THE PACIFIC INSURANCE BERHAD (Company. No.

91603-K)
40-01, Q-Sentral, 2A Jalan Stesen Sentral 2,
Kuala Lumpur Sentral, 50470 Kuala Lumpur.
P.O. Box 12490, 50780 Kuala Lumpur
Tel : 03 - 2633 8999 Fax : 03 - 2633 8998
Website: www.pacificinsurance.com.my
Toll-free: 1-800-88-1629

Quotation Date : 17 November 2022

Quotation Valid Until : 16 December 2022
MOTOR QUOTATION SLIP FOR RENEWAL
Name K CHRISTOPHER JOHN
Address NO 1 LORONG 8/14B
IC/Business Registration 380602-10-5393 (new)
Passport No
Telephone Number
Agent Code V0018116
SCHEDULE
Make & Model of PERODUA MYVI 1.3 EZ (A) Cubic Capacity H.P. of 1298.0CC
Vehicle Tonnage
Vehicle Body Sum Insured 16,800.00(Agreed
Value)
Registration No WXP7670 Excess 0.00
Vehicle Registration Use of Vehicle PRIVATE CAR
Card No
Year of Manufacture 2012 Cover Type PRIVATE CAR -
COMPREHENSIVE
Engine No T61A861 Vehicle Type MOTOR - PRIVATE
CAR
Chassis No PM2M602S002077264 Premium(RM) 417.87
Seat Capacity 5 Stamp Duty 10.00
Effective Date 15/12/2022 to 14/12/2023 Service Tax 25.07
Extra Benefit specified 1)ADD NAMED DRIVER Total Due 452.94
2)DRIVERS & PASSENGER
PERSONAL ACCIDENT
3)INCL S/PERIL
Additional Named 1)K CHRISTOPHER JOHN Vehicle Color
Driver 2)WILLIE DAVID CHRISTOPHER

QUOTATION
Premium Pricing RM
Basic Premium 872.60
All Rider Premium 0.00
-NCD (55.00%) 479.93

+Additional Coverage
ADD NAMED DRIVER 0.00
DRIVERS & PASSENGER PERSONAL ACCIDENT 0.00
INCL S/PERIL 25.20
Gross Premium 417.87
+Service Tax (6.00 %) 25.07
+Stamp Duty 10.00
Gross Due 452.94

Excess : Compulsory RM 400.00

: Voluntary RM 0.00

ENDORSEMENTS AND CLAUSES:-

B02F ENDORSEMENT 2(F) - COMPULSORY EXCESS
B030 ENDORSEMENT 30 - REPLACEMENT PARTS
W002 ENDORSEMENT 106 - INSURER'S AUTHORISED WORKSHOP
B057 ENDORSEMENT 57 - INCLUSION OF SPECIAL PERILS
B205 ADDITIONAL NAMED DRIVER
DPPA DRIVERS & PASSENGER PERSONAL ACCIDENT
B115 ENDORSEMENT 115 - SANCTION LIMITATION AND EXCLUSION CLAUSE (NON-TARIFF)
B087 AGREED VALUE