TAKAFUL IKHLAS GENERAL BERHAD (1233870-A)

IKHLAS Point, Tower 11A, Avenue 5, Bangsar South

No 8 Jalan Kerinchi, 59200 Kuala Lumpur
T : +603-27239696 F : +603-27239998 Website : www.takaful-ikhlas.com.my
(Licensed under Islamic Financial Services Act 2013 and regulated by Bank Negara Malaysia)

ss NON MOTOR ENDORSEMENT REQUEST FORM

To : TAKAFUL IKHLAS GENERAL BERHAD

KL MAIN BRANCH
Ground Floor, Tower 11A, Avenue 5, Bangsar South
No 8, Jalan Kerinchi
59200 Kuala Lumpur
Tel No.: 03-27239999 Fax No.:03-27118229

Date :

PARTICIPANT’S NAME :
CERTIFICATE NO. :
EXPIRY DATE :

We refer to the above matter, please take note that the following are to be amended as stated below;

[ ] Loan is fully settled. Delete “ Chargee/ Mortgagee Clause” w.e.f_________ and kindly
correspond directly with the Participant

[ ] The certificate is to be cancelled w.e.f _____________ due to property sold/ master

certificate / loan is fully settle

[ ] The occupancy of the property should read as ____________________________

[ ] Name of Participant should read as _____________________________________

[ ] Correspondence of address changed to _________________________________

_________________________________________________________________

[ ] Location of risk changed to ___________________________________________

_________________________________________________________________

[ ] Period of Takaful changed to __________________________________________

[ ] Extension of Period of Takaful from ____________________ to ______________

[ ] Sum Covered *Increase/ Decrease to RM _________ w.e.f. __________

[ ] Others (Please specify)_______________________________________________

__________________________________________________________________

Yours faithfully,

________________________________________
Name and NRIC No / Company’s Official Stamp

Note:
For increase of sum covered, the amount of additional contribution due is ___________. Kindly provide payment
detail as below.

Payment mode : Cheque/Cash/Credit Card/Internet Banking/Credit Advice

Payment detail : 1.Cheque a.Cheque No:___________________ b. Cheque Date: _________

2.Credit Card a. Credit Card No: _______________ b. Expiry Date: __________
c. Credit Card Type: Visa/Master Card d. Approval Code:________
e. Credit Card Holder Name: ________________________________
3.Internet Banking a. Bank Name:___________________ b. Payment Date:_________
c. Transaction Reference No:_______________________________
4.Credit Advice a. Bank Name:___________________ b. Credited Date:_________

CSC – ML005/FRM003/01