Date : 08/12/2022

MUHAMAD IQBAL BIN NOOR AZIZI

A-5-31, BLOK A
RESIDENSI MELOR BANGI
JALAN 5E/1, SEKSYEN 5
43650 BANDAR BARU BANGI
SELANGOR DARUL EHSAN

Dear MUHAMAD IQBAL BIN NOOR AZIZI,

Welcome to FWD Takaful Berhad

Thank you for choosing FWD Takaful Berhad as your preferred takaful provider and we’re pleased to welcome you as our
valued customer.

You’re good to go!

We’ve attached everything you need:

· Your Takaful Certificate Schedule – detail information of the plan you just participated.
· Your Takaful Certificate number EP264334. Keep this handy – it’ll be the first thing we ask for if you contact us.

Please check the accuracy of the information in these documents and kindly notify us if you need to make any changes. You can
do this via email or contact us directly - whichever suits you best:

What if you need to make a claim?

Just call or email us, and we’ll help you through the process.

What else are we going to write to you about?

We may share some information about other takaful plans which may interest you.

Once again, thanks for choosing FWD Takaful Berhad. It takes trust from your side – and we appreciate that.

Yours Sincerely,

Salim Majid Zain

CEO, FWD Takaful Berhad
FWD Takaful Berhad, Registration No. 200601011780 (731530-M)
Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800
 Takaful Certificate Schedule
This schedule should be read together with your Plan Summary
Master Certificate No. GC000011 Commencement Date 08/12/2022
Master Certificate Owner FWD Takaful Berhad Expiry Date 08/12/2023
Product Name FWD eTerm Takaful Plan Issue Date 08/12/2022
Takaful Certificate Schedule No. EP264334

Details of Person Covered

Age Next Birthday
Name NRIC No. Covered Term Expiry Date
- Admitted
MUHAMAD IQBAL BIN NOOR AZIZI 28 950125146329 1 year 08/12/2023

Your contractual contribution (RM)

Mode Single Contribution Payment Term 1 Year
Certificate Contribution RM 22.30 Last Due Date 08/12/2023
12.5%
Applicable Wakalah fees on your contributions – Percentage from contribution
RM 2.79
Tabarru’ charge = Contribution minus Wakalah fee.

Your benefits
Benefits Sum covered Description

We will pay 100% of the sum covered, if you, as the Person Covered,
Death Benefit RM 10,000.00
die.

Total & Permanent Disability Benefit We will pay 100% of the sum covered if you, suffer from TPD. Please
RM 10,000.00
(TPD) - Accelerated refer to the Plan Summary for the definition of TPD.
We will pay additional 100% of the sum covered, if you, die or suffer
Accidental Death/TPD benefit RM 10,000.00 from TPD due to accident. Please refer to the Plan Summary for the
definition of an accident.
We will pay MYR 3,000 as funeral benefit if you die, upon receipt
Funeral Benefit RM 3,000.00
of the death certificate.

FWD Takaful Berhad, Registration No.: 200601011780 [731530-M]

Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
 Plan Summary –
FWD eTerm Takaful Plan
How to resolve a concern or complaint
We want to resolve any concerns or complaint you may have as quickly as possible. You should follow the steps below to
resolve your concern.

How to resolve a concern or complaint

Step 1 – Talk to us The first thing you should do is talk to one of our consultants about your concerns. Call our
Service Hotline at 1300 131 005. The consultant may be able to resolve your concern (Monday
to Friday 9am to 6pm, excluding weekends and public holidays).

The consultant will try to resolve your complaint as soon as possible.

Step 2 – Call or If you feel that your complaint has not been resolved, you can write to:
write to our
Complaints Unit FWD Complaints Unit Toll Free: 1300 131 005
Level 29 Menara Shell Tel: 03-2771 7888
211 Jalan Tun Sambanthan Brickfields Fax: 03-2710 7800
50470 Kuala Lumpur E-mail: support.my@fwd.com

We will respond to your complaint within 3 working days of us receiving it.

Step 3 – Seek an If we cannot resolve your complaint, you can choose to lodge a complaint with the
external review from Ombudsman for Financial Services (OFS).
the OFS
The OFS is a free, independent dispute resolution centre for the resolution of disputes involving
financial institutions and consumers.

You can lodge a complaint by post, fax, online, or in-person. The Ombudsman’s details are:
Level 14 Tel: 03-2272 2811
Menara Takaful Malaysia Fax: 03-2272 1577
No. 4, Jalan Sultan Sulaiman E-mail: enquiry@ofs.org.my
50000 Kuala Lumpur Website: www.ofs.org.my

The sum involved in the dispute must be within the jurisdiction of the Ombudsman.

Step 4 – Seek an If we cannot resolve your complaint, or if the OFS cannot resolve your complaint, you can also
external review from choose to lodge a complaint with the Bank Negara Malaysia Laman Informasi Nasihat dan
BNMLINK or Khidmat (BNMLINK or BNMTELELINK).
BNMTELELINK
BNMLINK provides face-to-face customer service to walk-in visitors on general enquiries and
public complaints. BNMLINK’s details are:

Laman Informasi Nasihat dan Khidmat Operating hours:

(BNMLINK) 9.00 a.m. - 5.00 p.m.
Ground Floor, D Block (Monday - Friday)
Jalan Dato’ Onn
50480 Kuala Lumpur

Contact Centre (BNMTELELINK) Operating hours:

Bank Negara Malaysia 9.00 a.m. - 5.00 p.m.
P.O. Box 10922 (Monday - Friday)
50929 Kuala Lumpur E-mail: bnmtelelink@bnm.gov.my
Tel: 1-300-88-5465 (1-300-88-LINK) SMS: 15888
(Overseas: 603-2174 1717) Fax: 603-2174 1515

FWD eTerm Takaful Plan 1

 Plan Summary –
FWD eTerm Takaful Plan
Summary of benefits available for your plan.

Benefit & Description

Benefit Description

100% of the sum covered less any donation amount (if applicable) will be
Death Benefit
paid, if you die while the Takaful Certificate Schedule is still active.

Additional 100% of the sum covered less any donation amount (if applicable)
Accidental Death Benefit will be paid, if you die due to an accident while the Takaful Certificate
Schedule is still active.

Total and Permanent 100% of the sum covered will be paid, if you suffer from TPD while the Takaful
Disability Benefit (TPD) Certificate Schedule is still active.

Additional 100% of the sum covered will be paid, if you suffer from TPD due
Accidental TPD Benefit
to an accident while the Takaful Certificate Schedule is still active.

RM3,000 will be paid as funeral benefit if you die, upon receipt of the death
Funeral Benefit
certificate.

A portion of the Sum Covered (as selected by you) will be donated to the
Donation of Sum Covered
charity organization (as selected by us and approved by our Shariah
(optional)
Committee) on your behalf, if you die.

FWD eTerm Takaful Plan 2

 Exclusions
The list below explains the exclusions, the situation where benefit will not be paid under
your certificate.

General Exclusion

Death Benefit
Death benefit will not be payable if the claim is due to the following cause:

We will not pay death benefit under this certificate if the claim arises from suicide
within one year from the start of the certificate.
Suicide

This applies regardless of your mental state.

Total and Permanent Disability (TPD) Benefit

TPD benefit will not be payable if the claim is due to the following causes:

We will not pay TPD benefit under this certificate if the claim arises from attempted
Attempted Suicide or self- suicide or a self-inflicted act by you within one year from the start of the certificate.
inflicted act
This applies regardless of your mental state.

We will not pay TPD benefit under this certificate if the claim arises, if you wilfully
Unlawful acts
participated in an unlawful act, or unlawful failure to act.

We will not pay TPD benefit under this certificate if the claim is a result of an act of
War
war (whether declared or not), coup, revolution, riot, or any similar event.

FWD eTerm Takaful Plan 3

 Starting, changing or ending
the takaful coverage
The section explains when the takaful coverage starts and ends, and how to make changes
to the Takaful Certificate Schedule.

Starting the Takaful Coverage

Your takaful coverage starts on the commencement date as stated in Takaful Certificate Schedule.

The certificate term is one year from the commencement date shown in the Takaful Certificate Schedule.

Changes to the Takaful Certificate Schedule

You can make the following changes to the Takaful Certificate Schedule at any time by submitting the request to FWD
Takaful Berhad (“FWD Takaful”, “we”) through customer portal:

■ Change the address and contact details;

■ Nominate one or more persons to receive the death benefit either as an executor or as a beneficiary under a
conditional hibah, as the case may be, as stated in the nomination form.

FWD Takaful will make such changes by giving you formal written notice (called an endorsement).

Cancellation & Termination of Takaful Coverage

15-day Free Look Period

If cancellation requested within 15 days after you have received the Takaful Certificate Schedule, the contributions paid
less medical examination fees incurred (if any), under the certificate will be refunded back to your Employees Provident
Fund (EPF) account.

Surrender of Takaful Certificate Schedule

The Takaful Certificate Schedule may be cancelled by submitting the request through customer portal. Any unutilised
Tabarru’ shall be refunded into your EPF account. If you attain age 55 and above or your EPF account is inactive, the
unutilised Tabarru’ will be payable to your bank account that you have provided to us.

Termination of Takaful Coverage

Your takaful coverage will automatically end on the earliest of the following dates.

■ The date we pay death benefit.

■ The date we pay TPD benefit.
■ The date when you reached the coverage expiry age.
■ The date we approve your request to surrender (terminate) their Takaful Certificate Schedule.
■ The date we are informed that the contribution deduction from your EPF account is unsuccessful.
■ The date we are told to terminate their Takaful Certificate Schedule by law or regulation.

FWD eTerm Takaful Plan 4

 Starting, changing or ending
the takaful coverage
Your takaful coverage will be terminated immediately and our liability regarding the takaful coverage will cease.

Termination of Master Certificate

FWD Takaful may terminate the Master Certificate. This termination will not affect your current takaful coverage.

We will give notice within reasonable time in writing to you that takaful coverage will not be renewed on the next renewal
date of Takaful Certificate Schedule after the date of Master Certificate ends.

The termination of the Master Certificate will not affect the claims happen before the termination of the Takaful
Certificate Schedule.

Re-participation of Takaful Coverage

You can re-participate in the similar coverage for subsequent years without underwriting by applying within 30 days
before your expiry date, subject to terms and conditions.

FWD eTerm Takaful Plan 5

 Making a claim

How to Claim

Contact our Service Hotline at 1300 131 005 to make a claim. Notification to FWD Takaful Berhad as soon as possible if a
claim is made under this Takaful Certificate Schedule.

FWD Takaful Berhad may request any additional information and documents from you or claimant if necessary. You or
claimant should make every effort to send the claim to us within 6 months of the disability or death being claimed for.

Claim payment is based on claim event and the benefit payable will be based on the Sum Covered stated in the Takaful
Certificate Schedule.

FWD eTerm Takaful Plan 6

 Contribution and fees
This section explains the contributions and fees applicable under the certificate.

Paying the Contribution

We will specify the contribution amount for the takaful coverage provided to you. The total contribution and mode of
payment applicable are stated in the Takaful Certificate Schedule.

You must pay the first contribution payment before the individual commencement date and subsequent contributions (if
applicable) are payable on the contribution due date according to the mode of payment.

What We Do with the Contribution

Wakalah Fee
We manage all takaful certificates on behalf of you and the other participants on the basis of wakalah.

The contributions paid for coverage is subject to a wakalah fee. The exact percentage and amount of the wakalah fee paid
is shown in your Takaful Certificate Schedule.

FWD eTerm Takaful Plan 7

 Important words and phrases
The list below explains the meanings of important words and phrases related to your
plan & benefits.

Words & Phrases Definition

An accident is the abrupt, violent, unexpected, and unwanted visible contact

Accident
between you and an external object or substance.

The following activities:

■ Transfer: The ability to get in and out of a chair without requiring

physical assistance.
■ Mobility: the ability to move from room to room without requiring
physical assistance.
■ Continence: The ability to voluntarily control bowel and bladder
Activities of daily living functions such as to maintain personal hygiene.
■ Dressing: The ability to put on and take off all necessary items of
clothing without requiring the assistance of another person.
■ Bathing and washing: The ability to wash in the bath or shower
(including getting in or out of the bath or shower) or wash by any
other means.
■ Eating: All tasks of getting food into the body once it has been
prepared.

Age Your age based on age next birthday.

The payments made by the takaful participants from which assistance to

Contributions
takaful participants is given and fees to the takaful operator are paid.

Coverage expiry age The age when your coverage ends.

An extra document attached to the certificate that outlines any adjustments

Endorsement
that we make to the certificate.

The date that the Takaful Certificate Schedule ends. The expiry date is shown
Expiry date
in the Takaful Certificate Schedule.

The date an eligible person becomes a person covered under the Master
Individual commencement date
Certificate as stated in the Takaful Certificate Schedule.

The date the first contribution is due and the date the Takaful Certificate
Issue date
Schedule starts. This date is shown in the Takaful Certificate Schedule.

Master Certificate The contract which details the terms and conditions under the takaful plan.

The Master Certificate Owner as stated in the Takaful Certificate Schedule

Master Certificate Owner and this plan summary who can exercise all rights, privileges and options
available under the Master Certificate.

FWD eTerm Takaful Plan 8

 Important words and phrases
A person who is qualified and licensed to practice western medicine and
registered with the authorities in Malaysia to practice treatment within the
Medical Practitioner
scope of licensing permitted by the authorities and through his training but
excluding you, your spouse, or your immediate family.

A person who is eligible to participate under the Master Certificate as the

Person covered, you, your
Person Covered stated in the Takaful Certificate Schedule.

Means Islamic law.

Any interpretations and decisions about Shariah regarding your certificate
Shariah
will be made by our Shariah Committee, and they are binding on us, Master
Certificate Owner and you.

The committee formed by us to make sure that our takaful business complies
Shariah Committee
with the Shariah principles.

The sum covered of your takaful coverage under the Master Certificate as
Sum covered
stated in the Takaful Certificate Schedule.

The document issued by us that verifies the takaful coverage granted to you. It
provides details includes the following:
■ certificate number;
Takaful Certificate Schedule ■ details of Master Certificate Owner and you;
■ details of contribution; and
■ sum covered.

FWD Takaful Berhad, who is the takaful operator and issuer of the Master
Takaful operator, we, our, us
Certificate and this Takaful Certificate Schedule.

For a person covered under age 61 (age next birthday) who is working for
remuneration when they first suffer an illness or injury:

Means the person covered has suffered an illness or injury which has caused
them to be unable to work for at least six months in a row, and to be totally
and permanently unable to engage for profit or reward in:
■ the occupation they were engaged in when the illness or injury first
happened; and
Total and Permanent Disability ■ any occupation they are suited to base on their education,
(TPD)
experience, or training.

For a person covered under age 61 (age next birthday) who is not working
for remuneration when they first suffer an illness or injury:

Means the person covered has suffered an illness or injury, and totally and
permanently unable to perform at least 3 of the activities of daily living
without the assistance of another person for at least six months in a row.

FWD eTerm Takaful Plan 9

 Important words and phrases

For any person covered up to age 61 (age next birthday):

Means the person covered has suffered the total and irrecoverable loss of:
■ the sight of both eyes; or
■ the sight of one eye and the loss of use of one limb at above the
ankle or wrist; or
■ both hands at or above the wrists; or
■ both feet at or above the ankles; or
■ one hand at or above the wrist and one foot at or above the ankle.

For the purpose of this totally and permanently disabled definition, the word
“permanent” means beyond the hope of recovery and verified by a qualified
medical practitioner.

FWD eTerm Takaful Plan 10

 FWD eTerm Takaful Plan – Benefit Illustration
FWD Takaful Berhad
Level 29 Menara Shell, 211 Jalan Tun Sambanthan Brickfields, 50470 Kuala Lumpur

A. SUMMARY
The Master Certificate Owner for this plan is FWD Takaful Berhad. Below summarises what this plan offers, the
person covered and how much it will cost to participate in this plan.

Details of your plan

Person covered MUHAMAD IQBAL BIN NOOR AZIZI
Sum covered RM 10,000.00
Age next birthday at entry 28
Gender Male
Coverage term 1 year
Single contribution RM 22.30
Wakalah fee 12.5% of contribution equivalent to RM 2.79

Benefits covered
Death Benefit We will pay 100% of the sum covered, if you, as person covered, die.
Total and Permanent Disability (TPD) We will pay 100% of the sum covered, if person covered suffers TPD. You may refer to the
Benefit (Accelerated) certificate for TPD definition.
We will pay additional 100% of the sum covered, if person covered dies or suffers TPD as a
Accidental Death/TPD Benefit
result of an accident. You may refer to the certificate for accident definition.
We will pay the RM3,000 immediately upon the receipt of the death certificate of the person
Funeral Benefit
covered.

B. BENEFIT ILLUSTRATION TABLE

Guaranteed Benefit
Certificate
Age Death/TPD benefit – due to non- Death/TPD benefit – due to Funeral benefit Donation to
year
accident* (RM) accident* (RM) (RM) charity** (RM)
28 1 10,000.00 20,000.00 3,000.00 N/A
*This is the amount of sum covered before deduction of any donation amount upon death benefit payment.
**This amount is doubled upon accidental death.

IMPORTANT:
 A. This plan is a pure protection plan with no cash value. If you cancel the certificate, you may only receive any unutilised
tabarru’.

 B. You should satisfy yourself that the plan serves your needs and that you can afford the contribution.

FWD Takaful Berhad, Registration No.: 200601011780 (731530-M)

Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
 
 
 Product Disclosure Sheet
Note: Please read this Product Disclosure Sheet before you decide to participate in FWD eTerm Takaful Plan.
You should also read the general terms and conditions.
Name of takaful operator: FWD Takaful Berhad (‘the Takaful Operator’)
Product name: FWD eTerm Takaful Plan
Sum covered: RM 10,000.00
Date: 08/12/2022
Master certificate owner: FWD Takaful Berhad

1.  What is this product about?

■ FWD eTerm Takaful Plan is a term takaful plan that offers you, as person covered, a protection upon your death or total and
permanent disability (‘TPD’), and an additional benefit if the death or TPD is due to an accident. We will also pay RM3,000 upon
your death as funeral expense benefit.

2.  What are the Shariah concepts applicable?

■ Wakalah: The contract where the participant appoints the Takaful Operator to manage the participants’ risk fund and agrees to
remunerate the Takaful Operator on pre-agreed basis for the services provided.
■ Tabarru’: A donation for the purpose of takaful.
■ Ju'alah: It is the reward to the Takaful Operator for the good performance of the participants’ risk fund it will be managing. The
Takaful Operator will be rewarded with a 50% share of the surplus from the participants’ risk fund and the remaining 50% will be
distributed to eligible participants.
■ Qard: An interest-free loan that we grant to the participants’ risk fund if it is in deficit. The loan is repayable from the future
surplus arising in the participants’ risk fund.

3.  What are the covers/benefits provided?

■ FWD eTerm Takaful Plan covers:

Your benefits
Person covered Sum covered Coverage term
MUHAMAD IQBAL BIN
RM 10,000.00 1 year
NOOR AZIZI
Please refer to the Benefit Illustration and/or Takaful Certificate Schedule (‘certificate’) for more details.

Benefits covered
Death Benefit We will pay 100% of the sum covered, if you, as person covered, die.
TPD Benefit We will pay 100% of the sum covered, if person covered suffers TPD. You may refer to the certificate for
(Accelerated) TPD definition.
Accidental Death/TPD We will pay additional 100% of the sum covered, if person covered dies or suffers TPD as a result of an
Benefit accident. You may refer to the certificate for accident definition.
Funeral Benefit We will pay the RM3,000 immediately upon the receipt of the death certificate of the person covered.

FWD Takaful Berhad, Registration No.: 200601011780 (731530-M)

Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
 
 
 4.   How much contribution do I have to pay?
■ The single contribution that you have to pay is: RM 22.30.

5.  What are the fees and charges that I have to pay?

■ The wakalah fee will be deducted from your contributions is 12.5% of contribution. Please refer to the Benefit Illustration for the
wakalah fees amount payable.
■ Your contribution less wakalah fees is the amount of Tabarru’ charge.

6.  What are some of the key terms and conditions that I should be aware of?
■ Importance of disclosure: You must disclose all material facts such as medical conditions, gender and state your age correctly.
■ Free-look period: If you aren’t completely satisfied with your certificate, and you haven’t made a claim under it, you have 15 days
from the date you receive your certificate to cancel it and receive your contributions. You or your nominee(s) will not be able to
claim under your certificate once it is cancelled.
■ Claim: You should tell us as soon as possible if you need to make a claim under your certificate.
■ Re-participation: You can re-participate in the similar coverage for subsequent years without underwriting by applying within 30
days before your expiry date, subject to terms and conditions.
■ Termination of certificate: You may terminate this certificate at any time by writing to us. Your certificate shall terminate
immediately upon the following events, whichever occurs first:
a) upon death of person covered;
b) upon full payment of TPD benefit;
c) upon your request to cancel (terminate) your certificate; or
d) upon unsuccessful contribution payment from your Employees Provident Fund (‘EPF’) account.
Note: This list is non-exhaustive. Please refer to the master certificate for the terms and conditions under this plan.

7.  What are the limitations and major exclusions under this certificate?
■ Your certificate has certain exclusions, meaning situations where we won’t pay a benefit. We list below the exclusions that apply to
the benefits under your certificate.
■ We will not pay death benefit if the death is due to suicide regardless of the mental state of the person covered.
■ We will not pay TPD benefit due to the following causes:

Exclusion Description
We will not pay TPD benefit under this certificate if the claim arises from attempted suicide or a self-
Attempted suicide or self- inflicted act by the person covered.
inflicted act This applies regardless of the person covered’s mental state. If this happens, the certificate will be
terminated.

We will not pay TPD benefit under this certificate if the claim arises because the person covered
Unlawful acts
wilfully participated in an unlawful act, or unlawful failure to act.

We will not pay TPD benefit under this certificate if the claim is a result of an act of war (whether
War
declared or not), coup, revolution, riot, or any similar event.
 Note: Please refer to the master certificate for the full list of limitations and exclusions under this plan.

FWD Takaful Berhad, Registration No.: 200601011780 (731530-M)

Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
 
 
 8.  Can I cancel my certificate?
■ Yes, you can cancel (terminate) your certificate at any time. If you cancel your certificate, any unutilised tabarru’ will be refunded
to your individual EPF account and your cover will end from the date we cancel your certificate.
■ If you attain age 55 and above or your EPF account is inactive, we will refund any unutilised tabarru’ into your bank account that
you have provided to us.

9.  What do I need to do if there are changes to my/my nominee(s) contact details?

■ It is important that you inform us of any change in your/your nominee(s) contact details to ensure all correspondences reach
you/your nominee(s) in a timely manner.

10. Where can I get further information?

■ Should you require additional information, please visit fwd.com.my.
■ If you have any enquiries, please contact us at:

FWD Takaful Berhad

(Licensed under Islamic Financial Services Act 2013 and regulated by Bank Negara Malaysia)
 
 Head Office : Level 29 Menara Shell
  211 Jalan Tun Sambanthan Brickfields
  50470 Kuala Lumpur
 Service Hotline : 1300 131 005
 Tel : 03-2771 7888
 Fax : 03-2710 7800
 E-mail : support.my@fwd.com

    We will respond to your query within 3 working days of us receiving it.

11.  Other similar types of cover available

     You may contact us directly for other similar types of cover currently available.

IMPORTANT NOTICE:
YOU MUST CHOOSE THE TYPE OF CERTIFICATE THAT BEST SUITS YOUR PERSONAL CIRCUMSTANCES. YOU SHOULD READ AND
UNDERSTAND THE CERTIFICATE OR CONTACT US DIRECTLY FOR MORE INFORMATION.
 
The information provided in this disclosure sheet is valid as at 08/12/2022.

FWD Takaful Berhad, Registration No.: 200601011780 (731530-M)

Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
 
 
 Application
FWD eTerm Takaful Plan

IMPORTANT NOTE:
Pursuant to Paragraph 5 of Schedule 9 to the Islamic Financial Services Act 2013 (“IFSA”), you are required to answer fully and
accurately or correctly with reasonable care not to make any misrepresentation when answering any questions asked by FWD
Takaful Berhad (FWD Takaful).It is your duty to disclose fully and correctly matters that you know to be relevant to the decision
of FWD Takaful in accepting the risk, and determining the rates and terms to be applied; otherwise it may result in voidance
of the Takaful contract, refusal of claims or change of terms. This duty of disclosure shall continue until the time the Takaful
contract is entered into, varied or renewed. This is a common application form and you are at liberty to participate or not to
participate in any of the several products offered by this application form. If you do not understand your obligations as stated
above or if you need further explanation, please contact FWD Takaful.

Proof of age is required prior to payment of Takaful benefits under this Certificate.

Person Covered Personal Information

Name as shown in NRIC MUHAMAD IQBAL BIN NOOR AZIZI

NRIC Number
950125146329
EPF Number
22357360

Gender Smoking Status

M Non-Smoker
Date of Birth
25-01-1995

Age Marital Status

28 Single

Residential Address A-5-31, BLOK A

RESIDENSI MELOR BANGI
JALAN 5E/1, SEKSYEN 5
43650 BANDAR BARU BANGI
SELANGOR DARUL EHSAN,MALAYSIA

Mailing Address A-5-31, BLOK A

RESIDENSI MELOR BANGI
JALAN 5E/1, SEKSYEN 5
43650 BANDAR BARU BANGI
SELANGOR DARUL EHSAN,MALAYSIA

Email Address
mohd.iqbal95@gmail.com

Mobile Number
60-136087636
Home Number
60-136087636

Page 1 of 8
FWD Takaful Berhad, Registration No: 200601011780 [731530-M]
Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
Application

Donation of Donation
Contribution Sum Covered Contribution Payment
Product Sum Covered Amount
Term (RM) (RM) Frequency
(%) (RM)
FWD eTerm Single
Takaful Plan 1 10,000 22.30 0% 0 Contribution

Person Covered Health Information

1. I have never had, received medical advice or treatment for: cancer, chest pain, heart X Yes No
attack, stroke, high blood pressure, diabetes, Hepatitis B or C, HIV infection, loss of
hearing, loss of vision (other than vision corrected by prescription lens), any physical
disability or any condition of the heart, lungs, liver, kidney, digestive system, mental or
nervous system.

2. In the last 2 years, I have not had any other condition resulting in repeated consultations X Yes No
or follow-up with a doctor, specialist or hospital.

3. I am not continuously receiving medication for 14 days or more. X Yes No

4. I am not currently planning or been advised, to consult a doctor (aside from routine X Yes No
health check).

5. I am not undergoing investigation or awaiting the results of medical tests or follow-ups X Yes No

Page 2 of 8
FWD Takaful Berhad, Registration No: 200601011780 [731530-M]
Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
 Application
I declare and agree on behalf of myself and any person or persons who may have or claim any interest in this application form,
that:

1. I have read the Product Disclosure Sheet and Benefit Illustration and fully understood the contents of the Product
Disclosure Sheet and Benefit Illustration.
2. I declare that:
a. I am aware that it is my pre-contractual duty of disclosure that I must exercise reasonable care not to misrepresent i.e.
to give false answers and/or information when answering any questions asked by FWD Takaful and that I am to answer
the questions fully and accurately and/or correctly;
b. I have fully and accurately answered all the questions in this application form and the other questions asked by FWD
Takaful, if any, after having fully read and understood the questions;
c. I am aware that I must inform FWD Takaful of any change to the answers given in this application form if the change
occurred after I have submitted this application form but before the Takaful contract is entered into;
d. I fully understand that my answers and/or statements given in respect of the questions asked by FWD Takaful,
completed by me in this application form are relevant to FWD Takaful in deciding whether to accept my application
form or not and the rates and terms to be applied; and
e. I am aware that if the information given by me is not accurate or correct, the Takaful Certificate may be voided or
terminated, my claim denied or reduced, or the terms of the Takaful Certificate changed or varied.
3. I will keep FWD Takaful updated of any change to my personal information and person covered information as soon as
practicable.
4. I agree that neither FWD Takaful nor its employees shall be liable for any direct or indirect loss or damage due to my
inaccuracy or incompleteness in the personal information provided to FWD Takaful and shall include but shall not be
limited to personal details of transactions with or through FWD Takaful whether within or outside Malaysia involving any
party.
5. I hereby agree that my Takaful Contribution(s), as required by FWD Takaful, is to be payable from my Employee Provident
Fund (EPF) account as stated in this application form.
6. I confirm that this application form is independent of any statement made by myself to whom I have given no other
information, except those stated in this application form, and that to the best of my knowledge and belief. I further
acknowledge that all the terms and conditions have been fully explained to me and the answers provided are the actual
information disclosed by me.
7. I understand that upon receipt of the Takaful Certificate from FWD Takaful, I will have a 15-day free look period to evaluate
the suitability of the plan participated in. In the event that I wish to cancel the Takaful Certificate during this period, I may
do so by giving FWD Takaful written notice of my intention for cancellation. The contributions paid under the certificate
will be refunded back to my EPF account.
8. I understand that the coverage will only be effective upon receipt of the appropriate Takaful Contribution payment and
approval by FWD Takaful of this application and the relevant Takaful Certificate is issued and delivered to me pursuant to
this application during my lifetime and in good health. (Please ensure that you will receive and will be keeping the receipt
of payment from FWD Takaful or your Family Takaful Certificate (as the case may be) as proof of Takaful Contribution(s)
payment).
9. I confirm that I have been informed of the consequences of failure to pay the Takaful Contribution(s) within the grace
period.
10. I confirm my understanding on the provisions for nomination, including the importance of making a nomination and its
implications. I have also known to nominate a nominee(s) and ensure that the nominee(s) is aware of the Family Takaful
Certificate that I have participated in.
11. I agree to participate in the Takaful plan pursuant to this application form based on the principle of Takaful and pay the
required Takaful Contribution(s) which will be credited in the Participants’ Risk Fund (PRF) as a Tabarru’ (donation). It is to
be used for the Takaful coverage and for mutual financial aid and assistance to other participants in times of misfortune.
12. I understand that I am also entitled to receive any unutilised Tabarru’ (donation) of the Takaful Contribution(s) allocated in
the PRF, provided that no claim has been made, in the event of surrender. FWD Takaful will refund the unutilised Tabarru’
(donation) into my EPF account. If I attain age 55 and above or my EPF account is inactive, the refund will be payable to
my bank account.
13. I agree to appoint FWD Takaful based on the Wakalah (agency) principle to manage my Takaful Contribution(s) in the PRF
in accordance with Shariah principles.
14. I allow FWD Takaful to deduct a certain percentage (%) of the Takaful Contribution(s) as a Wakalah (agency) fee to FWD
Takaful for the services rendered and any other charges as stipulated in the Family Takaful Benefit Illustration.

Page 3 of 8
FWD Takaful Berhad, Registration No: 200601011780 [731530-M]
Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
 Application
15. I agree that any distributable Surplus will be shared between eligible participants and FWD Takaful in the ratio of 50:50.
FWD Takaful will transfer any distributable surplus amount to my bank account.
16. I agree that the percentage of my sum covered as donation amount stated in this proposal form will be donated to the
registered charitable organizations as approved by FWD Takaful Shariah Committee.
17. I agree that FWD Takaful have the right to freeze or seize any monies received or payable under my certificate:
a. at the order of the relevant authorities; or
b. if FWD Takaful discover, or if FWD Takaful have reasonable suspicion that, I am sanction under any competent
authorities recognised by us, for money laundering activities or activities relating to financing terrorism; under the
Anti-Money Laundering, Anti-Terrorism Financing and Proceeds of Unlawful Activities Act 2001.
If this happens, FWD Takaful will end my certificate and the cover under it immediately. FWD Takaful will deal with all
contributions paid and all amounts payable under my certificate in any manner we deem fit, which may include handing
it over to the relevant authorities.
18. I confirm that I am Malaysian citizen residing in Malaysia and holding a valid NRIC.

Personal Data Protection

I consent to the disclosure of my personal details for application of this Takaful certificate and its related services. I confirmed
that I have read and understood the Personal Data Protection Notice as made available at www.fwd.com.my. I am aware that
this consent can be withdrawn at any time by giving a written notice to FWD Takaful.

I agree for FWD Takaful to share my personal information with third parties for the marketing and promotional purposes.

This is a system generated application form. No signature is required.

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FWD Takaful Berhad, Registration No: 200601011780 [731530-M]
Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
 Application
Notice to Customers Relating to the Personal Data Protection Act 2010

FWD Takaful Berhad ("the Takaful Operator") is committed to the implementation and compliance with the provisions of the
Personal Data Protection Act 2010 of Malaysia ("the Act"). This Notice is issued pursuant to the requirements of the Act. In
this context, the Personal Data Protection Officer is responsible for coordinating and overseeing compliance with the Act and
the upholding of the Personal Data Protection Principles set out in the Act.

This Notice applies to all products and services provided by the Takaful Operator and sets out how the Takaful Operator may
collect, use, process, and disclose your personal information.

1. From time to time, it is necessary for you to supply the Takaful Operator, its affiliates, agents and representatives acting on
its behalf, or any selected third party (within or outside of Malaysia, including retakaful and claims investigation companies
and industry associations and federations), with personal information and particulars in connection with its services and
products as well as for compliance with any laws, guidelines or requests issued by regulators or any other governmental
authority. Apart from data provided by you, the Takaful Operator may obtain and/or verify your data with any third party,
including but not limited to, risk surveyors, medical practitioners, hospitals or medical institutions that have attended to you.
Failure to supply such personal data or to agree to the Takaful Operator’s collection of such personal data may result in the
Takaful Operator being unable to provide or continue to provide these services and products to you, including the termination
of your Takaful Certificate, in order to comply with any laws or guidelines issued by regulators or any other governmental
authorities.

2. Personal information and particulars requested may include information concerning your personal details (such as name,
age, identity card number, passport number, gender, date of birth, race, nationality, citizenship and marital status), contact
details (such as address, email and phone numbers), family information (such as marital status, name of your spouse or child
or immediate family members), occupation details (such as your employer’s name, annual income, job title, nature and
description of job) and financial details (such as bank account number and credit card number).

3. In addition, the Takaful Operator may from time to time request for:
(i) information relating to your medical records or health condition in general from you or any medical practitioner,
hospital, medical institution or any person (whether incorporated or not) who has ever attended to you or has
records regarding your health or medical condition; and/or
(ii) such other personal information that may be relevant for the Takaful Operator to consider your application for
Takaful cover or the continuous provision of the Takaful Certificate and/or Takaful services under a Takaful
Certificate issued by the Takaful Operator. This includes but is not limited to tax information about you, your
designated beneficiary(ies) or any person entitled to any benefits/payment under the Takaful Certificate.

4. Personal information and data may also be collected from:

(i) other sources in the ordinary course of the continuation of the Takaful relationship, for example, when you write
cheques or provide your credit card or bank account details to the Takaful Operator for contribution payment
of the Takaful coverage or when you nominate a nominee to receive Takaful benefits payable under a Takaful
Certificate; and/or
(ii) a person acting on behalf of the individual whose personal data is provided and if you provide personal data on behalf
of any person, you hereby confirm that you are either their parent or guardian or you have obtained that person’s
consent to provide that personal data for use by the Takaful Operator; and/or
(iii) from other sources (including from publicly available information).

Data may also be generated, processed or combined with other information available to the Takaful Operator or any
of the Takaful Operator’s subsidiaries, holding companies, associated or affiliated companies and companies
controlled by or under common control with the Takaful Operator (collectively, the “Group”).

5. The purposes for which your personal data may be used and/or processed are as follows:
(i) providing our services and products to you, including administering, maintaining, managing and operating such
services and products;
(ii) processing, assessing and determining any applications or requests made by you in connection with the Takaful
Operator’s services or products and maintaining your account and/or Takaful Certificate with the Takaful
Operator;
(iii) developing Takaful financial services and products;
(iv) developing and maintaining credit and risk related models;
(v) processing payment instructions;

Page 5 of 8
FWD Takaful Berhad, Registration No: 200601011780 [731530-M]
Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
 Application
(vi) determining any indebtedness owing to or from you, and collecting and recovering any amount owing from you
or any person who has provided any security or other undertakings for your liabilities;
(vii) exercising any rights that the Takaful Operator may have in connection with our services and/or products;
(viii) carrying out and/or verifying any eligibility, credit, physical, medical, security, underwriting and/or identity
checks in connection with our services and products;
(ix) any purposes in connection with any claims made by or against or otherwise involving you in respect of any of our
services or products, including, making, defending, analysing, investigating, processing, assessing, determining,
responding to, resolving or settling such claims;
(x) performing policy reviews and needs analysis (whether or not on a regular basis);
(xi) meeting disclosure obligations and other requirements imposed by or for the purposes of any laws, rules, regulations,
codes of practice or guidelines (whether applicable in or outside Malaysia) binding on the Takaful Operator or any
other member of the Group, including making disclosure to any legal, regulatory, governmental, tax, law enforcement
or other authorities (including for compliance with sanctions laws, the prevention or detection of money laundering,
terrorist financing or other unlawful activities) or to any self-regulatory or industry bodies such as federations or
associations of insurers/ Takaful operators;
(xii) for any corporate exercise or transactions relating to the Takaful Operator e.g. sale and purchase of assets,
reorganisations or amalgamation or collaboration;
(xiii) for statistical or actuarial research undertaken by the Takaful Operator or any member of the Group; and
(xiv) fulfilling any other purposes directly related to (i) to (xiii) above;

6. Personal data will be kept confidential, but to facilitate the purposes set out in paragraph 5 above, the Takaful Operator may
transfer, disclose, grant access to or share personal data with the following:
(i) other members of the Group;
(ii) any person or company carrying on Takaful-related and/or retakaful-related business which is engaged by the
Takaful Operator in connection with the Takaful Operator's business;
(iii) any physicians, hospitals, clinics, medical practitioners, laboratories, technicians, loss adjustors, risk
intelligence providers, claims investigators, legal advisors and/or other professional advisors engaged in
connection with the Takaful Operator's business;
(iv) any agent, contractor or service provider providing administrative, distribution, credit reference, debt
collection, telecommunications, computer, call centre, data processing, payment processing, printing,
redemption or other services in connection with the Takaful Operator's business;
(v) any official, regulator, ministry, law enforcement agent or other person (whether within or outside Malaysia) to
whom the Takaful Operator or another member of the Group is under an obligation or otherwise required or
expected to make disclosures under the requirements of any law, rules, regulations, codes of practice or
guidelines (whether applicable in or outside Malaysia); and/or
(vi) third parties involved in any corporate exercise or transactions relating to the Takaful Operator e.g. sale and
purchase of assets, reorganisations or amalgamation or collaboration.

7. Your personal data may be transferred or disclosed to any assignee, transferee, participant or sub-participant of all or
any substantial part of the Takaful Operator's business.

8. The Takaful Operator is only allowed to: (i) use your personal data in direct marketing; or (ii) provide your personal data
to another person or company for its use in direct marketing, if you provide your consent or do not object in writing.

9. In connection with direct marketing, the Takaful Operator intends:

(i) to use your name, contact details, services and products portfolio information, financial background and
demographic data held by the Takaful Operator from time to time in direct marketing to market the following classes
of services and products offered by the Takaful Operator, other members of the Group and/or our business partners
(being providers of the product and services described below):
a) Takaful services and products;
b) wealth management services and products;
c) pensions, investments, brokering, financial advisory, financial services and products;
d) health-check and wellness services and products;
e) media, entertainment and telecommunications services;
f) reward, loyalty or privileges programmes and related services and products; and
g) donations and contributions for charitable and/or non-profit making purposes; and
(ii) to provide your name and contact details to any members of the Group and/or our business partners for their
use in direct marketing the classes of services and products described in paragraph 9(i) above (including, in the
case of our business partners, for money or other commercial benefit).

Page 6 of 8
FWD Takaful Berhad, Registration No: 200601011780 [731530-M]
Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
 Application
10. If you do NOT wish the Takaful Operator to use your personal data in direct marketing or provide your personal
data to other members of the Group and/or our business partners for their use in direct marketing, (in paragraph 9
above) you may write to the Personal Data Protection Officer of the Takaful Operator at the address below to opt
out from direct marketing at any time.

11. To facilitate the purposes set out in paragraphs 5 and 9 above, the Takaful Operator may transfer, disclose, grant
access to or share your personal data with the parties set out in paragraphs 6 and 9(ii) and you acknowledge that those
parties may be based outside Malaysia and that your personal information and personal data may be transferred to
places where there may not be in place data protection laws which are substantially similar to, or serve the same
purposes as, the Act.

12. Under the Act:

(i) you have the right to request access to your personal data held by the Takaful Operator and request correction
of any of your personal data which is incorrect or to limit the processing of your personal data; and
(ii) the Takaful Operator has the right to charge you a reasonable fee for processing and complying with your data
access or correction request.

13. Requests for access to or correction of your personal data should be made in writing to the Personal Data Protection
Officer of the Takaful Operator at the address below.

14. The Takaful Operator may review and update this Notice from time to time to reflect changes in the law, changes in
the business practices, procedures and structure of our Takaful Operator, and changes in the community’s privacy
expectations. It is not generally feasible to notify you of changes to this Notice and as such, you can log on to our
website at www.fwd.com.my/PDPA to obtain the latest version of the Notice at any time.

15. Accuracy of Personal Information

The Takaful Operator will ensure the accuracy of all personal data collected and processed by the Takaful Operator.
Appropriate procedures are implemented so that all personal data is regularly checked and updated to ensure that it is
reasonably accurate having regard to the purposes for which that data is used. In so far as personal data held by the
Takaful Operator consists of statements of opinion, all reasonably practicable steps are taken to ensure that any facts
cited in support of such statements of opinion are correct.

The Takaful Operator will at all times endeavour to ensure the accuracy of personal data held by the Takaful Operator,
and if such personal data is transferred to third parties, it will notify that third party of any correction to be made.

16. Retention of Personal Information

No personal data is kept for longer than is necessary and that the Takaful Operator will comply with all statutory and
regulatory requirements in Malaysia concerning the retention of personally identifiable information.

Your personal data may be collected via, and stored in, an electronic or mobile application (FWD Smart) (the “App”).

17. Data Security

The Takaful Operator will ensure an appropriate level of protection for personal data in order to prevent unauthorized
access, processing or other use of that data, commensurate with the sensitivity of the data and the harm that would be
caused by unauthorized access to that data. It is the practice of the Takaful Operator to achieve appropriate levels of
security by restricting physical access to data, providing secure storage facilities and incorporating security measures into
equipment in which data is held. Measures are taken to ensure the integrity, prudence and competence of persons having
access to personal data and personal data is only transmitted by secure means.

In addition, the Takaful Operator takes prudent security measures to ensure personal data collected via the App are
stored and transmitted under protection.
(i) For mobile app development, the App is developed by secure coding and annual penetration testing is
conducted by third party security professionals.
(ii) The personal data collected via the App is stored in an encrypted database.
(iii) Data transfers between the Takaful Operator and the App are made in SSL secured connection and valid session
key management is in place to ensure unauthorized access is restricted and prevented.

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FWD Takaful Berhad, Registration No: 200601011780 [731530-M]
Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my
 Application
(iv) A multi-layered defense system is used in the Takaful Operator’s data centre to secure transmission and ensure
effective data protection is in place.

18. Use of Cookies and Third Party Links

The Takaful Operator’s website may include hyperlinks to third party websites. The Takaful Operator has no control over the
content, accuracy, opinion expressed, and other links provided at these third party websites or how these third party websites
deal with your personal data. You should visit these third party websites for details of their privacy policies in relation to their
handling of your personal data.

The Takaful Operator may use "cookies" to improve our internet service to you. Cookies are small data files that are automatically
stored on your web browser in your computer that can be retrieved by the Takaful Operator’s website. Cookies enable the
Takaful Operator’s website to remember you and your preferences when you visit the website and enable us to tailor the website
to your needs. The information collected by cookies is anonymous visitor’s personalised settings information and
contains no name or address information or any information that will enable anyone to contact you via telephone, e-
mail or any other means. No customer personal data is stored in cookies. However, you can disable cookies by changing
the settings of your web browser.

In case of discrepancies between the English and Bahasa Melayu versions, the English version shall apply and prevail.

Further enquiries regarding the Takaful Operator's Personal Data Protection Policy and Practices may be directed to:

The Personal Data Protection Officer

FWD Takaful Berhad
Level 29 Menara Shell
211 Jalan Tun Sambanthan Brickfields
50470 Kuala Lumpur
Tel: 1300 13 7988

Page 8 of 8
FWD Takaful Berhad, Registration No: 200601011780 [731530-M]
Level 29 Menara Shell, 211 Jalan Tun Sambanthan, Brickfields, 50470 Kuala Lumpur | (T) 03 2771 7888 | (F) 03 2710 7800 | fwd.com.my