CERTIFICATE OF INSURANCE Page 3 of4

CERTIFICATE OF INSURANCE
SIJIL INSURANS
POLICYHOLDER/PEMEGANG POLISI POLICY NUMBER/NOMBOR POLISI

PMMB-419237
REGISTRATION NO. / No PENDAFTARAN
AHMAD BASYIR BIN SADAN
G4 BLOK 8
TAMAN ALAM MEGAH SEK 28 WRN3163
40400 SHAH ALAM
SELANGOR PERIOD OF INSURANCE TEMPOH
INSURANS

23 NOV 2022 to 22 NOV 2023

C.I CODE: M.X.1

Person or classes of person entitled to drive /Orang atau kelas orang yang layak memandu

a) The Policyholder.
b) Any other person who is driving on the Policyholder's order or with his permission.
to drive the Motor
Provided that the person is permitted in accordance with the licensing or other laws or regulations
Vehicle or has been so permitted and is not disqualified by
the Motor Vehicle.
order of a Court of Law or by reason of any enactment or regulation in that behalf from driving
memandu menurut undang-undang perlesenan atau undang-undang
lain atau
syarat orang tersebut dibenarkan
Dengan
peraturan untuk memandu Kenderaan Bermotor Mahkamah atau oleh sebab mana-mana
tersebut atau telah dibenarkan dan tidak dilucutkan kelayakan di atas perintah
enakmen atau peraturan daripada memandu Kenderaan
Bermotor tersebut.
LIMITATION AS TO USE*
HAD PENGUNAAN*
business.
Use only for social, domestic and pleasure purposes and for the Policyholder's
The Policy does not cover
() Use for hire or reward
(i) Use for racing pace-making reliability trial or speed-testing
connection with any trade or business
ii) Use for the carriage of goods (other than samples) in
Limitation rendered inoperative by Section 95 of the Road Transport Act 1987 (Malaysia) or section 8 of the Motor
Vehicle (Third Party Risks and Compensation) Act(189)
Brunei Darussalam are
Repulic of Singapore or Section 7 of the Motor Insurance(Third Party Risks) Act(Cap90) Negara
not to be included under this headingPengehadan
Jalan 1987 (Malaysia) atau Section8 of the Motor
dijadikan tidak berkuatkuasa oleh Seksyen 95 Akta Pengangkutan
Vehicle(Third Party Risks and Compensation)Act(Cap 189)
90)Negara Brunei
Republic of Singapore or Section 7 of the Motor Vehicle Insurance (Third Party Risks)Act(Cap
Darussalam tidak termasuk dibawah tajuk ini.
2013. Liberty Insurance Berhad is committed to
The Personal Data Protection Act 2010 came into force on 15 November
protecting your privacy. Please visit www.libertyinsurance.com.my
for our complete and detailed privacy notice.

LIBERTY INSURANCE BERHAD(16688-K)

P
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THE SCHEDULE Page 1 of 19

Liberty
insurancc
THE SCHEDULE
JADUAL
STAMP DUTY PAIDD PRIVATE CAR INSURANCE POLICY
DUTI SETEM TELAH DIBAYAR POLISI INSURANS KERETA PERSENDIRIAN

POLICY NUMBER
PMMB-419237 NOMBOR POLISIPMMB-419237

AHMAD BASYIR BIN SADAN

ACCOUNT CODE KGPM001
KOD AKAUN
G4 BLOK 8
BRANCH CODE
TAMAN ALAM MEGAH SEK 28 05107
40400 SHAH ALAM KOD CAWANGAN
LASS
SELANGOR PRIVATE CAR
KELAS

Business Registration
NRIC No
880629-07-5121
No.Kad Pengenalan No.Pendaftaran
Perniagaan
Business or Profession
Cover Note No.
Perniagaan atau Others : PMMB-419237
No Nota Perlindungan
Pekerjaan
Period of Insurance
23 NOV 2022 to 22 NOV 2023
Tempoh Insurans

Any subsequent period for which you shall pay and we shall agree to accept a renewal premium.
Sebarang tempoh selanjutnya di mana Anda hendaklah membayar, dan kami hendaklah bersetuju untuk menerima premium
pembaharuan.

Vehicle Registration No. Basic Premium

No Pendaftaran Kenderaan
WRN3163
Premium Asas
RM 479.70
Regn. Card No.
No Perakuan Pendaftaran Kenderaan
C.cTonnage/HP
Keupayaan Enjin :1598CC
Your Estimated Value
NCD:()
Including Accessories
Nilai Anggaran Anda Termasuk
19100.00 (25.00 %) RM 119.93
Aksesori Diskaun Tanpa Tuntutan

Year of Manufacture Extra Coverage :(+)

Tahun Diperbuat 2008 Perlindungan Tambahan RM 0.00
Excess Service Tax
Lebihan yang Dikenakan :0.00 (6.00%) RM 21.59
Cukai Perkhidmatan
Make &Type of Body Stamp Duty
Buatan & Jenis Badan MAZDA 3 Duti Setem RM 10.00
Engine No.
:Z6B20000
No. Enjin
Chassis No. Total
No. Chasis JM6BK106280420264 Jumlah RM 391.35
Seating Capacity
Muatan Tempat Duduk Termasuk 5
Pemandu
Type of Cover Third Party Fire & Act Premium:
Perlindungan yang Diberi Theft RM 313.07
Akta Premium
Hire Purchase Owner
Syarikat Kewangan
LIBERTY INSURANCE BERHAD (16688-K) CUSTOMER SERVICE TOLL FREE: 1-300-888-990 | www.libertyinsurance.com.my

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Page 2 of 19

LEGISLATION
Road Transport Act.1987 (Malaysia) Motor Vehicle (Third Party Risks and Compensation) Act (CAP 189) Republic of
Singapore Motor Vehicles (Third Party Risks and Compensation) Rules 1960 (Republic of Singapore) Motor Vehicle
Insurance(Third Party Risks) Act (CAP 90) Negara Brunei Darussalam(the reference to legislation under the heading
"Avoidance of certain Terms and Right of Recovery" is limited to Section 94,95,and 96 of the Road Transport Act 1987
(Malaysia) Section 7,8 and 9 of the Motor Vehicles (Third Party Risks and Compensation) Act (Cap 189) Republic of
Singapore and Section 7 of the Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam.

PERUNDANGAN

Akta Pengangkutan Jalan,1987 (Malaysia) Motor Vehicle(Third Party Risks and Compensation Act (Cap 189) Republic of
Singapore The Motor Vehicle (Third Party Risks and Compensation) Rules 1960 (Republic of Singapore) Motor Vehicles
Insurance (Third Party Risks) Act Cap 90 Negara Brunei Darussalam
(rujukan kepada perundangan di bawah tajuk
"Pengelakan Sesetengah Terma dan Hak Tuntut Balik" adalah terhad kepada Seksyen 94,95 dan 96 Akta Pengangkutan
Jalan 1987 (Malaysia) Section 7,8 and 9 of Motor Vehicles(Third Party Risks and
Compensation) Act (Cap Darussalam.
of Singapore dan Section 7 of the Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei90) Republic

Authorised Driver
Pemandu yang diberi kuasa

ENDORSEMENTICLAUSE/WARRANTIES APPLICABLE TO THIS POLICY

PENGENDORSAN / FASAL / WARANTI YANG DITERIMA PAKAI DI DALAM POLISI INI: 3q, 30, 100, 113
Renewal of Policy No.
Pembaharuan No. : NOT APPLICABLE
Polisi

Date of Signature of
Proposal
and Declaration : 23-11-2022 13:59:35.916
Tarikh Tandatangan
Cadangan
dan Akaun

Entered by
20658FIZAH
Operator
Issued at POS MALAYSIA BERHAD Giant Putra Date : 23-11-2022
Dikeluarkan di Heights Tarikh 13:59:35.916
PRINT DATE 23/11/2022
Tarikh dicetak

LIBERTY INSURANCE BERHAD (16688-K) CUSTOMER SERVICE TOLL FREE: 1-300-888-990 | www.libertyinsurance.com.my

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POS MALAYSIA PA PRODUCT

POS MOTORIST'S COMPANION (PMC1)
CERTIFICATE
SIJIL
|Master Policy No. KLMPC0000056
Batch No.
Cover Note No. PMNA-731912
KGPMO01 Period of Insurance:
Account Code
(A) From 23 NOV 2022 TO MIDNIGHT 22 NOV 2023 (BOTH DATES
INCLUSIVE)_
(B) ANY SUBSÉQUENT PERIOD FOR WHICH INSURED SHALL PAY AND
THE COMPANY SHALL AGREE ARENEWAL PREMIUM
THE INSURED CLASS PRIVATE CAR
PREMIUM RM 60.00
AHMAD BASYIR BIN SADAN SERVICE TAX (6.00%) :RM 3.60
G4 BLOK 8
TAMAN ALAM MEGAH SEK 28
TOTAL RM 63.60
40400 SHAH ALAM
SELANGOR
RENEWALPREMIUM.RM 60.00

GEORAPHICAL LIMIT:
WITHIN MALAYSIA,SINGAPORE AND BRUNE
ITEM DESCRIPTION SUM INSURED (RM)
MAXIMUM RM10,000 PER PERSON 50,000.00
10,000.00
|1.Accidental Death
2.Permanent Dismemberment 10, 000.00
i) Loss of both hands or both feet
i) Loss of sight of both eyes 10, 000.00
ii) Loss of one hand and one foot 10, 000.00
iv) Loss of sight of one eye and one hand or one foot 10, 000.000
v) Loss of one hand or one foot 5, 000.00
vi) Loss of sight of one eye 5, 000.00
3.Medical Expenses Reimbursement 500.00

THE VEHICLE:
REGISTRATION NO. WRN3163
SEATING CAPACITY :5
MAZDA 3
DYPEMAKE/MODEL
Subject to the following clauses/ warranties / endorsement printed on the policy or attached hereto-
DESCRIPTION
CODE
PAL PA LIABILITY
NMA2920 TERRORISM EXCLUSION ENDORSEMENT
FSA CONSUMER INSURANCE CONTRACT
PDPA PERSONAL DATA PROTECTION ACT 2010
SANCTIONS LIMITATION AND EXCLUSION CLAUSE
P2214
CBC CASH BEFORE COVER
sSUED IN LIEU OF AND CANCELLING COVER NOTE NO.
REPLACING POLICY NO.:
Witness whereof this policy has been signed on behalf and with the authority of the company
ISsUED ON :23-11-2022
SIGNED AT
EXAMINED & PREPARED BY
For and behalf of Libety Insurance Berhad

Chief Executive Officer

Liberty
9th Insurance
Floor, Menara Berhad
Liberty, [16688-K]
1008 Jalan Sultan Ismail, 50250 Kuala Lumpur, Malaysia
P.O. Box 6120 Pudu, 55916 Kuala Lumpur
Tel:03-2619 9000 Fax:03-2693 0111
www.libertyinsurance.com.my
Important Note:
a) This Personal Accident (PA) product is being offered on stand-alone basis and it is not a pre-condition to purchase a Motor Insurance policy from Liberty
Insurance Berhad or its representatives.
b) If you find this plan is unsuitable for any reason, please contact us during the 15 days review period which will commence from the day you receive the
certificate of Insurance and any premiums will be refunded accordingly should you decide to cancel this policy.
Kindly contact our Customer Service Centre at Toll Free 1-300-888-990 if you have any queries.
d) Term & Conditionsof Master Policy No. KLMPCO000056 can be obtalned from LIB Office (HQ), if required.
e POS (M) Bhd. is a licensed insurance agent of LIB and is entited to ean a 10% commission for distributing LIB's products.

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