General Insurance

Cancellation

Account No.: V0030981 Policy No. : CVP-V6119891-Y4

________________________________________________________________________________
Insured's Name ... : HEW YIT LENG
Postal Address ... : A-33A-09 RESIDENSI LAGENDA
NO 61 JALAN UDANG SIAR
TAMAN SRI SEGAMBUT
52200 KUALA LUMPUR

________________________________________________________________________________
Endorsement No ... : 00005

Period of Insurance: From 03/04/2022 to 02/04/2023

Effective Date of Change : 15/11/2022
Revised Total Sum Insured: RM 8,100
Additional/Refund Premium: RM 124.98-
Service Tax : RM 7.49-
----------------------
Total Amount Payable : RM 132.47-
======================
________________________________________________________________________________
Particulars of Endorsement :-

Cancellation of Policy
======================
With effect from 15/11/2022 the policy is deemed to be
cancelled.Vehicle has been sold.

NCD entitlement:55.00% on policy.

Vehicle No:WSH2891

This endorsement is issued subject to the terms and conditions of the above
numbered policy issued by ETIQA GENERAL INSURANCE BERHAD
to which this endorsement should be attached.

Issued on 17/11/2022 For and on behalf of,

-1-

Etiqa General Insurance Berhad (197001000276) Etiqa Oneline 1300 13 8888

(Licensed under Financial Services Act 2013 and regulated by Bank Negara Malaysia)
Dataran Maybank, No. 1, Jalan Maarof, 59000 Kuala Lumpur
T +603 2297 3888 F +603 2297 3800 E info@etiqa.com.my www.etiqa.com.my
This Page Is Intentionally Left Blank
 General Insurance

Client's Copy/Salinan Pelanggan

Credit Note No/ No Nota Kredit : 02299108
Date/ Tarikh : 17/11/2022

C R E D I T N O T E /
N O T A K R E D I T

ETIQA GENERAL INSURANCE BERHAD

LEVEL 19, TOWER C
DATARAN MAYBANK
NO 1, JALAN MAAROF
59000 KUALA LUMPUR
(Service Tax No ................ : W10-1808-31009769)

To/ Kepada : Account No/No Akaun : V0030981

MR HEW YIT LENG
A-33A-09 RESIDENSI LAGENDA
NO 61 JALAN UDANG SIAR
TAMAN SRI SEGAMBUT
52200 KUALA LUMPUR

Particulars Amount(RM )

Type Of Policy/ Jenis Polisi :Motor Private Car

Policy No/ No. Polisi :CVP-V6119891-Y4

Period Of Cover/ :From/Dari 03/04/2022 To/hingga 02/04/2023
Tempoh Perlindungan
Endorsement Reason :ISM Cancel - Vehicle Sold
Invoice No/ No Invois Asal :EIBG2022UWFL00117540
Date of Original Invoice/ Tarikh Invois Cukai Asal : 18/03/2022

Premium : 124.98-
-----------------
Total(Excluding Service Tax)/
Jumlah(Tidak Termasuk Cukai Perkhidmatan) : 124.98-
Service Tax Payable/
Cukai Perkhidmatan Perlu Dibayar @ 6.00% : 7.49-
-----------------
Total Amount Payable/ Jumlah Perlu Dibayar : 132.47-
=================

Service Tax (ST) is effective 01/09/2018.

Cukai Perkhidmatan (ST) berkuatkuasa 01/09/2018.

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

Ini adalah dokumen yang dijana komputer. Oleh itu, tiada tandatangan diperlukan.

Etiqa General Insurance Berhad (197001000276) Etiqa Oneline 1300 13 8888

(Licensed under Financial Services Act 2013 and regulated by Bank Negara Malaysia)
Dataran Maybank, No. 1, Jalan Maarof, 59000 Kuala Lumpur
T +603 2297 3888 F +603 2297 3800 E info@etiqa.com.my www.etiqa.com.my