TAKAFUL IKHLAS GENERAL BERHAD

AUTHORISATION FORM FOR INTERBANK GIRO FUND TRANSFER

New registration Change of details

Company Details :-

Name of Applicant/Company
NRIC No./Co. Registration No.
Address

Telephone No.
Fax No.
Person In Charge Name 1. 2.
E-mail Address 1. 2.
Telephone No. 1. 2.

Banking Details :-

Name of Bank MAYBANK

Bank Address CAMERON HIGHLANDS BRANCH, 69-70, PERSIARAN CAMELIA 4 ,
39000 TANAH RATA,CAMERON HIGHLANDS

Bank Account No. 156048127828

SWIFT Code MBBEMYKL

We hereby authorise Takaful Ikhlas General Berhad to credit all monies due to us into bank account
as indicated above. We declare that all the above information is true and correct. Takaful Ikhlas General
Berhad will not be liable for any financial loss due to inaccuracies of the information provided.

Authorised Signatory (ies) Company Stamp

Name : ZARINA BINTI JUSOH

Date :
Designation :

** Important
1. This facility allows payment to be credited into the above mentioned account.
2. Please attached (i) copy of NRIC or Passport or Business Registration Form whichever is applicable and (ii) 1st page of [a] your bank
statement: or [b] your bank saving book showing the account name and account number; or [c] details of your bank account
obtained from your bank's website that has been certified by your bank; or [d] letter from your bank confirming bank account
details.