E-Receipt

Acknowledgement No. : AF23230847

Receipt No : 107*2023034638
Payment Date : 20 Jun 2023 4:31:44AM
Pay Mode : WEB FPX @ Corp Website

SHIRAJ SHAH BIN SUBAHAN

72-A, JALAN 35, SELAYANG BARU
BATU CAVES
68100 BATU CAVES

Application/Certificate No : Z184084022
Participant Name : SHIRAJ SHAH BIN SUBAHAN
Person Covered : SHIRAJ SHAH BIN SUBAHAN

Payment Description Due Date Amount (RM)

Contribution 20 May 2023 RM 194.22

Next Due Date / Tarikh Seterusnya : 20 Jun 2023

Payable / Dibayar : 006Y03M

Agent : AZLINA BINTI ABDUL MUIS

Payment received by Zurich Takaful Malaysia Berhad under the application for Takaful Family
Coverage will be treated as deposit until the application is approved. When we receive the application
form with the deposit, we will issue interim coverage to the applicant applying for coverage, subject to
terms and conditions as per below:
Terms & Conditions :
a. Acceptance of payment is subject to the terms and conditions of the Takaful certificate,
application forms or any requirements or conditions set by the company.
b. Total benefits of the interim Takaful Family Coverage with effect on the applicant applying for
coverage will not exceed RM500,000.
c. If the application for Takaful coverage is not accepted as stated in paragraph (a), or the applicant
applying for coverage requests for cancellation, no Takaful coverage will take effect and the
contribution will be returned.
d. Should the Company offer Takaful coverage other than those applied at the standard contribution
rate and the applicant accepts the offered Takaful coverage within the stipulated time frame
prescribed by the company, these payments shall apply as the first contribution and the Takaful
coverage certificate will take effect.
e. When coverage for the Takaful certificate takes effect, payment for the contribution is
non-refundable, except for the further amount required to provide the maximum period of Takaful
coverage for this receipt.
f. Death of applicants applying for coverage must be caused directly and solely by accidental means
as defined in paragraph (g) below and subject to exemptions in the Takaful Coverage Plan applied
for.
g. Accidental is defined as a sudden, unintentional, unexpected, unusual and specific in time and
place identified, to be independent of any other reason, as the only reason for bodily injury.
h. Interim coverage commences from the date of this receipt and is effective for 90 days from the date
of this receipt (inclusive).
i. Notwithstanding paragraph (h), this interim coverage will terminate on the date that the company:
(i)issues a Takaful certificate (ii)declines the application for Takaful family
(iii)makes a counter offer (iv)requests for further deposit, or (v)requests for insurable
interest,whichever is earlier.
This is computer generated document. No signature required.
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