Setem Hasil Dibayar Jadual Kereta Persendirian: Stamp Duty Paid

Stamp Duty Paid PRIVATE CAR SCHEDULE
Setem Hasil Dibayar JADUAL KERETA PERSENDIRIAN
The Insured / Pihak Diinsuranskan e-Policy No RBS-0216280

No e-Polisi
CLAR RULLES BIN BENEDIK
SUPER TOP WHOLESALE SDN BHD Account No. / Agent's Name KK2020917ZM
A5&6-0, BLK A BEVERLY HILLS APT. PH 1 No. Akaun / Nama Ejen
DWELLUCK ENTERPRISE
88300 KOTA KINABALU
SABAH Date of Proposal or Declaration 10-01-2017 06:52:33PM
Tarikh Tandatangan Cadangan atau Akuan
Geographical Area/ Kawasan Geografi: Malaysia, Republic of Singapore and Negara Brunei Darussalam
Business/Profession EMPLOYED OR SELF- Agreed Value 41,000.00
Perniagaan/Pekerjaan EMPLOYED: DOES NOT Nilai yang dipersetujui
REQUIRE USAGE OF
VEHICLE FOR
OCCUPATIONAL DUTIES
I/C/Business Reg. 891101-12-6123 Trailer Sum Insured 0.00
No K/P Baru/No Pendaftaran Perniagaan Jumlah Treler Diinsuranskan
Nationality MALAYSIAN Excess 0.00

Warganegara Lebihan
Period Insurance / Tempoh Insurans Cover Type COMPREHENSIVE

From/Dari 10-01-2017 06:52:33PM To/Hingga 09-01-2018 Jenis Perlindungan
Class of Vehicle Private Vehicle - Exc. Basic Premium RM 1,032.00

Kelas Kenderaan Goods ( Private Car ) Premium Asas
All Riders RM 0.00
Hire Purchase PUBLIC BANK Semua Pemandu
Sewa Beli Loading RM 0.00
Caj Tambahan
Regn. Card No/Trailer Regn. Card No SAB5810W/- NCB (30.00%) RM 309.60
No Perakuan Pendaftaran Kenderaan/Trailer DTT
NCB Effective Date (10-01-2017)
Registration No Tarikh Berkuatkuasa DTT
SAB5810W
No Pendaftaran Kenderaan Trailer Premium RM 0.00
Premium Treler
Trailer Registration No Trailer Loading RM 0.00
-
No Treler
Extra Benefit
Make & Type of Body Manfaat Tambahan
PERODUA MYVI / 4D
Buatan & Jenis Badan HATCHBACK
Cubic Capacity 1495 CC
Keupayaan Enjin
Year of Manufacture 2014

Tahun Diperbuat
Seating Capacity(including driver) 5

Muatan Tempat Duduk Termasuk Pemandu
Engine/Motor No R22A70N Gross Premium RM 722.40

No Enjin/Motor Premium Kasar
Chassis No PM2M603S002110764 GST / RM 43.34

No Casis Cukai Barangan dan Perkhidmatan
Trailer Chassis No - Stamp Duty RM 10.00

No Casis Treler Setem Hasil
Named Driver(s) Total RM 775.74

Pemandu yang Diberi Kuasa Jumlah
THE POLICYHOLDER
Act RM43.47
Akta
Limitation as to use: As per Certificate of Insurance attached / Had Penggunaan: Seperti Sijil Insuran yang disertakan
Subject to following clauses printed herein or attached hereto/ Tertakluk kepada fasal-fasal dicetak atau dikepil disini
15,87
This Renewal Policy should be read in conjuction with the Original Policy subject to the terms and conditions thereof including the
Endorsements issued prior to this renewal and all amendments incorporated herein for the above period of insurance.
LEGISLATION/PERUNDANGAN:
Road Transport Act, 1987(Malaysia) Motor Vehicles (Third-Party Risks and Compensation) Act (Cap 189) Republic of Singapore Motor Vehicles (Third Party Risks and Compensation)
Rules (Republic of Singapore) Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam (the reference to legislation under the heading "Avoidance of Certain
Terms and Right of Recovery is limited to Section 94, 95 and 96 of the Road Transport Act 1987 (Malaysia) Section 7, 8 and 9 of the Motor Vehicles (Third Party Risks and Compensation)
Act (Cap 189) Republic of Singapore and Section 7 of the Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam.
BERJAYA SOMPO INSURANCE BERHAD (62605-U)

Customer Service Centre: Lot G027G, Ground Floor, Podium Block, Menara BGI, Plaza Berjaya, 12, Jalan Imbi, 55100 Kuala Lumpur, Malaysia.
Head Office: 1-38-1 & 1-38-2, Menara Bangkok Bank, Laman Sentral Berjaya, No.105, Jalan Ampang, 50450 Kuala Lumpur, Malaysia.
Tel: (603) 2117 2118 Fax: (603) 2181 0558 http://www.berjayasompo.com.my
Page 1 10-01-2017 18:52:42

Important Notice: For environmental conservation, we no longer print the policy wording/fact sheet/pocket sized card/directory of panel workshop/important notice. You may view the policy documents for the
above policy number at www.berjayasompo.com.my. Print out can be obtained from our branch offices located nationwide or from your servicing agent.
Nota penting: Untuk kepentingan alam sekitar, kami tidak lagi mencetak isi kandungan polisi/lembaran fakta/kad saiz poket/panduan bengkel membaiki kenderaan/notis mustahak. Anda boleh meneliti dokumen-
dokumen untuk polisi tersebut di www.berjayasompo.com.my. Salinan bercetak boleh didapati dari cawangan kami di seluruh negara ataupun ejen anda.
***THIS IS A COMPUTER GENERATED DOCUMENT AND IT DOES NOT REQUIRE SIGNATURE.***
THIS DOCUMENT SHALL NOT BE INVALIDATED SOLELY ON THE GROUND THAT IT IS NOT SIGNED.
***INI ADALAH DOKUMEN YANG DIKELUARKAN OLEH KOMPUTER DAN TANDATANGAN TIDAK DIPERLUKAN.***
DOKUMEN INI TIDAK HARUS DITAKSAHKAN SEMATA-MATA ATAS ALASAN IA TIDAK DITANDATANGANI.
e-ASC 8*W01*E000*10P*1*8-0-1 Renewal of Policy No. 15DKKEMPE1100641

Page 2 10-01-2017 18:52:42

CERTIFICATE OF INSURANCE / SIJIL INSURANS
ROAD TRANSPORT ACT, 1987 (MALAYSIA)
MOTOR VEHICLES (THIRD PARTY RISKS) RULES, 1959 (MALAYSIA)
MOTOR VEHICLES (THIRD PARTY RISKS & COMPENSATION) ACT (CAP, 189) REPUBLIC OF SINGAPORE
MOTOR VEHICLES (THIRD PARTY RISKS & COMPENSATION) RULES (REPUBLIC OF SINGAPORE)
MOTOR VEHICLES INSURANCE (THIRD PARTY RISKS) ACT (CAP, 90) NEGARA BRUNEI DARUSSALAM
C.I. Code / Kod Sijil Insurans : BX1
CERTIFICATE NO / NO SIJIL : RBS-0216280
1. Index Mark and Registration Number of Vehicle /Tanda Indek dan Nombor Pendaftaran Kenderaan : SAB5810W
2. Name of Policyholder / Nama Pemegang Polisi : CLAR RULLES BIN BENEDIK
3. Effective date of the Commencement of Insurance for purposes of the Regulations, Ordinance or Enactment : 10-01-2017 06:52:33PM
Tarikh berkuatkuasa bagi Permulaan Insuran Untuk tujuan Peraturan, Ordinan atau Enakmen
4. Date of expiry of the Insurance / Tarikh Tamat Insuran : 09-01-2018
5. Persons or Classes of persons entitled to drive*/Orang atau Kelas Orang yang layak memandu*
a) The Policyholder
b) Any other person who is driving on the Policyholder's order or with his permission /
a) Pemegang Polisi
b) Sesiapa yang memandu atas arahan Pemegang Polisi atau dengan kebenarannya
Provided that the person driving is permitted in accordance with the licensing or other laws or regulation to drive the Motor Vehicle or has been so permitted and is not disqualified by order of a Court of Law or by
reason of any enactment or regulation in that behalf from driving the Motor Vehicle.
Dengan syarat orang tersebut dibenarkan memandu menurut undang-undang perlesenan atau undang-undang lain atau peraturan untuk memandu kenderaan Bermotor tersebut atau telah dibenarkan dan tidak
dilucutkan kelayakannya di atas perintah Mahkamah atau oleh sebab mana-mana enakmen atau peraturan daripada memandu Kenderaan Bermotor tersebut.
6. Limitations as to use* / Had Penggunaan*

Use only for social domestic and pleasure purposes and for the Policyholder's business.
The Policy does not cover use for hire or reward,racing pace-making,reliability trial speedtesting,the carriage of goods other
than samples in connection with any trade or business. /
Digunakan hanya untuk tujuan sosial, domestik dan persiaran dan untuk perniagaan Pemegang Polisi.
Polisi ini tidak melindungi untuk sewaan atau ganjaran, perlumbaan, mengkadar kelajuan, ujian kebolehpercayaan, membawa
barangan selain daripada sampel yang berkaitan dengan apa-apa pekerjaan atau perniagaan.
*Limitations rendered inoperative by Section 95 of the Road Transport Act 1987 (Malaysia) or Section 8 of the Motor Vehicles (Third Party Risks and Compensation) Act (Cap 189)
Republic of Singapore or Section 7 of the Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam are not included under this heading.
Pengehadan dijadikan tidak berkuatkuasa oleh Seksyen 95 Akta Pengangkutan Jalan 1987 (Malaysia) atau Seksyen 8 of the Motor Vehicles (Third Party Risks and Compensation) Act (Cap 189)
Republic of Singapore or Section 7 of the Motor Vehicles Insurance (Third party Risks) Act (Cap 90) Negara Brunei Darussalam tidak termasuk di bawah tajuk ini.
I/We hereby certify that this covering note is issued in accordance with the provision of Part IV of the Road Transport Act 1987 (Malaysia) and The Motor Vehicles (Third Party Risks and Compensation) Act
(Republic of Singapore) The Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam.
***THIS IS A COMPUTER GENERATED DOCUMENT AND IT DOES NOT REQUIRE SIGNATURE.***

THIS DOCUMENT SHALL NOT BE INVALIDATED SOLELY ON THE GROUND THAT IT IS NOT SIGNED.
***INI ADALAH DOKUMEN YANG DIKELUARKAN OLEH KOMPUTER DAN TANDATANGAN TIDAK DIPERLUKAN.***
DOKUMEN INI TIDAK HARUS DITAKSAHKAN SEMATA-MATA ATAS ALASAN IA TIDAK DITANDATANGANI.
e-ASC 8*W01*E000*10P*1*8-0-1

Page 3 10-01-2017 18:52:42

ADDITIONAL QUESTIONNAIRE/SOALAN-SOALAN TAMBAHAN
MODIFICATION/ALTERATION AND ACCESSORIES/PENGUBAHSUAIAN DAN AKSESORI
The policy only covers for standard factory-fitted accessories. Are there any other additional accessories/spare parts added or alteration/modification made from the original
specification? Polisi ini hanya melindungi aksesori standard pemasangan pengilang. Adakah terdapat apa-apa aksesori tambahan/tambahan alat ganti lain atau diubah daripada
spesifikasi kenderaan asal?
NO/TIDAK
(If this is not specified, no cover is provided in respect of such modification and additional accessories and We may repudiate a claim arising from an accident directly relating
to any such modification/alterations having made /Jika tidak dinyatakan, tiada perlindungan akan diberikan ke atas pengubahsuaian dan penambahan aksesori dan Kami mungkin
akan menolak tuntutan kemalangan secara lansung berkaitan pengubahsuaian/pengubahan yang dibuat.)
TRAFFIC OFFENCES/KESALAHAN TRAFIK

Have you or you authorised driver(s) been jailed or fined for more than RM1,000 over the last 24 months for traffic related offences? Adakah anda atau pemandu yang dibenarkan
pernah dipenjarakan atau didenda lebih daripada RM1000 dalam tempoh 24 bulan lalu kerana kesalahan berkaitan lalu lintas?
NO/TIDAK
LOCATION OF USE/KAWASAN PENGUNAAN

Is the vehicle used within the confines of airports?
Adakah kenderaan yang digunakan di dalam kawasan lapangan terbang?
NO
Is the vehicle licensed for road use?
Adakah kenderaan itu dilesenkan untuk kegunaan di atas jalan raya?
YES

Page 4 10-01-2017 18:52:42

Privacy Notice
The Personal Data you have provided to us will be processed for the purpose of processing your insurance application/proposal, provision of insurance
related products or services or any addition, alteration, variation, cancellation, renewal or reinstatement thereof, performing statistical/actuarial research or
data study, promoting products and services and other related purposes.
Although you are not obliged to provide us with your Personal Data, we will not be able to process your application for insurance cover or process your claim if
you fail to provide all requested information.
Your Personal Data may be disclosed to any related company or any other company carrying on insurance or reinsurance related business or an intermediary
or a claims or investigation or other service provider and to any association, federation or similar organisation of insurance companies that exists or is formed
from time to time for the Purpose or to fulfil some legal or regulatory function or is reasonably required in the interest of the insurance industry.
We may also disclose your Personal Data where such disclosure is required under the law, court orders or pursuant to guidelines issued by regulatory or
other relevant authorities, if we reasonably believe that we have a lawful right to disclose your Personal Data to any third party or that we would have had your
consent for such disclosure if you had known of the same, and/or if the disclosure is in the public interest.
Please be informed that your Personal Data may also be transferred to any of our related companies which may be located outside Malaysia for the Purpose.
In the event that we use external service providers, specific security and confidentiality safeguards have been put in place to ensure your privacy rights
remain unaffected.
You may make inquiries, complaints or request for access to or correction of your Personal Data or limit the processing of your Personal Data at any time
hereafter by submitting such request to us via email at info@berjayasompo.com.my or mailing it to our Customer Service Centre, Lot G027G, Ground Floor,
Podium Block, Plaza Berjaya, 12, Jalan Imbi, 55100 Kuala Lumpur.
We trust that you will consent and agree to the terms above with respect to the processing of your Personal Data. If we do not receive any
response from you on the above, we shall assume that you are agreeable to the same**.
** where sensitive personal data is being processed (i.e. medical history, religious beliefs, political opinions and the commission or alleged commission of any
offence), and personal data is used for cross-selling within Berjaya Sompo Insurance Berhad (BSIB) or by our Group Companies, this privacy notice must be
signed and returned to us.
CONSENT TO USE SENSITIVE PERSONAL DATA AND FOR CROSS-SELLING WITHIN BSIB OR BY OUR GROUP COMPANIES
I have read and understood the terms of this Privacy Notice and hereby consent to BSIB for the processing of my Sensitive Personal Data for the purposes
described above and for cross-selling within BSIB or by their Group Companies.
..............................................
Signature Policyholders Full Name : CLAR RULLES BIN BENEDIK
Date : 10-01-2017 NRIC/Passport No. : 891101126123
Policy No : RBS-0216280 Vehicle No : SAB5810W

Page 5 10-01-2017 18:52:42

Notis Privasi
Data Peribadi anda akan diproses untuk tujuan memproses permohonan/cadangan insurans, penyediaan produk atau perkhidmatan berkaitan insurans atau
sebarang penambahan, pindaan, perubahan, pembatalan, pembaharuan dan penyambungan, pelaksanaan penyelidikan statistik/aktuari atau kajian data,
promosi produk dan perkhidmatan dan untuk tujuan lain yang berkaitan.
Walaupun anda tidak diwajibkan untuk memberi kami Data Peribadi anda, kami tidak dapat memproses permohonan anda untuk perlindungan insurans atau
memproses tuntutan jika anda tidak memberikan semua maklumat yang diminta.
Data Peribadi anda mungkin didedahkan kepada mana-mana syarikat berkaitan atau mana-mana syarikat lain yang menjalankan perniagaan berkaitan
insurans semula atau syarikat perantara atau tuntutan atau penyiasatan atau penyedia perkhidmatan lain dan kepada mana-mana persatuan, persekutuan
atau organisasi syarikat insurans serupa yang wujud atau yang ditubuhkan dari masa ke masa untuk Tujuan tersebut atau untuk memenuhi fungsi
perundangan atau peraturan atau diperlukan dengan sewajarnya demi kepentingan industri insurans.
Kami juga mungkin mendedahkan Data Peribadi anda apabila pendedahan sedemikian diperlukan di bawah undang-undang, atas arahan mahkamah atau
menurut garis panduan yang dikeluarkan oleh pihak berkuasa kawal selia atau pihak berkuasa lain, jika kami percaya bahawa kami mempunyai hak di bawah
undang-undang untuk mendedahkan Data Peribadi anda kepada mana-mana pihak ketiga atau mungkin akan mendapatkan persetujuan bagi pendedahan
tersebut jika anda mengetahui tentangnya, dan/atau jika pendedahan adalah berasaskan kepentingan umum.
Anda dimaklumkan bahawa Data Peribadi anda juga boleh dipindahkan kepada mana-mana syarikat berkaitan kami yang mungkin terletak di luar Malaysia
untuk Tujuan tersebut. Sekiranya kami menggunakan penyedia perkhidmatan luar, langkah keselamatan dan kerahsiaan tertentu diambil untuk memastikan
hak kerahsiaan anda tidak terjejas.
Anda boleh membuat pertanyaan, aduan atau permintaan untuk mendapatkan atau membetulkan Data Peribadi anda atau mengehadkan pemprosesan Data
Peribadi pada bila-bila masa selepas itu dengan mengemukakan permintaan tersebut menerusi emel ke info@berjayasompo.com.my atau menghantar surat
ke Pejabat Khidmat Pelanggan, Lot G027G, Ground Floor, Podium Block, Plaza Berjaya, 12, Jalan Imbi, 55100 Kuala Lumpur.
Kami yakin bahawa anda akan memberikan kebenaran dan bersetuju dengan terma di atas berkaitan dengan pemprosesan Data Peribadi anda.
Jika kami tidak menerima sebarang jawapan daripada anda mengenai perkara di atas, kami mengandaikan bahawa anda bersetuju dengannya.**
** sekiranya data peribadi sensitif diproses (iaitu maklumat tentang kesihatan atau keadaan fizikal atau mental seseorang, pendapat politik, kepercayaan
agama atau kepercayaan lain yang bersifat seumpamanya, pelakuan atau pengataan pelakuan apa-apa kesalahan olehnya) dan berhasrat menggunakan
data peribadi anda untuk tujuan jualan silang oleh Berjaya Sompo Insurance Berhad (BSIB) atau gabungan syarikat-syarikat kami, kebenaran nyata perlu
diperolehi - iaitu notis privasi ini mesti ditandatangani dan dipulangkan kepada kami.
PERAKUAN DAN PERSETUJUAN UNTUK PEMPROSESAN DATA PERIBADI SENSITIF DAN UNTUK JUALAN SILANG OLEH BSIB ATAU
GABUNGAN SYARIKAT-SYARIKAT KAMI
Saya telah membaca dan memahami terma dan syarat Notis Privasi ini dan bersetuju membenarkan BSIB memproses maklumat Data Peribadi Sensitif saya
seperti yang dinyatakan di atas dan juga untuk tujuan jualan silang oleh BSIB atau gabungan syarikat-syarikat mereka.
..............................................
Tandatangan Pemegang Polisi Nama Penuh Pemegang Polisi : CLAR RULLES BIN
BENEDIK
Tarikh : 10-01-2017 No. NRIC/Passpot : 891101126123
No. Polisi : RBS-0216280 No. Plat Kenderaan : SAB5810W

Page 6 10-01-2017 18:52:42

CONFIRMATION
Confirm NCD Percentage Result Page

* OK for successful NCD confirmation / Enquiry
Cover Note No. RBS-0216280
Confirmation Type ISM NCD Confirmation (New Business - Registered Vehicle)
NCD Confirmation Approval Code 242242100117T998
Policy Expiry Date 11/12/2016
Current NCD Percentage 25.00
Current NCD Effective Date 12/12/2015
Next NCD Percentage 30.00
Next NCD Effective Date 12/12/2016
Insurer BERJAYA SOMPO INSURANCE BERHAD
Policy Number 15DKKEMPE1100641
Vehicle Class Private Vehicle - Exc. Goods
Vehicle Registration Number SAB5810W
New Vehicle Registration No SAB5810W
ID No (NEW) 891101-12-6123
ID NO (Old)/Passport No/Business Registration Number
Insured Name CLAR RULLES BIN BENEDIK
No. of days gap in cover : 29
No. of claims for the past 3 years: 0
No. of claims at fault for the past 3 years: 0
No. of Windscreen claims for the past 3 years: 0

Page 7 10-01-2017 18:52:42

Notice to Private Car Comprehensive Policyholders
.
We are pleased to advise that we have implemented the following initiatives with the aim to serve our policyholders better :
.
1) Direct Repairs Service Quality workshops (DRS Quality workshops)
.
In the unfortunate event that your car met with an accident which gives rise to a claim for repairs, you now have an additional choice of sending your car to
our panel of DRS Quality workshops. These DRS Quality workshops are an addition to our current panel of collision repair workshops. These DRS Quality
workshops are quality collision repair centres. Presently, our DRS Quality workshops are located at certain areas only and will be available nationwide in
the near future.
.
Please note that you still have a choice of sending your car to our current panel of collision repair workshops, instead of these DRS Quality workshops, if
that's more convenient for you. For more information on these DRS Quality workshops and their services as well as our current panel of collision repair
workshops, please visit our website at www.berjayasompo.com.my.
.
2) Windscreen Repairs and Replacement Centres (WRRC)

.
For the benefit of our policyholders, we have also set up a panel of Windscreen repairs and replacement centres to serve you in the unfortunate event that
your car's windscreen or window glass is damaged. You are not required to make any payment (depending on whether the sum insured of your windscreen
is adequate or not) or lodge a police report. There are 141 centres located throughout the country that provide these services. For more information on the
location of these centres, please visit our website at www.berjayasompo.com.my.
.
You may also repair or replace your damaged windscreen or window glass at our panel of collision repair workshops or DRS Quality workshops. They too
offer their services to you similarly on a 'cashless' basis and you are exempted from having to lodge a police report.
.
However, should you choose to repair or replace your damaged windscreen or window glass outside of the above panel of Windscreen repairs and
replacement centres or, outside of our panel of collision repair workshops or DRS Quality workshops, then a police report is required.
.
3) Rakan Auto
.
We provide Rakan Auto Service to our comprehensive motor insurance policyholders that offers 24-hour emergency roadside assistance.
.
To enjoy our Rakan Auto benefits, you are required to contact our Rakan Auto 24-hour Call Centre at 03-7628 3822/03-7841 5660 for any emergency
roadside assistance.
.
Benefits
.
24-hour Emergency Towing Services Following an Accident
.
In the event of your car being immobilised following an accident, arrangements will be made by our Call Centre with a member of our approved panel
workshops nearest to you to tow your car for repairs.
.
24-hour Emergency Breakdown and Minor Roadside Repair Services
.
In the event your car breaks down, our Call Centre will arrange for roadside repairs and if that cannot be carried out, arrangements can be made to tow your
car to an approved workshop for repairs.
.
Conditions
(i) The Company's maximum liability in respect of labour costs for roadside repairs and towing charges in any one event shall be limited to RM300/- for
policies incepted from 1st January 2016 onwards (RM150 for policies incepted before 1st January 2016). Any additional charges exceeding this limit
shall be borned by the policyholder.
.
(ii) Cost of parts and toll charges are excluded and must be paid by the policyholder to the workshop directly.
.
(iii) If you do not call Rakan Auto for assistance, you are deemed to have waived your rights to such services offered by us and therefore you have to bear
all charges and expenses incurred by using other service providers.
.
If you have any further query, kindly contact us at 1800 889 933, or log on to www.berjayasompo.com.my, or visit any of our offices nationwide.
Thank you.

Page 8 10-01-2017 18:52:42

NOTICE TO ALL POLICYHOLDERS / NOTIS KEPADA SEMUA PEMEGANG POLISI
If you have any complaints relating to this insurance policy, please contact our local branch manager or our complaints unit officer at :
Jika anda mempunyai aduan berhubung dengan polisi insurans ini, sila hubungi pengurus cawangan kami atau pegawai unit aduan di :
COMPLAINTS UNIT / UNIT ADUAN

CUSTOMER SERVICE CENTRE
BERJAYA SOMPO INSURANCE BERHAD
Lot G 027G, Ground Floor, Podium Block
Menara BGI, Plaza Berjaya
12, Jalan Imbi
55100 Kuala Lumpur
Tel. : 03-2117 2118 / 03-2141 3323
Fax : 03-2142 4730
Toll Free No. : 1-800-88-9933
E-mail : info@berjayasompo.com.my
Or / Atau
The following bodies who are authorised to oversee public enquiries and complaints on insurance related matters :
Pihak-pihak yang diberi kuasa untuk mengendalikan soalan-soalan umum dan pengaduan mengenai perkara-perkara berkenaan insurans :
1. OMBUDSMAN FOR FINANCIAL SERVICES / OMBUDSMAN PERKHIDMATAN KEWANGAN

Level 14, Main Block, Menara Takaful Malaysia
No. 4, Jalan Sultan Sulaiman
50000 Kuala Lumpur
Tel. : 03-2272 2811
Fax : 03-2272 1577
E-mail : enquiry@ofs.org.my
Website : www.ofs.org.my
2. LAMAN INFORMASI NASIHAT DAN KHIDMAT (LINK)

Pengarah
Jabatan LINK & Pejabat Wilayah
Bank Negara Malaysia
P.O Box 10922
50929 Kuala Lumpur
Tel. : 1-300-88-5465
Fax : 03-2174 1515
E-mail: bnmtelelink@bnm.gov.my

Page 9 10-01-2017 18:52:42

1-38-1 & 1-38-2, MENARA BANGKOK BANK,
LAMAN SENTRAL BERJAYA,
NO.105, JALAN AMPANG,
50450 KUALA LUMPUR
GST Registration No : 000234881024
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
TAX INVOICE
------------------------------
Tax Invoice No : UOTR-10890246-0117

Date : 10/01/2017
CLAR RULLES BIN BENEDIK
SUPER TOP WHOLESALE SDN BHD
A5&6-0, BLK A BEVERLY HILLS APT. PH 1
88300 KOTA KINABALU
Account No : KK2020917ZM
Class : MOTOR
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Particulars
-----------------
Policy No. : RBS-0216280
Period of Insurance : 10/01/2017 To 09/01/2018
Currency : RINGGIT MALAYSIA
Gross Premium : 722.40
Discount 0.00% : 0.00
----------------------------------------
Total Excluding GST : 722.40
GST 6.00% : 43.34
Stamp Duty : 10.00
----------------------------------------
Total Amount Payable : 775.74
----------------------------------------
This is computer generated documents. Signature is not required .

Page 10 10-01-2017 18:52:42

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Setem Hasil Dibayar Jadual Kereta Persendirian: Stamp Duty Paid

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Stamp Duty Paid PRIVATE CAR SCHEDULE

Setem Hasil Dibayar JADUAL KERETA PERSENDIRIAN

The Insured / Pihak Diinsuranskan e-Policy No RBS-0216280

Nationality MALAYSIAN Excess 0.00

Period Insurance / Tempoh Insurans Cover Type COMPREHENSIVE

Class of Vehicle Private Vehicle - Exc. Basic Premium RM 1,032.00

Year of Manufacture 2014

Seating Capacity(including driver) 5

Engine/Motor No R22A70N Gross Premium RM 722.40

Chassis No PM2M603S002110764 GST / RM 43.34

Trailer Chassis No - Stamp Duty RM 10.00

Named Driver(s) Total RM 775.74

BERJAYA SOMPO INSURANCE BERHAD (62605-U)

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e-ASC 8*W01*E000*10P*1*8-0-1 Renewal of Policy No. 15DKKEMPE1100641

BERJAYA SOMPO INSURANCE BERHAD (62605-U)

Page 2 10-01-2017 18:52:42

C.I. Code / Kod Sijil Insurans : BX1

CERTIFICATE NO / NO SIJIL : RBS-0216280

2. Name of Policyholder / Nama Pemegang Polisi : CLAR RULLES BIN BENEDIK

4. Date of expiry of the Insurance / Tarikh Tamat Insuran : 09-01-2018

6. Limitations as to use* / Had Penggunaan*

***THIS IS A COMPUTER GENERATED DOCUMENT AND IT DOES NOT REQUIRE SIGNATURE.***

BERJAYA SOMPO INSURANCE BERHAD (62605-U)

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TRAFFIC OFFENCES/KESALAHAN TRAFIK

LOCATION OF USE/KAWASAN PENGUNAAN

BERJAYA SOMPO INSURANCE BERHAD (62605-U)

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Date : 10-01-2017 NRIC/Passport No. : 891101126123

Policy No : RBS-0216280 Vehicle No : SAB5810W

BERJAYA SOMPO INSURANCE BERHAD (62605-U)

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No. Polisi : RBS-0216280 No. Plat Kenderaan : SAB5810W

BERJAYA SOMPO INSURANCE BERHAD (62605-U)

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Confirm NCD Percentage Result Page

BERJAYA SOMPO INSURANCE BERHAD (62605-U)

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2) Windscreen Repairs and Replacement Centres (WRRC)

BERJAYA SOMPO INSURANCE BERHAD (62605-U)

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COMPLAINTS UNIT / UNIT ADUAN

1. OMBUDSMAN FOR FINANCIAL SERVICES / OMBUDSMAN PERKHIDMATAN KEWANGAN

2. LAMAN INFORMASI NASIHAT DAN KHIDMAT (LINK)

BERJAYA SOMPO INSURANCE BERHAD (62605-U)

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Tax Invoice No : UOTR-10890246-0117

Policy No. : RBS-0216280

Period of Insurance : 10/01/2017 To 09/01/2018

Currency : RINGGIT MALAYSIA

Gross Premium : 722.40

Discount 0.00% : 0.00

Total Excluding GST : 722.40

GST 6.00% : 43.34

Stamp Duty : 10.00

Total Amount Payable : 775.74

This is computer generated documents. Signature is not required .

BERJAYA SOMPO INSURANCE BERHAD (62605-U)

Page 10 10-01-2017 18:52:42

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e-ASC 8W01E00010P1*8-0-1 Renewal of Policy No. 15DKKEMPE1100641

THIS IS A COMPUTER GENERATED DOCUMENT AND IT DOES NOT REQUIRE SIGNATURE.