24/09/2023

STANDARD LETTER OF QUERY

MUHAMAD ALIFF FARHAN BIN

DC Rep : 1343160 KUALA LUMPUR
MOHAMAD ZUBIR
Imm : 1093694 KUALA LUMPUR LIYANA BINTI DZULKEFFLEE
GM : 1093694 KUALA LUMPUR LIYANA BINTI DZULKEFFLEE

Dear Sir/Madam

Proposal No :KLO/28367/23 Certificate No : 4027792578

Name of Proposer/Grantee :ENCIK MOHD ROSLI BIN A.HAMID
Name of Person to be Covered : ENCIK MOHD ROSLI BIN A.HAMID (Person Covered 1)

To enable us to process the above proposal, we would appreciate it if you could kindly arrange to complete the
additional requirements as indicated below :

MEDICAL REQUIREMENT
MEDICAL EXAMINATION TO BE DONE BY PANEL DOCTOR (Question to Person Covered 1).
GREAT EASTERN PROFILE 11 - RENAL FUNCTION TEST (Question to Person Covered 1).
URINE F.E.M.E. WITH REPORT (FOR FEMALE APPLICANT; IT IS RECOMMENDED TO PERFORM TEST A
WEEK AFTER MENSTRUAL IS OVER OR NOT MORE THAN A WEEK PRIOR TO NEXT MENSTRUAL
CYCLE FOR ACCURACY ON RESULT) (Question to Person Covered 1).

QUESTIONNAIRES
KIDNEY / BLADDER / URINARY STONES QUESTIONNAIRE FOR PERSON TO BE COVERED'S
COMPLETION (Question to Person Covered 1).

We reserve the right to call for additional underwriting requirements if the above are not complied within 14 days
from the date of this letter.

In all cases, a Health Warranty Tendering First Contribution will be required if more than 30 days have elapsed
since the date of proposal or medical examination, whichever is later.

If you have any questions, please do not hesitate to contact us.

Yours faithfully

Page 1 of 4
Proposal No/No. Cadangan: KLO/28367/23 Certificate No/No. Sijil:4027792578
Great Eastern Takaful Berhad (916257-H)
Head Office : Menara Great Eastern 303 Jalan Ampang 50450 Kuala Lumpur
Telephone: +603 4259 8338 Facsimile: +603 4259 8808 Careline: 1 300 13 8338
Email: i-greatcare@greateasterntakaful.com Website: www.greateasterntakaful.com
 24/09/2023

FADZUIN KARUDDIN ( TEL. NO.: 03-4259 8338 )

ASSISTANT VICE PRESIDENT
NEW BUSINESS
This is a computer generated letter which requires no signature.

Page 2 of 4
Proposal No/No. Cadangan: KLO/28367/23 Certificate No/No. Sijil:4027792578
Great Eastern Takaful Berhad (916257-H)
Head Office : Menara Great Eastern 303 Jalan Ampang 50450 Kuala Lumpur
Telephone: +603 4259 8338 Facsimile: +603 4259 8808 Careline: 1 300 13 8338
Email: i-greatcare@greateasterntakaful.com Website: www.greateasterntakaful.com
 24/09/2023

KEPERLUAN PENGUNDERAITAN TAMBAHAN

MUHAMAD ALIFF FARHAN BIN
Wakil Saluran : 1343160 KUALA LUMPUR
MOHAMAD ZUBIR
Pegawai Atasan : 1093694 KUALA LUMPUR LIYANA BINTI DZULKEFFLEE
Pengurus Kumpulan/ PK : 1093694 KUALA LUMPUR LIYANA BINTI DZULKEFFLEE

Tuan/Puan

No. Cadangan :KLO/28367/23 No. Sijil : 4027792578

Nama Pencadang / Granti :ENCIK MOHD ROSLI BIN A.HAMID
Nama orang yang akan dilindungi : ENCIK MOHD ROSLI BIN A.HAMID (Orang Yang Dilindungi 1)

Untuk membolehkan kami memproses permohonan anda, sila lengkapkan keperluan tambahan berikut:

KEPERLUAN PERUBATAN
PEMERIKSAAN PERUBATAN DILAKUKAN OLEH DOKTOR PANEL (Soalan untuk Orang Yang Dilindungi 1).
GREAT EASTERN PROFIL 11 - UJIAN FUNGSI RENAL (Soalan untuk Orang Yang Dilindungi 1).
LAPORAN URIN F.E.M.E. (BAGI WANITA; UNTUK KETEPATAN KEPUTUSAN, LAKUKAN UJIAN INI
SEMINGGU SELEPAS MENSTRUASI BERAKHIR ATAU SEMINGGU SEBELUM KITARAN MENSTRUASI
BERMULA) (Soalan untuk Orang Yang Dilindungi 1).

SOAL SELIDIK
SOAL SELIDIK BATU KARANG BUAH PINGGANG / PUNDI KENCING / SALURAN URINARI UNTUK
DILENGKAPKAN OLEH ORANG YANG AKAN DILINDUNGI (Soalan untuk Orang Yang Dilindungi 1).

Kami berhak meminta keperluan pengunderaitan tambahan jika keperluan di atas tidak dilengkapkan dalam
masa 14 hari daripada tarikh surat ini.

Dalam semua kes, borang Tawaran Penyerahan Caruman Pertama diperlukan selepas melebihi 30 hari dari
tarikh permohonan atau pemeriksaan perubatan, mana yang kemudian.

Jika anda mempunyai sebarang pertanyaan, sila hubungi kami.

Yang benar

FADZUIN KARUDDIN ( TEL. NO.: 03-4259 8338 )

PENOLONG NAIB PRESIDEN

Page 3 of 4
Proposal No/No. Cadangan: KLO/28367/23 Certificate No/No. Sijil:4027792578
Great Eastern Takaful Berhad (916257-H)
Head Office : Menara Great Eastern 303 Jalan Ampang 50450 Kuala Lumpur
Telephone: +603 4259 8338 Facsimile: +603 4259 8808 Careline: 1 300 13 8338
Email: i-greatcare@greateasterntakaful.com Website: www.greateasterntakaful.com
 24/09/2023

NEW BUSINESS

Ini adalah surat yang dikeluarkan oleh komputer dan tandatangan tidak diperlukan.

Page 4 of 4
Proposal No/No. Cadangan: KLO/28367/23 Certificate No/No. Sijil:4027792578
Great Eastern Takaful Berhad (916257-H)
Head Office : Menara Great Eastern 303 Jalan Ampang 50450 Kuala Lumpur
Telephone: +603 4259 8338 Facsimile: +603 4259 8808 Careline: 1 300 13 8338
Email: i-greatcare@greateasterntakaful.com Website: www.greateasterntakaful.com