MEMO

To : Prudential BSN Takaful Berhad

Operation Department
Kuala Lumpur Office

Date : 7 APRIL 2024

From : NAMA
AGENT CODE
C/O KOTA KINABALU

REQUEST REFUND FOR CERTIFICATE 00000000

____________________________________________________________________

Refer to the above subject.

This is to inform I have mistakenly pay extra for the month of April. Therefore, I would
like to request for a refund for my extra contribution.

Certificate number : 0000000

Person Covered :

Your cooperation is much appreciated.

Thank you.

Yours truly, Witnessed by,

————————————————— —————————————————
NAMA NAMA
IC IC
0140000000 0140000000