AIA PUBLIC Takaful Bhd.

(935955-M)
(Formerly known as ING PUBLIC Takaful Ehsan Berhad)
99 Jalan Ampang
50450 Kuala Lumpur
P.O. Box 13009, 50704 Kuala Lumpur
50796 Kuala Lumpur
Care Line: (603) 2037 1333
1300 88 8922
(603) 2056 3690
AIA.COM.MY

24 May 2023 15:08:43 Ref: X977740A07

SALWA NOOR BINTI OMAR

CP101, OPAL RESIDENSI CONDO NB
JLN BAIDURI BULAN 7/28
SEKSYEN 7
SHAH ALAM

Dear Sir/Madam

YOUR APPLICATION NO. : X977740A07 dated 23 May 2023

PROPOSED PERSON COVERED : SALWA NOOR BINTI OMAR

We thank you for your application and we are very pleased that you have taken this important step to participate in the
Takaful plan with us.

We would like to advise you that due to PHYSICAL FINDINGS - EXCLUSION, we are offering you a revised plan to the
one originally applied for. Your authorised representative will contact you shortly to explain the details of this revised
plan. Please see overleaf for the details.

We hope that you will accept the revised plan offered. We will be most obliged if you could indicate your acceptance by
signing the Declaration of Acceptance and returning it to us together with any balance of the first Monthly Contribution
by 23 Jun 2023.

Your coverage will commence on receipt of those items by us. Do act as quickly as possible so that your coverage will
commence at the earliest possible date.

Please do not hesitate to ask your authorised representative if you have any queries.

Thank you.

New Business Underwriting

Kuala Lumpur Service Center - EP - AL ALR

This is a computer generated letter, signature is not required.

 AIA PUBLIC Takaful Bhd. (935955-M)
(Formerly known as ING PUBLIC Takaful Ehsan Berhad)
99 Jalan Ampang
50450 Kuala Lumpur
P.O. Box 13009, 50704 Kuala Lumpur
50796 Kuala Lumpur
Care Line: (603) 2037 1333
1300 88 8922
(603) 2056 3690
AIA.COM.MY

Application No X977740A07

Proposed P.Covered SALWA NOOR BINTI OMAR

*X977740A07*
Owner/Payor SALWA NOOR BINTI OMAR
*S0703024*

Agency KL ELITE EMPIRE - 6704

Agent SITI ZATUL ITRI BINTI MOHD ZABIDI - 1086W

Branch Kuala Lumpur Service Center

Date 23 May 2023

Revised programme offered to SALWA NOOR BINTI OMAR on the name of SALWA NOOR BINTI OMAR.

Monthly
PLAN TYPE AMOUNT CONTRIBUTION
A-Life Medik Famili PLAN150-PC 100.22
TOTAL CONTRIBUTION RM 100.22
===============================

Your certificate will be subject to the endorsements attached.

DECLARATION OF ACCEPTANCE OF REVISED PLAN:

I SALWA NOOR BINTI OMAR agree to accept the proposal outlined above and confirm myself, and on behalf of any
person covered other than myself, that the statements made in my application for Takaful plan are still true. My
particular attention has been drawn to the essential information on the revised key benefits and/or risk adherence and/or
exclusion and/or waiting period and/or medical & health Takaful benefits, features and limitations (if applicable) of which
has been satisfactory explained to me.

Signature Applicant

Date

cc (SITI ZATUL ITRI BINTI MOHD ZABIDI)(KL ELITE EMPIRE) / 1086W / 6704 /

CNTOF FILE / AGENT'S COPY

Kuala Lumpur Service Center - EP - AL ALR
 AIA PUBLIC Takaful Bhd. (935955-M)
(Formerly known as ING PUBLIC Takaful Ehsan Berhad)
99 Jalan Ampang
50450 Kuala Lumpur
P.O. Box 13009, 50704 Kuala Lumpur
50796 Kuala Lumpur
Care Line: (603) 2037 1333
1300 88 8922
(603) 2056 3690
AIA.COM.MY

ATTACHED TO AND FORMING PART OF CERTIFICATE NUMBER X977740A07

ISSUED ON THE LIFE OF SALWA NOOR BINTI OMAR

Exclusion Clause

Without affecting any of the provisions contained in the certificate mentioned below,

It is understood and agreed that the following certificate shall not cover any indemnity due to any treatment or surgery
on Myasthenia Gravis and any disease or disorder of the thymus gland or complications thereof
1. A-Life Medik Famili