FAMILY PARTICULARS AND INSTRUCTION TO PAY FORM

PART A - PARTICULARS OF FAMILY MEMBER(S)

Current Studying in Disabled

Date of Birth NRIC / Passport Marital
Name as per NRIC Relationship Occupation Qualification Malaysia / child or
(dd/mmm/yyy) No. Status
Level* Oversea? * spouse?
Parents

Zulkifli Bin Abd Rahman father 21/09/1964 640921-08-5519 business spm

Aida Binti Ab Hamid mother 17/04/1969 690417106136 housewife spm
Spouse
Working or
N/A N/A N/A Yes or No
Not Working
Children
Married Working or Malaysia or
or Single Studying Oversea Yes or No
Married Working or Malaysia or
or Single Studying Oversea Yes or No
Married Working or Malaysia or
or Single Studying Oversea Yes or No
Married Working or Malaysia or
or Single Studying Oversea Yes or No
Married Working or Malaysia or
or Single Studying Oversea Yes or No
Married Working or Malaysia or
or Single Studying Oversea Yes or No
Married Working or Malaysia or
or Single Studying Oversea Yes or No
Married Working or Malaysia or
or Single Studying Oversea Yes or No

*Current Qualification Level & Studying In Malaysia/Oversea fields are only applicable to Children.
The information stated above is essential as it may have an impact on the Monthly Tax Deduction (MTD/PCB) or Pruflexiben benefits.

PART B - INSTRUCTION TO PAY

In consideration of the indemnity as provided below, Prudential Services Asia Sdn Bhd ("PSA") agrees that in the event of my death,
PSA shall pay all moneys (including but not limited to all benefits and entitlements, group insurance scheme, salaries, reimbursements,
etc) payable pursuant to my contract of employment with PSA to the following individual(s):

* IMPORTANT: As at the date when you complete this form, this form shall supersede all previous filing with the Company and the
individuals below must be at least 18 years old and competent to contract.

Name as per NRIC Relationship NRIC / Passport No. Contact No. %

Qausar Aimi Bin Zulkifli siblings 050428140641 0186627514 100

Total must add up to 100%

DECLARATION & INDEMNITY

I hereby declare that all information provided in this form are complete and accurate.
I hereby fully indemnify PSA and keep PSA harmless and fully indemnified against all claims, actions, losses, damages, expenses,
costs (including but not limited to legal costs on solicitor and client basis), howsoever arising from the payment made by PSA in
accordance to my instructions in this form. Such payment of moneys shall fully discharge PSA from any liability. This Instruction To
Pay and this indemnity shall bind my personal representative(s) and successor(s).

Qistina Aliya Binti Zulkifli 9990829145056

Signature Name NRIC / Passport No. Date