COVER NOTE

STAMP DUTY PAID

Participant Cover Note No. : 86983793

Account No. : V0026098
MURALY A/L VELAMUTHU Agent Name : MYAMJ SERVICES
A06-10 PUTRA SURIA RESIDENSI
JALAN JELAWAT 2 CHERAS Product Type : Goods Carrying "C" - Permit
KUALA LUMPUR Period of Takaful from 05/03/2024 To 04/03/2025 (both Dates
56000 KUALA LUMPUR Inclusive). Any subsequent period for which the Participant shall pay
and the Takaful Operator shall agree to accept a renewal contribution..

NRIC No : Business Reg No : 201903303899 Sum Covered RM 15000.00

Business/Occupation : Other Service Other ID No : Gross Contribution RM 1041.70
Activities No Claim Discount 0.00% RM 0.00
Vehicle Information ______
JPJ Document No : RM 1041.70
Vehicle Reg No : BJJ9862 Log Book No : NIL Add : Service Tax 8.00 % RM 83.34
Make : NISSAN Stamp Duty RM 10.00
Model : NISSAN VANETTE CHASIS CAB
Engine No : A15C086720 Cover Type : Comprehensive TOTAL AMOUNT DUE RM 1135.04
Chassis No : PN8PGC22JTCA59317 Vehicle Type : Commercial
Year of : 2007 License Type : Goods Carrying Veh "C"
Manufacture - Permit Excess All Claims RM 300.00
Tonnage :1 Use For : Goods Carrying Vehicle
Seating Capacity : 3
Financial Interest : NIL

IMPORTANT NOTICE - APPLICABLE TO ALL NON CONSUMER PRODUCTS

(Takaful wholly for purposes related to your trade, business or profession)
This Certificate is issued in consideration of the payment of premium as specified in the Certificate Schedule and pursuant to the answers given in
your Proposal Form (or when you applied for this Takaful) and any other disclosures made by you between the time of submission of your
Proposal Form (or when you applied for this Takaful) and the time this contract is entered into. The answers and any other disclosures given by
you shall form part of this contract of takaful between you and us. In the event of any pre-contractual misrepresentation made in relation to your
answers or in any disclosures made by you, it may result in avoidance of your contract of takaful, refusal or reduction of your claim(s), change of
terms or termination of your contract of takaful.

This Certificate reflects the terms and conditions of the contract of takaful as agreed between you and us.

Issue Date : 05-03-2024/05:41 PM For and on behalf of

Issue At : B3 Etiqa General Takaful Berhad
Issue By : v0026098
 Invoice No: ETBG2024UWFL00640949
Date: 05/03/2024

INVOICE

ETIQA GENERAL TAKAFUL BERHAD (201701025031)

LEVEL 19 TOWER C
DATARAN MAYBANK
NO 1 JALAN MAAROF
59000 KUALA LUMPUR
(SST Reg No: W10-1808-31012539)

To Account Number: V0026098

MURALY A/L VELAMUTHU
A06-10 PUTRA SURIA RESIDENSI
JALAN JELAWAT 2 CHERAS
KUALA LUMPUR
56000 KUALA LUMPUR

Description Total (RM)

Type of Certificate: Goods Carrying "C" - Permit
Certificate Number: 86983793
Period of Takaful: 05/03/2024 to 04/03/2025

Contribution 1041.70
Total (Excluding SST) 1041.70
SST payable @ 8.00% 83.34
Stamp Duty 10.00

Total Amount Payable 1135.04

This is a computer generated document. Therefore, no signature is required