DIGITAL DEPARTMENT

03-21708282
03-20317282
customer.service@axa.com.my
www.axa.com.my

NOORHASNIDAH BINTI MOHD KASSIM Issued Date

C21-21 28/09/2022 21:53:00
SPLENDOR SEMARAK PLATINUM Your servicing representative
54100 KUALA LUMPUR
32379, AXA DIRECT ONLINE
WILAYAH PERSEKUTUAN MALAYSIA
Your servicing representative contact
03-21708282

Quotation Slip
Your AXA TRAVEL ONLINE SINGLE TRIP - CLASSIC STANDARD PLAN (Individual)

Quotation holder name NOORHASNIDAH BINTI MOHD KASSIM

Quotation number AXA0083131
Destination AREA1 (INDONESIA) Trip type ROUND TRIP
Period of Insurance from 11/11/2022 to 13/11/2022 (both dates inclusive)
Number of days 3
Premium breakdown
Gross Premium RM 20.00
Rebate 25 % RM 5.00
Total RM 15.00
Service Tax 0 % RM 0.00
Stamp duty RM 10.00
Final Premium RM 25.00

Traveller details
No. Traveller name Date of birth NRIC/Passport No. Plan
1 NOORHASNIDAH BINTI MOHD KASSIM 21/11/1978 781121145842 CLASSIC STANDARD
PLAN - INDIVIDUAL

Nominee details
S.No. Nominee name Insured Name Relationship with insured Percentage %
1 RADZUAN MOHD KASSIM NOORHASNIDAH BINTI SIBLINGS 100
MOHD KASSIM
AXA Affin General Insurance Berhad
This is an auto-generated document thus no signature is required

AXA Affin General Insurance Berhad (197501002042) - Ground Floor, Wisma Boustead, 71 Jalan Raja Chulan, 50200 Kuala Lumpur
Telephone: (603) 2170 8282 - Fax: (603) 2031 7282 - Email: customer.service@axa.com.my - www.axa.com.my – Service Tax Reg. No.: W10-1808-31015017

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