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

NO. 1 , JALAN PRIMA 9

PUSAT NIAGA METRO PRIMA 52100 KUALA LUMPUR
Tel No: 03-62586888/62527655 Fax No: 03-62592554 E-Mail: -

JPJ CODE /KOD JPJ : 13

MOTOR INSURANCE CONFIRMATION SLIP ORIGINAL COPY
Issued Date : 22-09-2015
ELECTRONIC COVER NOTE NO. : AEKP0258299 (02:48:16 PM)
No. Nota Perlindungan
Insured's Name : GOH KIM CHENG
Nama Pencadang
Address : A-13A-5 , IMPIAN HEIGHTS APARTMENTS,
Alamat OFF JALAN PIPIT,
BANDAR PUCHONG JAYA,

Postcode : 47100 PUCHONG

Poskod
Telephone No.
No. Telefon
NRIC/Passport/Bus. Reg. No. : 750715075421
No. KP Baru/No. Pendaftaran Perniagaan
Occupation/Type of Business : OTHERS
Pekerjaan/Perniagaan
Vehicle Registration No. : WUJ6128
No. Pendaftaran
Make/Model : NISSAN SENTRA 1.6
Buatan / Model
Year of Manufacture : 2010
Tahun Dibuat
Engine/Motor No. : QG16C037344
No. Enjin/Motor
Chassis No. : PN8CFAN16TCC50604
No. Casis
Vehicle Registration Card No. : 0011992
No. Kenderaan Pendaftaran
C.C/Carrying Capacity (kg) : 1597.00 CC
Keupayaan Enjin / Muatan
Use of Vehicle : PRIVATE CAR FOR PRIVATE USE
Kelas Kegunaan
Period Of Cover : 25-09-2015 - 21-03-2016
Tempoh Insuran
Type of Cover : COMPREHENSIVE
Jenis Perlindungan
Sum Insured / Trailer SI : RM 57,000.00 (Agreed Value) / 0.00
(Nissan Sentra SG Saloon (A) 1.6i [4door 4speed FWD (Facelift)])
Jumlah Diinsurankan
Premium : RM 1,015.06
Premium
Amount Payable (Rounded) : RM 1,015.05
Amount Payable (Rounded)
Excess : RM 0.00
Lebihan
Hire Purchase : HONG LEONG BANK BERHAD
Syarikat Sewa Beli
Additional Benefits : WINDSCREEN RM1,400.00 102.70
Perlindungan Tambahan

NCD (%) : 0.00

Diskaun Tanpa Tuntutan
JPJ e-Insurance Status : OK
Status JPJ e-Insuran
Named Drivers : 1. THE POLICYHOLDER
2. GOH WAN THAI
Nama Pemandu Tambahan

THIS IS A COMPUTER GENERATED DOCUMENT, SIGNATURE IS NOT REQUIRED

INI ADALAH DOKUMEN CETAKAN KOMPUTER, TANDATANGAN TIDAK DIPERLUKAN
Agent Information : KP50347 / EDARAN SURIA MOTOR SDN BHD / EDARAN SURIA MOTOR SDN BHD
Butir-butir Agent
Address : 41 G
Alamat JLN WAWASAN AMPANG 2/1
BANDAR BARU AMPANG
Postcode : 68000 AMPANG
Poskod
Type of Insurance Required : Extension Prorate
Jenis Perlindungan Dipohon
Previous Policy Number :14VKP052105
Nombor Polisi Terdahulu

Page 1 19-11-2015 11:59:41

Allianz General Insurance Company (Malaysia) Berhad (735426-V)
NO. 1 , JALAN PRIMA 9
PUSAT NIAGA METRO PRIMA 52100 KUALA LUMPUR
Tel No: 03-62586888/62527655 Fax No: 03-62592554 E-Mail: -

JPJ CODE /KOD JPJ : 13

MOTOR INSURANCE CONFIRMATION SLIP OFFICE COPY
Issued Date : 22-09-2015
ELECTRONIC COVER NOTE NO. : AEKP0258299 (02:48:16 PM)
No. Nota Perlindungan
Insured's Name : GOH KIM CHENG
Nama Pencadang
Address : A-13A-5 , IMPIAN HEIGHTS APARTMENTS,
Alamat OFF JALAN PIPIT,
BANDAR PUCHONG JAYA,

Postcode : 47100 PUCHONG

Poskod
Telephone No.
No. Telefon
NRIC/Passport/Bus. Reg. No. : 750715075421
No. KP Baru/No. Pendaftaran Perniagaan
Occupation/Type of Business : OTHERS
Pekerjaan/Perniagaan
Vehicle Registration No. : WUJ6128
No. Pendaftaran
Make/Model : NISSAN SENTRA 1.6
Buatan / Model
Year of Manufacture : 2010
Tahun Dibuat
Engine/Motor No. : QG16C037344
No. Enjin/Motor
Chassis No. : PN8CFAN16TCC50604
No. Casis
Vehicle Registration Card No. : 0011992
No. Kenderaan Pendaftaran
C.C/Carrying Capacity (kg) : 1597.00 CC
Keupayaan Enjin / Muatan
Use of Vehicle : PRIVATE CAR FOR PRIVATE USE
Kelas Kegunaan
Period Of Cover : 25-09-2015 - 21-03-2016
Tempoh Insuran
Type of Cover : COMPREHENSIVE
Jenis Perlindungan
Sum Insured / Trailer SI : RM 57,000.00 (Agreed Value) / 0.00
(Nissan Sentra SG Saloon (A) 1.6i [4door 4speed FWD (Facelift)])
Jumlah Diinsurankan
Premium : RM 1,015.06
Premium
Amount Payable (Rounded) : RM 1,015.05
Amount Payable (Rounded)
Excess : RM 0.00
Lebihan
Hire Purchase : HONG LEONG BANK BERHAD
Syarikat Sewa Beli
Additional Benefits : WINDSCREEN RM1,400.00 102.70
Perlindungan Tambahan

NCD (%) : 0.00

Diskaun Tanpa Tuntutan
JPJ e-Insurance Status : OK
Status JPJ e-Insuran
Named Drivers : 1. THE POLICYHOLDER
2. GOH WAN THAI
Nama Pemandu Tambahan

THIS IS A COMPUTER GENERATED DOCUMENT, SIGNATURE IS NOT REQUIRED

INI ADALAH DOKUMEN CETAKAN KOMPUTER, TANDATANGAN TIDAK DIPERLUKAN
Agent Information : KP50347 / EDARAN SURIA MOTOR SDN BHD / EDARAN SURIA MOTOR SDN BHD
Butir-butir Agent
Address : 41 G
Alamat JLN WAWASAN AMPANG 2/1
BANDAR BARU AMPANG
Postcode : 68000 AMPANG
Poskod
Type of Insurance Required : Extension Prorate
Jenis Perlindungan Dipohon
Previous Policy Number :14VKP052105
Nombor Polisi Terdahulu

Page 2 19-11-2015 11:59:41