11/26/2018 Cover Note

LIBERTY INSURANCE BERHAD (16688-K)

HEAD OFFICE: 9th Floor, Menara Liberty, 1008 Jalan Sultan Ismail, 50250 Kuala Lumpur
PO BOX 6120, PUDU, 55916 KUALA LUMPUR.
TEL: 603-2619 9000 FAX: 603-2693 0111 Website: wwww.libertyinsurance.com.my

CONFIRMATION OF PURCHASE OF INSURANCE

JPJ Code No. : 30

Cover Note
: KGMA-290917
No.
Issued Date : 26-11-2018
Transaction
: NEW INSURANCE (REGISTERED)
Type
Insured : MD NASIR BIN DAUD
New IC/Old
: 580608-06-5341
IC
: NO 10 DESA D'FIRDAUS SG MERAB 43000 KAJANG SELANGOR 43000
Address
KAJANG SELANGOR
Contact No. : (HP) 0162752849 (H) 0162752849
Nationality : MALAYSIA

Motor Vehicle
: MOTOR CYCLE PRIVATE -
Class Sum Insured : RM 0.00
ALL RIDERS
Cover Type : Third Party Basic Premium : 41.30
Cover Period : 27/11/2018 to 26/11/2019 NCD : 25.00% (30.98)
Registration
: WSB2014 Loading : 100.00 % (61.95)
No.
Engine No. : E3A8EE039177 Excess : 0.00
Stamp Duty/Service
Chassis No. : PMYKE108080039177 : 10.00 / 5.58
Tax
Logbook No. : NIL Additional Coverage :
Named ALL RIDER - RM 20.65
: NA
Driver(s)
Make and
: YAMAHA - YAMAHA EGO S
Model
Year of
: 2008
Manufactured
Capacity : 115 CC
Hire Amount Payable : 108.50
: NIL
Purchase

JPJ Status:
Reply
: PENDING REPLY
Message

Agent Information:
Agent Name : HOI CAPITAL SDN BHD (KGAN172)
: L3-4 BLOCK G PUCHONG PRIMA TRADE CENTRE JALAN PRIMA 5/4
Address
PUCHONG PRIMA PUCHONG 47150 PUCHONG SELANGOR
Telephone : 0383200200

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11/26/2018 Cover Note

Note to Policyholder:
If "Reply Message" is "OK", you may proceed to any JPJ or Pos Malaysia branch to purchase/renew the road tax for your vehicle.
If "Reply Message" is "Pending" or "Rejected", please wait until the next working day before proceeding to any JPJ or Pos Malaysia branch to
purchase/renew the road tax for your vehicle. If in the mean time, you would like to check on whether the status of the "Reply Message" has been updated
to "OK", please call your agent for an update.
Note: The policy Terms and Conditions remain unchanged subject to No Claim made until expiry of period of insurance.
Note: You should receive the Company's policy within 30 days from inception of risk. If not, please refer to the Company's head office or the nearest branch
office.
Nota: Anda patut menerima polisi syarikat dalam tempoh 30 hari dari tarikh permulaan tempoh risiko. Jika anda tidak menerima polisi, anda patut merujuk
kepada ibu pejabat syarikat atau mana-mana cawangan syarikat yang berdekatan.
This is computer generated document and no signature is required.

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