Allianz General Insurance Company (Malaysia) Berhad (200601015674)(735426-V)

No. 374, Ground & 1st Floor, Jalan Melaka Raya 6

75000 Melaka

Our Ref : VMA9037198

07 APRIL 2023

EON AUTO MART SDN BHD

NO.37, JALAN IKS M8,
TAMAN IKS MERDEKA,BATU BERENDAM
73550 MELAKA
MELAKA

Dear Sirs

REF: INSURED : SITI NOOR AISHAH A ROHMAN

POLICY NO. : 22VMA0025640-00
ACCIDENT TO VEHICLE NO. VJH3487 ON 18/02/2023

We refer to our representative's recent inspection of the above mentioned vehicle and our repair recommendation is as follows:-.

Parts and Labour RM 4,174.60

Less excess 0.00
Less excess 2(f) 0.00
4,174.60
* Please note that the offer amount includes system usage of RM15.00 paid on our behalf.

This offer is only valid once we have verified all relevant documents and the validity of the claim is confirmed. We reserve the right to
investigate/repudiate or rescind this offer if the claim is not in order. You must comply with the requirements of the Road Transport Act
and its subsidiary legislations in carrying out the repairs.

Upon completion of repairs to the satisfaction of our Insured, kindly collect the duly signed discharge voucher and excess amount (as
stated) from Insured. You may then send us the bill for RM4,174.60 together with the duly signed Discharge Voucher for our attention.
Please be informed that your compliance of the above is condition precedent to our liability to pay your bill.

Any comments or objection raised pertaining to the repair will not be regarded after seven (7) days hereof and the company shall
presume that the offer is accepted by all concerned.

Thank you.

Yours faithfully,

ALLIANZ GENERAL INSURANCE COMPANY (MALAYSIA) BERHAD

MENMIT SINGH TANJIT SINGH

(This is a computer generated form, no signature required.)

Note: For offer amount above RM5,000.00, you are required to submit reinspection photographs on the repaired vehicle for our further
action.
cc Insured - Kindly take note that upon your satisfaction of the repairs, please sign the attached Discharge Voucher and
pass them to the repairer concerned at the time you collect the vehicle.

HEAD OFFICE - CLAIMS CUSTOMER SERVICE

Level 21, Menara Allianz Sentral Tel: 03-2264 1188
203 Jalan Tun Sambanthan 03-2264 0688
Kuala Lumpur Sentral Fax: 03-2264 0402
50470 Kuala Lumpur Website: www.allianz.com.my
Allianz Arena, Ground Floor, Block 2A,
Plaza Sentral, Jalan Stesen Sentral 5, Allianz Contact Centre : 1 300 22 5542
Kuala Lumpur Sentral Fax: 03-2264 0602
Email:
50470 Kuala Lumpur
customer.service@allianz.com.my
Allianz General Insurance Company (Malaysia) Berhad (200601015674)(735426-V)
No. 374, Ground & 1st Floor, Jalan Melaka Raya 6
75000 Melaka

MOTOR CLAIM DISCHARGE

INSURED : SITI NOOR AISHAH A ROHMAN VEHICLE REGN. NO : VJH3487

CLAIM NO : VMA9037198 POLICY NO : 22VMA0025640-00

I/We confirm that I/we have taken delivery of Car/Lorry/Motor Cycle Registration No. VJH3487 from the repairer, Messrs
EON AUTO MART SDN BHD and that all repairs as a result of an accident in which the said vehicle was involved on or
about the 18 day of February 2023 have been completed to my/our satisfaction, and I/we have no further claims on the
above Insurers in respect thereof.

It is hereby agreed and understood that upon settlement of this claim the said Insurer will be subrogated to all my/our
rights and remedies in respect of the said damage and will be authorized to make use of my/our name for the purpose of
any proceedings or otherwise which the said Insurers deem fit to take for the enforcement of such rights or remedies and
accordingly I/We undertake to furnish all documents and correspondence and to make such affidavits or declarations and
to give and generally render such assistance as the said Insurer may require from time to time in connection with any
such proceedings.

Dated ___________day of ____________(Month) _________ (Year)

WITNESS
Signature : Signature :
I/C No : I/C No : 930730065502
Name : Name : Siti Noor Aishah BintiA Rohman
Address : Address : no 31 lorong 6 taman tas
25150 kuantan pahang

Note: Please note the warranty period should based on manufacturer standard warranty for any unsatisfactory
repairs from the date of this duly signed Discharge Voucher.

*THIRD PARTY VERIFICATION

I_________________________NRIC No.______________________of____________________________
Hereby certify that the customer's / beneficiary's original NRIC / Business Registration Cerificate was verified and
authenticated prior to / at the time of payment of monies due under this claim. I further confirm that the relevant
documents were sighted and verified and there is no reason to suspect money laundering or financing of terrorism.

____________________________________
Signature
Date

Note: For insurance policies with annual premium exceeding RM50,000.00 and RM100,000.00 in respect of individual and
group policies respectively, a copy of the verified documents have been retained for record purposes.

*Third Party herein refers to an employee / an Agent of Allianz General Insurance Company (Malaysia) Berhad / a Broker /
an Adjuster / a Workshop Personnel acting on behalf of the insurers.

HEAD OFFICE - CLAIMS CUSTOMER SERVICE

Level 21, Menara Allianz Sentral Tel: 03-2264 1188 Allianz Arena, Ground Floor, Block 2A,
203 Jalan Tun Sambanthan 03-2264 0688 Plaza Sentral, Jalan Stesen Sentral 5, Allianz Contact Centre : 1 300 22 5542
Kuala Lumpur Sentral Fax: 03-2264 0402 Kuala Lumpur Sentral Fax: 03-2264 0602
Email:
50470 Kuala Lumpur Website: www.allianz.com.my 50470 Kuala Lumpur
customer.service@allianz.com.my
Allianz General Insurance Company (Malaysia) Berhad (200601015674)(735426-V)
No. 374, Ground & 1st Floor, Jalan Melaka Raya 6
75000 Melaka

Claim No: VMA9037198 Date: 07/04/2023

Repairer: EON AUTO MART SDN BHD
REFERENCE
Insured: SITI NOOR AISHAH A ROHMAN Policy No: 22VMA0025640-00
Date of Loss: 18/02/2023 Nature of Claim: OD
Sum Insured: RM 126,000.00
Est. Duration of
7 days
Repair:
DESCRIPTION & IDENTIFICATION OF VEHICLE
PICKUP - 4 DR
Reg. No: VJH3487 Type:
DBL.CAB
Make & Model: MITSUBISHI TRITON 2019 ON, 4 DR PICKUP DBL.CAB Reg. Date: 15/08/2022
2.4 VGT PREMIUM 178BHP (A) [01/19-]
Engine No: 4N15UJL5077 Chassis No: MMBJLKL10PH017545
REPAIR DETAILS
Recommended Parts
No. Qty Part No. Particulars Src Condition Svg %Depr Amount

1 1 6400HW220P *FACE, FR BUMPER F Scratched - 0.00 Replace F

2 1 5220AG83 *FENDER, FR LH F Slightly - 0.00 Repair
Duplicated bent
3 1 6407A335 *BUMPER GARNISH FR LH UPPER F Broken - 0.00 Replace F
4 1 6407A337 *BUMPER GARNISH FR LH LOWER F Broken off - 0.00 Replace F
5 1 8315A059 *LAMP ASSY, T/SIG, FR LH F Scratched - 0.00 Replace F
6 1 6402A534 *GRILLE, FR BUMPER F Cracked - 0.00 Replace F
7 1 5370C153 *SHILED, FR WHEELHOUSE SPLASH,FR LH F Cut - 0.00 Replace F
8 1 5370C149 *SHILED, FR WHEELHOUSE SPLASH,FR LH F Cut - 0.00 Repeat
9 2 MU001623 *CLIP, FR BUMPER F Necessary - 0.00 Replace F
10 1 6400J287 *BRACKET, FR BUMPER SUPPORT LH F Serviceable - 0.00 Reuse
Duplicated
Supplementary #1
11 1 6400J287 Bumper Front Bracket Support LH F Cracked - 0.00 Replace F
12 1 5220AG83 Fender Front LH F Slightly - 0.00 Repair
bent
Supplementary #2
13 1 *LH LAMP, ASSY TURN SIGNAL, FOG F repeated - 0.00 Repeat
Please remove previous part number and price due to wrong model
(8315A055 RM1,018.00)
Src=Price Source (F=MRC Franchise,NF=MRC Non-Franchise,O=Others). F=Franchise part.
Allianz General Insurance Company (Malaysia) Berhad/VJH3487/07/04/2023 18:13

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