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NEW BUSINESS REQUIREMENT FORM

TO : MOHD RIDZUAN BIN AZIS D3500078 DATE : 14/07/2022


PJ33 REF : NBA/NBUWSAB

FROM : OPERATIONS

PROPOSAL NO: 320225957

Please refer to the following requirements/remark :-

FIKRI AFIQ BIN AZIZ JAAFAR


NEW REQUIREMENT

1. Please have the enclosed Personal Medical Attendant's Report (PMAR) completed by The Attending Doctor
from Hospital Gleneagles for Consultation in June 2018 . Our usual fee for a PMAR is RM80. You will be
reimbursed upon receipt of the medical report AND original receipt on certificate issuance. Please submit
receipt with report.
2. Please have the enclosed Personal Medical Attendant's Report (PMAR) completed by The latest Attending
Doctor from KPJ Kajang for Left upper lobe pneumonia on November 2021 . Our usual fee for a PMAR is
RM80. You will be reimbursed upon receipt of the medical report AND original receipt on certificate issuance.
Please submit receipt with report.

Please submit requirement(s) by 12/09/2022.

This is a computer generated document which does not require a signature.

Prudential BSN Takaful Berhad (Company number: 200601020898)


Level 13, Menara Prudential, Persiaran TRX Barat, 55188 Tun Razak Exchange, Kuala Lumpur
Customer Service Hotline: 03 2053 7188 E-mail: customer@prubsn.com.my Website: www.prubsn.com.my
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