Allianz General Insurance Company (Malaysia) Berhad(735426-V)

LEVEL 29, MENARA ALLIANZ SENTRAL,

203, JALAN TUN SAMBANTHAN, Tel : 03-22641188
KUALA LUMPUR SENTRAL 50470 KUALA LUMPUR Fax : 03-22641199
Customer Service
GROUND FLOOR, BLOCK 2A,
PLAZA SENTRAL, JALAN STESEN SENTRAL 5, Tel : 03-2264 0700
KUALA LUMPUR SENTRAL, 50470 KUALA LUMPUR Fax : 03-2264 0602
Email : customer.service@allianz.com.my Toll Free No : 1-300-88-1028
RTD CODE : 13
ORIGINAL COPY THE SCHEDULE STAMP DUTY PAID
JADUAL DUTI SETEM DIBAYAR
M.X.1 PRIVATE CAR -PRIVATE USE (DRIVE TO WORK/DAILY USE)
PERIOD OF INSURANCE (a) From 29/10/2021 (both dates inclusive) Date of Issue/Time 29-10-2021
TEMPOH INSURANS Dari 29/10/2021 (termasuk kedua-dua tarikh) Tarikh Dikeluarkan/Waktu 10:53 AM
To 28/10/2022
Hingga 28/10/2022 E-Policy Number. MIT-147361
No. Polisi
(b) From Any subsequent period for which the Insured shall pay and the
Company shall agree to accept a renewal premium. E-Cover Note No. MIT-147361
Sebarang tempoh selanjutnya di mana Anda hendaklah membayar, dan Kami hendaklah No. Nota Perlindungan
bersetuju menerima premium pembaharuan. Account No. KJ33635
No. Akaun
Premium 2411.50
INSURED MUHAMMAD HARITH JUWAIDI BIN JUZAIREN Loading 0.00% 0.00
PEMUNYA
NCD 0.00% 0.00
ADDRESS 11A, JLN KASTURISARI 2D
ALAMAT Extra Coverage
BANDAR SUNGAI BUAYA
48010 UN-NAMED DRIVERS 20.00
RAWANG
SELANGOR GROSS PREM 2431.50

OCCUPATION/TYPE OF BUSINESS OTHERS STAMP DUTY 10.00

PERNIAGAAN/PEKERJAAN SERVICE TAX 145.89
HIRE PURCHASE OWNERS/EMPLOYER'S TOYOTA CAPITAL MALAYSIA SDN BHD TOTAL DUE 2587.39
LOAN
SEWA BELI/PINJAMAN MAJIKAN AMOUNT PAYABLE(ROUNDED) 2587.40
PARTICULARS OF VEHICLE EXCESS0.00
BUTIR-BUTIR KENDERAAN LEBIHAN

Make and Type of Body Registration No./Trailer No.

Buatan dan Jenis Badan No. Pendaftaran/No. Treler
TOYOTA - TOYOTA YARIS 1.5E (AT) VGV6376
Engine No. Engine C.C/Horse Power/Tonnage Act. 67.50
No. Enjin CC Enjin/Kuasa Kuda/Tan Akta
2NR0P46947 1496 CC
Chassis No. Seating Capacity Year Of Manufacture Sum Insured 82000.00
No. Casis Muatan Tempat Duduk Tahun Dibuat Jumlah Diinsurankan
PN154SYF103537371 5 2021
NRIC No./Passport/Bus. Regn. No./ Telephone No. Regn. Card No. Type of Cover
No. Kad Pengenalan/Pasport/No. Pendaftaran Perniagaan No. Telefon No. Kad Pendaftaran Jenis Perlindungan
980917-10-5055 / - / 01140043260 Comprehensive

This Policy is subject to the following endorsements as printed in this Policy or added thereon or attached thereto :-
Polisi ini adalah tertakluk kepada pengendorsan yang telah dicetak atau dikembali atau dimasukkan ke dalamnya.
ENDT.1 - EXCESS ALL CLAIMS
ENDT.100 - EXCLUSION OF LEGAL LIABILITY TO PASSENGERS -(Private car only)
ENDT.106 - INSURER'S AUTHORISED WORKSHOP
ENDT.2(f) - COMPULSORY EXCESS
ENDT.30 - REPLACEMENT PARTS
ENDT.A200 - WAIVER OF COMPULSORY EXCESS IF NOT NAMED DRIVER(Non - Tariff)
ENDT.87 - AGREED VALUE
NAMED DRIVERS
LODGING COMPLAINTS & GRIEVANCES
IF YOU HAVE ANY COMPLAINTS OF UNFAIR MARKET PRACTICES BY THE COMPANY, YOU MAY CALL OR WRITE TO :
1. CUSTOMER FEEDBACK CENTER 2. OMBUDSMAN FOR FINANCIAL SERVICES ("OFS") 3. LAMAN INFORMASI NASIHAT DAN
ALLIANZ GENERAL INSURANCE COMPANY (Formerly known as Financial Mediation Bureau) KHIDMAT (LINK)
(MALAYSIA) BERHAD LEVEL 14, MAIN BLOCK, MENARA TAKAFUL BANK NEGARA MALAYSIA
GROUND FLOOR, BLOCK 2A, MALAYSIA, GROUND FLOOR, BLOCK C,
PLAZA SENTRAL, JALAN STESEN SENTRAL 5, NO.4, JALAN SULTAN SULAIMAN, JALAN DATO ONN,
KUALA LUMPUR SENTRAL, 50000 KUALA LUMPUR 50480 KUALA LUMPUR.
50470 KUALA LUMPUR. TEL NO: +603-22722811 TOLL FREE: 1-300-88-5465
TEL : 03-2264 0700 FAX : 03-2264 0602 FAX NO: +603-22721577 FAX : 03-2174 1515
EMAIL : customer.service@allianz.com.my EMAIL: enquiry@ofs.org.my EMAIL : bnmtelelink@bnm.gov.com.my
Geographical Area : Malaysia, Republic of Singapore and Negara Brunei Darussalam Issued By / Dikeluarkan oleh
Kawasan Geografi : Malaysia, Republik of Singapura dan Negara Brunei Darussalam
G-MART MOTOR SDN BHD
Limitations as to Use / Authorised Driver : As described in the Certificate of Insurance KJ KAJANG
Had Penggunaan / Pemandu Yang Diberi kuasa : Seperti yang tercatat dalam Sijil Insurans

Please ensure All accidents are reported to the Police within 24 hours. ALLIANZ GENERAL INSURANCE COMPANY (MALAYSIA) BERHAD.
Pastikan semua kemalangan hendaklah dilaporkan kepada pihak Polis didalam masa 24 jam. (735426-V)
Issued in lieu of and Cancelling/Replacing Cover Note/Policy No. :
Dikeluarkan Sebagai Pembatalan/Penggantian/No. Nota Perlindungan/ No. Polisi

Date of Signature of Proposal & Declaration : 29-10-2021

Tarikh Tandatangan Cadangan dan Akuan

Authorised Signature
Important Notice : Policy print out can be obtained from our branch offices located nationwide or from your servicing agents.
Kenyataan Penting : Cetakan polisi boleh diperolehi daripada pejabat cawangan kami di seluruh negara ataupun daripada ejen Allianz Anda.

KJ33635/KJ/FJ052
Allianz General Insurance Company (Malaysia) Berhad (735426-V)
LEVEL 29, MENARA ALLIANZ SENTRAL,
203, JALAN TUN SAMBANTHAN,Tel : 03-22641188
KUALA LUMPUR SENTRAL 50470 KUALA LUMPURFax : 03-22641199
(Service Tax Reg. No : W10-1808-31006172)

INVOICE

eSchedule No : MIT-147361 Class : PRIVATE CAR -PRIVATE USE

(DRIVE TO WORK/DAILY USE)
Account No : KJ33635 Invoice No : STAX21104000094996
Insured / Policy Holder : MUHAMMAD HARITH JUWAIDI Invoice Date: : 29/10/2021
BIN JUZAIREN
11A, JLN KASTURISARI 2D
BANDAR SUNGAI BUAYA
48010
RAWANG
SELANGOR
Period of Insurance : 29/10/2021 - 28/10/2022

Serial No Description Total Amount (RM)

1. Gross Premium 2431.50
Stamp Duty 10.00
Premium Payable excluding Service Tax 2441.50

Premium Subject to Service Tax at 6.00% 2431.50

(Period of Insurance : 29/10/2021 - 28/10/2022)

Service Tax Payable 145.89

Total Premium Payable inclusive Service Tax 2587.39
Amount Payable (Rounded) 2587.40

Allianz General Insurance Company (Malaysia) Berhad

This is computer generated. No signature is required.