bacterium, parasite or other organism or any variation thereof, whether decked living or not, and 2.2 the mothod of transmission, whether direct or indirect, includes Dut is not Limited to, airborne transmission, bedily fluid transmigsion, transmigsion from or to any surface or cbject, solid, Liquid or eae or between organisms, and 2.3 the disease, substance or agent can cause or threaten bodily injury, illness) emotional distress or damage to human health, human Me wee s5/ Bh en eer cone er entins i ion wrdre Tip pate he coryaunon soe ga General Takaful Berhad wevowren [ilu ogonzae ae sce ore eng ao) Dataran Maybank, No.1 Jalan Maar, 39000 Kusle Lrpur +603 2297 3888 F +603 2297 3800 E infogetiga.commy _ www.tiga.commy tiga natn 3003 8 ss1onaie @MaybankeTiga “General Takaful JIRDURL/ SCHEDULE OA~02123672-H1 Rapid~Takaful PA Plus (Monthly welfare property damage Subject otherwise to the terms, exceptions and conditions of the Certificate. 09/06/2021 oo267436527%3 Tarikh Dikeluarken/Date Tesued ‘Kod Agensi /Agency Code Oleh/ey ccn978 For and on behalf of, BTUOR GENERAL TAKAFUL SBRHAD s Bevrrersarrecrstcaarnunm en Etiqa General Takaful Berhad tr:yeoes00 {tiga Onoline 300 3 8888 igen eh cet since eyo Dataran Maybank, No, lalan Maro, $9000 Kuala Lumpur [7 +603 2297 3868 F603 2297 3800 € Inlogetiqacommy _ wwrwatiga.com.ny‘This Page Is Intentionally Left BlankeTiga “General Takaful Client's Copy/Salinan Pelenggan Invoice No/ No.Tavois ‘ecrGz0z10MPM00264138 Date/ Tarikh : 22/04/2021 INVOICE/ INVOIS [ETIQA GENERAL TAKAFUL, BERHAD LEVEL 19, TOWER C DATARAN MAYERKK WO 1, JALAN NAAROF 59000 KUALA LUMPUR (Service Tax No .e.cccecceeseeee # WLO-1808-31012539) To/ Kepada : Account Wo/No Akaun + 40026743 MR NUHANAD NURAPIQ BIN RUSLAN NO 16,1ORONG SRI SEMENTA 128, ‘IVAN SRI SEMENTA BATU 7, JALAN KAPAR, KLANG 42100 SELANGOR Particulars Amount (RI) Type Of Certificate/Jenis Sijil:Takatul PA certificate Number/No Siji) — +7Da-J2123472-W1 Period Of Cover/ :Fron/Dari 22/04/2021 To/hingga 21/04/2022 Tenpoh Perlindungan Yesrly Contributien/Sunbangan Tahunan : 492.00 ‘Total (Excluding Service Tax) / ‘Duman (Tidak Termasuk Cukai Perkhidnatan} : 492.00 Service Tax Payable/ Cukai Perkhidnatan Pert Dibayar @ 6.008 29.51 ‘Total Anount Payable/ Jumlah Perlu Dibayar : 321.51 Nonthly Contribution/Sunbangan Bulansn : 43.46 Service Tax (87) is effective 01/09/2018 Cukai Perknidnatan (ST) berkuatkuasa 01/09/2018. ‘This is 2 computer generated document. Therefore, no signature is required. Ini adalah dokumen yang dijana konputer. Oleh itu, tiada tandatangan diperlukan, eae Sinaitaatt nana sens heh ceed by eke Mao tiga Onetine 130033 8888 Daren Maybank, No.3 jelan Mar sp0ce Kuala Lumpur nemgan @) [T2603 2297 3888 "3603 2297 3800. infogetiqa.commy — www.etiga.com.myThis Page Is ntentionally Left BlankeTiQa “General Takaful Personal Data Protection Act Slip for Individual Customers Name MUHAMAD NURAFIQ BIN RUSLAN NRIC No 930914-14-6163 Certificate No TDA-J2123472-W1 ‘Type of Certificate GENERAL TAKAFUL Date 30-01-2021 We, agree, consent and allow Etiqa General Takaful Berhad (hereinafter called “Etiga General Takafut') to process my/our personal data (including sensitive personal data) ("Personal Data") with the intention of entering into a contract of Takaful, in compliance with the provisions of the Personal Data Protection Act 2010. \Mee, understand and agree that any Personal Data collected or held by Etiqa General Takaful (whether contained in this application or otherwise obtained) may be held, used, processed and disclosed by Etiga General Takaful to individuals and/or organizations related to and associated with Etiqa General Takaful or any selected third party (within or outside Malaysia, including medical institutions, reinsurers, claim adjusters/investigators, solicitors, industry associations, regulators, statutory bodies and government authorities) for the purpose of processing this application and providing subsequent service related to it and to communicate with me/us for such purposes. We understand that We have a right to obtain access to and to request correction of any Personal Data held by Etia General Takaful concerning me/us. Such request can be made by completing the Access Request Form available at Etiqa website, all Etiqa Takaful branches or contact Etiga General Takaful via email at POPA@etiga.com.my. In accordance with the provisions of the Personal Data Protection Act 2010, I/We may contact the Customer Service Centre at Etiga Oneline 1 300 13 8888 for the details of my/our Personal Data. Such information shall only be granted upon verification We agree, consent and allow Etiqa General Takaful to share my/our Personal Data with Maybank Group, Etiqa General Takaful’s agents or strategic partners and other third parties (‘other entities") as Etiqa General Takaful deems fit. We agree to receive marketing communication from Etiqa General Takaful or from these other entities about products and services that may be of interest to Me/Us. [ X] Yes [] No Note: If you no longer wish to receive marketing communications, please notify Etiqa General Takaful to withdraw your consent and Etiqa General Takaful will stop processing and sharing your Personal Data with these other entities for the purpose of sending you marketing communications. For avoidance of doubt, the withdrawal does not include processing of your mandatory Personal Data. THIS IS A COMPUTER GENERATED DOCUMENT AND IT DOES NOT REQUIRE A SIGNATURE. tiga General Takaful Berhad (ieeet atari rset cody Banke) Dataran Maybank, Wo, jalan Maarol, 39000 Kuala Lumpur sangun T #603 22973868 F +603 2297 3600 E info@etigacommy — wawatiga.com.my vwoonin @ Maybank ga Oneline 30013 8868