FWD tekaful Cancellation/Surrender Application Form Borang Permohonan Pembatalon/Serchon scour L O1s40.26 mansuizret Royendran Yo Rays roreertevton OIG — 913.4963 Torth Permehoné= 0+/u1/ 092 important Notes: [Note Penting: We would like to aavise you that by surrendering your Cetfcate, you wi ote coverage en yout Me and protection fo your loved ones % addition, unnecessary financial oases may be incured if you decide to tate up to the folowing reasons Kom nin menosihot onde bohowe dengan venyerohan sili, perindungon hayot onda akenterlucut don uga pertindungan untek mereto yong tersoyong.Seloin tv, onda juga mungkin okan menanggung Kerugen bemongon ha membvot Keputvsen untuk mengombi sil 124 plan msuron yarg boru peda mosa hadopen, dsebobton oleh perhoro:pertorabertut certificate er 2 new insurance pian at ater stage due 1. Higher contributions wil be charged becouse of age and/or you have heath nsues ‘Sumbongan yong lebih tinggi oton dkencken esebcblon leh pennghoten unur dar/otou ho orda memounyal su keshatan pedo set #2 dn 2 By cancelling or surrendering your Certificate, you would lose the benefits under Certfcate and what you might recene may be HS than the total Contributions you have pad ‘Dengan pembotolon etou serchan Sil, orde chen keblongon foedonfoedoh denon unt Syl ini don opa yong ahon anda terme ‘murgkin kurang doripede Keseluruhon jumioh sumbongon yong telah orco bayer UWe the Certificate Owner/Assignee inthe tile ofthe sbove mentioned certificate athorite and request FO Takaful Berhad ("FWO Tahal") to effect the selected option below. Please tick (\) where applicable ‘Soyo/tami, Pemilk Sjil/Pemegang Seroh Hok 86 ates membenorkon FWD Tekoful Berhod ("FWD Takat") mengombu tindakon berkut Silo tondokan(\) dolam hotok yeng berkenoon PARTA:TYPEOF PLAN Prenipee rer A oveseenteUnkes Play PelonBerbotan Flatron CI Non investment Liked Froduet/ Felon Berkoton Sein Pelsburon Do er ‘BAHAGUAN 2} SEBAB UNTUK PEMBATALAN/PENTERAAN Crease of ait /Pembetonoset 1 Unsafe sees /PetBdeton yong 40k memueshon Corotherimvesment/Untkpelobuon ion _ Setlement Financing /Pembiyoanhewongon erro expeses | Perbeoroon perdi DD unsaustactory return /Pulengon yong tidck memvaskon otters, please specty/Lomn-ion, sila nyotokon Fao tact stertee Cengery he 22189 oerFWD takaful pease provide the following bank detais in orde 1 FWD Tahal 10 arrange for saymentis 10 your Rank account This only applicable ‘you are applying for Direct Credit Facty for the fst time or updating your bank account details Sia fenghopton butirbuty bork seperti yong dinyotokon @ dalam Buty sureenon Berk ofou gervata Bonk votub FWD Taboful mengater ‘pemboy2r0” He okoun Bonk ongo. In hanya terpekol iho endo memohon Kemudohon Kredit Ter untuk Nal pertama otou mengemoskin! ‘ativan okoun Bonk onde, Copy PO ered Payrent Methoe rear Peboyeron Direct Ore dd indo Savings account home Peper Ato Rey eh Ray Bank's Name in ° oe Maybank wt ceursnatemeunnny — UY FETOSA TC Terms and Conditions of Direct Credit Instruction Terma dan Syarat Arahan Pengkrediton Terus In consi¢eration of FWD Takafu's agreement to accept my authorisation to credit my bank account to receive monies payable to me under the given cerficate number(s, expressly agree tothe flowing teins and conditions ‘Sebogoi bolason kepada persetujvon FWD Tokofu untuk menerima Kebeneren saya untuk mengkredithan okoun bonk soya begi mer en™ma ‘wong yong elboyar kepada soyo di bowoh nom sil yang dberkan, Soya dengon mi Bersetuw dengon terme don syorot berikut 1 Lam aware thatthe Payor in ths appeation frm refers to Cruel Owner and the Payee i he person enile to receive monies pursuant to the Preposal/Tokatul Cette Soyo memahomibohowo Pemboja di dolam boron pemokonan wo mer epede Femi i con Penerira merurakon inééuyong berhok menerima wang menurt Sil Tkofl ik 2. hereby agree forFWO Takaflto use this bank acount forthe purpose ofrelund or any aher payment ue tome a5 determined by FWO Takaful unless FWO Tabaulreceves a witten ston fom the Payee to reve ts lasvuction withthe Payee provd ng neu Dark accour etals which fo be approved by FWD Taku prior te etond or gayentelfectve date Soyo dergoo i ersetuy untuk FWD Tokofl mencourronatovn bark i Bogue DoyOran Gok otou seberong perbayaren 01a 009 dboyorkepodo Soyo mengiatketetuon FWD Totfu, melon FWD Teaful enema arohon betuls orpedo Penerma unit ‘menork bali erehon ic: mana Fenermo memberhon bution ehoun Bonk yng bor yong chon divushoncleh FWD Tobat.! sebelum [pemboyoron both otou trith perboyaron berkuottsos. 3. Ttake net tat the Diect Creat fcity is eny alowed fer aval bank account with 2 Ncensed financial shivton Im Malays thot partipatesin the interbank Gro 8) payretpatcrm anal prove the Bark account tas required Soyo mengor’ mollurs bokewo perthidmoten Feagrredten Tes hanya ebenarken ke otas okour bank ang seh Cersoms rst us) eworgonterlesendMolays2 yong menyerelsiatfom cemboyaran nterbonk Gio '86} 4 $0)0.hon mer terkiorbutroncheun bork yong person 4, Any lets) imposed by the icensed finan isttution fr ts service sabe flr bore by me $Seborong fi yong etenakon oleh sts! kewongonberesen untuk pehidroton il okondtanggung oleh £270. 5 Hake rote hat aor pat the contributions, charges ane paymerts for ths application arm may be subjected tothe Sales and Service Tox(SST) atthe apphieabe preva rate which shal be payable by the Cencae Owner Soyo mergombil moklum behowa keslyuhor ateu sebohogion dovgods sumbongan, cj don boyoran untuk borong permohore in ee eee aed tmemreten t| xoria e 19g epee fare be enor COR This nsvuctionis tobe binding upon me until WD Talal rece of my wren retiaton to cancel he struction Aroron ri chon mengikot sya sehngge FWD Tofu menerrm nts bers darpeso sya untuk rembotoon ovahon 7. FWDTabautie nor tobe held esgonsle fran ss incurred de tothe wcrc bank account deta rowed bythe Cetlaate Owner forthe purese of eposting ary payments eve tome. WO Tekof rok oon aoertonggungjowabkon ke os setorong Fehdongon oko! dorpods pemberon bution ekOUM Bonk yarg scleh eieh Feri Sj bopr tsar mencecesion sebcreng ce bave!on keoases0y8FWD takaful 8 FaDtaatueseres tte gta apie $49 Yoallterne rove be nese 4° whet ir nee to Guert-ve,imtgt.mthrn er wscrd Ys rece NK eee Fae att geod Boe saiceer ard TWD Tal ol tobe Mes abe leony ew ertacipe sven tenttouseree ny by WO Takatul . Tone neta terol rtd mention mengcrggn ners 6 eeu merogivhongeshmoton whan 40°W08 seswo on tango merbrken eerorgGlson en FAD Tels ace hen aveorgpengewoter tosses ice 9 Hh w-4eh ov eotoken yong ofongpung eh so/hor oe dpe néton og ove eh HD Tots Toa ceee amend anyelthe steve coreronn Scr aneraeenu bone cit or enane at 401 laadopt andthe contnve ef hs vercey refs er coritce let acest he ieaonareceh Untuk merontoh mengeuaton ot nerd yo tiou merndo avairan yet ees Paseo Bhs eerie ate ON F7 Stenson oleh FWD Toll don peneraienpegpeaon perinaton roth eetons nga meepaun ever moe” Aoaher terhodop pindoon tersebut ™ a poten « Toheld monies ds tothe Payee nie este orsen roe bow nae acon ae uetonatauc17W0 Tata acento rcs ha eat ant are etutronareened Vom he Payee Untuk megs wong yong boo teade ener erane maton yrg eraen@ posed ate pe, 40 rap Serfoau FWD Toto iek bere un memerar ermratnn bueno tb econ FWO Tate sehiggawehon tow deren doped enema rot possible Personal Data Protection Perlindungon Moklumot Peribodi fom form 1. WWe understand and agree that any personal information colt cr held by WO Tabafl (whether cortaned in Us api oF otherwise obtained} may be used, processed, dslosed and shared by FWD Tataful to Idivcuasforganvaticns related to ane associated with FWD Tahafu or any selected thd party (within r outside ef Malaya, including retabafl and claims sncesigation companies and industry association /federations) forthe purpose of processing ths application form and providing subsequent services {or this and other financial products and services and to communicate with me/us fr such purposes. ‘Seyo/komimemahom don bersetyu bohows mora-mona maklunet perbodi yong ¢humpullon atou dsmpen oleh FWD Toefl (somoda terkandung dalam borong permokonan inl atoudieralehi dengan core lon) boleh igunaton, drreses, idedohkon an gtcngs oleh FWD Teokofulkepodo inivdu/organisosiberhubung otou berkiton dengan FWO Takoful tov mano-mano pak ktige yong terpiih (dolor? ‘teu diver Moloyig,termosokretokoful don syankotpenvicsetontuntuton don persotvan indvstr/zobungon} bog! tyu2n pempresesen ‘orang permohonan ini dan pemberioncerkhidmotan ssulon untuk produ Il don produ don perbhiématen loin don untuk Berhubung dengon saye/komy bog! tyvan ersebut 2. Wwe understand thet I/we havea right to request access to my personal nfermaton held by FAD Tatalu and to request corrector of any personal information whchislacerrect ot limit the processing of my perioral nformation (/We consent ang hereby auther'se WD Tahal to charge a fee for processing and complying with such data acces request o°corecion reguest. 1a/romi memohomi bohowe s0y0/kom mempunyaihokuntukmencopeteanoxses boda meklumot gerbes: yong olwmoon cieh FD Tokofu don memoron pembetulon ora-mone maklumatreibod yong scion ety untuk merghokan perprosesor maklumat penBod! WD Tokeful untuk mengenaton furtve memprosesten oye/hami Seya/nom mergizrhan don dengan nirernber heberaro% bepa don meimotuhi permntaon obses cto ofou germinooa remetuion 3. WWeturther agree tht a photecony f this authonsaticn willbe as effective snd vald asthe original ‘Soyo/Kami,selonjnyo bersetuys bohowo stinn Kebenaron in okanberkuthuasa don soh seperti kebenoron yorg ose. ‘4. By submitting this application, we confi that Ve have read and apree tothe Personal Data Protection Act 2010 Notce set out below DDengon menyerohtan permohenen ini, syarkami mengesohton bohowo saya/tom sudoh memboca dan bersetuy dengon Not’ Perindungon Motlurt Perbod Ako 2010 seperti yong tertrod bowch:Notice Under The Personal Data Protection Act 2010 Notis Di Bawah Akto Perlindungan Dato Peribodi 2010 takaful ‘hs ler tothe Notice to Customers Rearing othe Persona! Dota Frotection Ac 2010 POFA notee | attchec te you cer Mcate trv merajudkepodo Not's Kepodo Pelonggon yorg Berton dengon Alto Ferirdungen Dota Fer! 2CiC (ret FORA yong lerkordung 6 doom sjilord You and the person covered agree to the cortent of the FOPA netice 25 well a content ard authense ut to 1Ne clect on, process 4nd sharing ofa your persona data, sucha, ‘Ano don orong yong ciindungybersetuy dengan kondungon nots POFA.tertebersetuly can ember Auota legocs k2y urtuk mengunipul ‘memproses don berkongs! seve dota peribod anc, sere + your fullname, andthe full names ofthe persons covered, noma penuh onéo, don nome penuh orang yong dlindung! your dent ty card number; rnombor kad pengenaton onde: ‘your address deta and bution olomet endo; don + Yourmedical records; as stated nthe POPA notice ‘rekod perubaton endo, sepeti yong diyotokon éolom mots POPA, Your Right To Ask For More Information Hok Ando Untuk Mendopatkan Maklumat Lanjut You or the person covered can ask us tos, or correc, the personal data we hold ‘Ando otou orong yong dlindungi boleh meminta untuk metho, tou membetiton, dota penbed yong kom! pegong You or the person covered can alto ask us for information about: ‘Anda etou orang yong dilndungijuge boleh meminto kom moklumat mengendi. + curpersonal data protection polices and practices and dosor don omolen perlindungon doropeibod! kom: don 4+ the nds of data ho by us {en's dato yong dipegong oleh bom Youreed to iin and send us data access request form ‘eda peru mengsi den menghartor berong permokonon ses dito kepods kor farangFWD takaful ‘Your Sight To Ask Us To Stop Using Your Personal Data A Meminta Konw Berhenti Menggunokan Data Peribadi Ando covered Nave Se ght 15 48h OED Ang Te Berson Aneo obs Orang yang cintary memze=yei Pel watch memets tom berhenn mer gpenshon dots Fe: Aad & howah 1}! ands 1 yoe (OF NeY) Go ask ste stop. mew 42.0909 (otbu metho) menorta hans berhert, wy ches + M00 WE Vs Sersonal uta ane Cestrey [erent we wre regered to retan a ty aM! beers menggunoten dete sorted ends. don memusrstlonnya (meientes la tom B4ehendst me" weersh + eethecenteate ant meometion nyt eon + Seduct he avout lor you ern ef cover bd the aomntatve le trom ary cortibater youMe phd and thund yeu wnat left memetong Amon witud tempeh perlndungan 0780 42> paren pentocbren dvi ef0-000 KomDOTGOR y>"9 IDA end Bayer 2% renger testes era rong Dertois seemye meg hens Te as ustostep, you cr IN BeIO™ Covered need toserd Uta request in wring Untut memnta bars berbent onde tev ereng yong dindung’ perky merghontar pemrtsonsecoratertls Changes To The PDPA Notice Perubohan Kepoda notis POPA We may amend the PDA note at anytime, and the changes wil apD 10 you andthe pericn covered Kor boleh meminda nots POPA pees blo-bia mess, dan pervtchon odoloh kepada orca gon ereng yong bindu! we do mate a change, we will communicate the change on our website, or by anther method we chcctt La kori memtvet perutchon koniokion memeklumion gerutohan 8 doiom oman web bom. etov dengan haedch lon yong kame Blin eseDeclaration Pengokuon takaful Uwe understand that Saye / Kom memohomi Bohowo 1 My/Our application will cot take eHect unt itis accepted and notiied tome /usby FWD Tabata Permehonen soya / emi tdok oken berhvatkvesa sehinggo terme dan dimoklumkon kepada Soyo / kom oleh FWD Tokofl 2 Tanes at the prevaing rate may be charged on any ofthe contribution, cr ary ether payments due (where applicable ureter lec! Malaysian taxation laws) under this taaful eriiate uta! pace kodar semoso boleh dkenckan ke atos maro-mano boyoren sumbengan. tov opa-0p0 boyoren tertunggok yang Kein {testokiuk tepodo undong-undong percukoionMolayso) bog! sj tokofl in 13 Any changes or updates throveh this transaction willbe treated as updated information and particulars forthe Certificate Owner's relevant certificate(s. Seboreng rerubchon otov kemos kni melolu permcheron ini chon danggoa Sebogor motlumetterkini don but-but» yang berkoiton dengan semuo iis berkaton Perk Sit 44. Tokeep WO Takaful harmless and fully and eHectivelyindemfieg aganst any actions clams, costs (incling but rt ried to any and sil legal costs on soliator and cent basis), demands, detnmest, expenses, fines, ables, loss and damage, penalties and proceedings that FWD Takaful may incur or suffer arising from or incidental to any act, breach, deed, negligent or omission of the Cerificate Owner in elation to the transaction. ‘Memastkon FWD Tokoful tidak termudorot dan menanggungruglsezenuhnyoterhodap opo-opatindokon,tuntutan, kos (termosuk tetopitidokterhod kepodo opo-op0 don semua kos quoman ato desor prquemcero don pelonggen). permintoon, meniejosten perbelaniaon, dendo,lobilt,kerugion don Kerosoken, penal don prosiaing yong FWO Tokoful boleh menonggung atau menderito dorinedo atou bersompingon dengan opa-opo perbuoton,pelonggoron, srct ket, kecvaion atau peninggolon Penk Sj berhubur dengon tronsoks ity 5. FWD Takaful reserves the right to change any part of the terms an conditions ofthis Wansacton. FWD Takofl mempunyaihck untuk menukor mara-mano bahogion terme don syerttransos! in Signature of Certificate Owner: Signature of Witness Sipnature of Asignee if anv: Tondatongan Pemitk Sil: Tandotongon Sots Tendotongon Pemegang Serah Hok (ko ode) R O77 2 Date / Tork Pataclsareare yeas Kol wer fetes A4OI29 ~ o|— Flyer pot Tendetongon Dura: a Pegenoon SVU tenperYonotngen Orvontan Tempot Tonto Ie up Date /Terikh 07/ W>o2a + fo Re paceot nate EL rmpotTondatorgon Oiwnkon: K* ory= Mee $30) needs Name / No Fan Touts teraaicoepiny Ne 102 seers