Innovation for Wellbeing

Dear Valued Customer,

Thank you for choosing Berjaya Sompo Insurance as your insurance partner.
Here is your insurance policy for your perusal and safekeeping. If you require any revision, please email us at
customer@bsompo.com.my.
You may also contact our Customer Service at 1-800-88-9933 or reach out to your servicing marketer or agent
for further assistance. Our service level promises can be found at
https://www.berjayasompo.com.my/customer-service-charter

Good News!
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policies with ease, reach your agents effortlessly and submit claims with a snap. It’s your all-in-one insurance
solution for peace of mind, right on your phone.
Our comprehensive private car motor insurance policyholders are entitled to redeem RM200 TNG e-Wallet
Credit for towing services requested via MySOMPO App following an accident only from now until
31 December 2024*.
In addition to roadside assistance, the App also provides the following benefits to our policyholders:

24/7 nationwide emergency Real-time roadside

roadside assistance assistance updates

Search nearby panel workshops Submit and track claims, easily

Track and view insurance details

MySOMPO is now available for download at Google Play Store and Apple App Store. For more information
and *Terms and Conditions, please visit https://www.berjayasompo.com.my/mysompo.

This is a computer-generated letter and does not require a signature.

Always there for you, on and off the road.

GET IT ON

TRACK NOW
Stamp Duty Paid PRIVATE CAR SCHEDULE
Setem Hasil Dibayar JADUAL KERETA PERSENDIRIAN
The benefits payable under eligible certificate/policy/product is/are protected by PIDM up to limits. Please refer to PIDM’s TIPS Brochure or contact Berjaya
Sompo Insurance Berhad or PIDM (visit www.pidm.gov.my).

Manfaat-manfaat yang dibayar di bawah sijil/polisi/produk yang layak adalah dilindungi oleh PIDM sehingga had perlindungan. Sila rujuk Brosur Sistem
Perlindungan Manfaat Takaful dan Insurans PIDM atau hubungi Berjaya Sompo Insurance Berhad atau PIDM (layari www.pidm.gov.my).
The Insured / Pihak Diinsuranskan Policy No / Master Policy No.
MD490228
FAUZIE BIN ZAINNI No Polisi / No Polisi Induk
NO 48 A JALAN PERDANA
KAMPUNG MUHIBBAH Intermediary No. / Name BP - 10008653
86600 PALOH No. Wakil Insurans / Nama SALNIZA ENTERPRISE
JOHOR Date of Proposal or Declaration
Tarikh Tandatangan Cadangan atau 20-10-2024 07:00:51 AM
Akuan
Geographical Area /Kawasan Geografi: Malaysia, Republic of Singapore and Negara Brunei Darussalam
Occupation Sum Insured
OTHER OCCUPATION Jumlah Diinsuranskan RM 13,000.00
Pekerjaan
NRIC / Business Reg. / Others ID Trailer Sum Insured
No K/P Baru/No Pendaftaran 781201-01-5079 RM 0.00
Jumlah Treler Diinsuranskan
Perniagaan / ID Lain-lain
Nationality Excess / Ekses RM 0.00
MALAYSIAN
Warganegara

Period Insurance / Tempoh Insurans Cover Type THIRD PARTY, FIRE AND THEFT
From/Dari 01-11-2024 12:00:01 AM To /Hingga 31-10-2025 Jenis Perlindungan

Class of Vehicle PRIVATE VEHICLE - Basic Premium RM 505.25

Kelas Kenderaan EXCLUDING GOODS Premium Asas
No-Claim-Discount(NCD)(55.00%) RM 277.89
Diskaun Tanpa Tuntutan(DTT)
Hire Purchase -
NCD Effective Date (01-11-2024)
Sewa Beli
Tarikh Berkuatkuasa DTT
Trailer Premium RM 0.00
Registration No. Premium Treler
JKH4954
No. Pendaftaran Kenderaan

RM 227.36
Trailer Registration No.
-
No. Treler

Make & Type Of Body TOYOTA AVANZA / 4D WAGON

Buatan & Jenis Badan

Vehicle/Cubic Capacity
Keupayaan Enjin 1298 CC

Year of Manufacture Total Premium RM 227.36

2007 Jumlah Premium
Tahun Diperbuat
Service Tax (8.00%) RM 18.19
Seating Capacity(including driver) Cukai Perkhidmatan
Muatan Tempat Duduk Termasuk 7
Stamp Duty RM 10.00
Pemandu Setem Hasil

Engine No.
PM32955
No. Enjin

Chassis No.
No. Casis PN2F601M002532869

Trailer Chassis No.

-
No. Casis Treler
Named Driver(s) Total Amount Payable RM 255.55
Pemandu yang Diberi Kuasa Jumlah Perlu Dibayar
ANY AUTHORIZED DRIVER Act RM 137.02
Akta
Limitation as to use: As per Certificate of Insurance attached / Had Penggunaan: Seperti Sijil Insuran yang disertakan
Subject to following endorsements printed herein or attached hereto / Tertakluk kepada endorsmen-endorsmen dicetak atau dikepil disini
113, 3(q)

Page 1 20-10-2024 07:01:02 AM

This Renewal Policy should be read in conjunction 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 Rights of Recovery is limited to Section 94, 95 and 96 of the Road Transport Act
1987 (Malaysia) Section7,8 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.

PRIVACY NOTICE:
The Personal Data provided by and collected from you may be used and processed by us in order for us to provide our services and to operate and
manage our function as an insurance company. You consent to the use and processing of your Personal Data by the Sompo Group of Companies and
Berjaya Group of Companies (within or outside Malaysia) for the purposes as stated in our Privacy Notice. Please refer to our Privacy Notice which is
available at our website at www.berjayasompo.com.my for details. You may contact us for access to or correction of your Personal Data or for any other
queries or feedback.

IMPORTANT NOTICE:
1. Pursuant to Schedule 9 of the Financial Services Act 2013:
If you are applying for this insurance wholly for purposes unrelated to your trade, business or profession, you have a duty to take reasonable care not
to make a misrepresentation in answering the questions asked by us and a duty to disclose any other matter that you know to be relevant to our
decision in accepting the risks and determining the rates and terms to be applied and any matter a reasonable person in the circumstances could be
expected to know to be relevant, otherwise it may result in avoidance of contract, claim denied or reduced, terms changed or varied, or contract
terminated.This duty of disclosure shall continue until the time the contract is entered into, varied or renewed.
2. For environmental conservation, policy documents will no longer be printed (unless necessary or upon request) but may be produced and delivered
to you in an electronic form or provided and displayed to you online through our website at www.berjayasompo.com.my Please check our website for
any updates or changes to your insurance policy which may be published from time to time. For more information, please call our customer service
at 1-800-889-933.
3. Please read your Policy Schedule and Policy Wording for the terms and conditions of your insurance policy, including the extent of coverage
and exclusions as well as endorsements, if applicable. Please refer to the Policy Wording on our website at the Download Library Section
(https://www.berjayasompo.com.my/page/download-library#p-2). If you are unable to access our website or refer or obtain the Policy Wording,
please contact us or your servicing agent for assistance. You may also request for a printed copy from any of our branch offices located nationwide.

NOTIS PRIVASI:
Data Peribadi yang diberi dan dikumpul dari anda akan digunakan dan diproses oleh kami untuk memberi perkhidmatan kami dan menjalankan fungsi
kami sebagai syarikat insurans. Anda bersetuju dengan penggunaan dan pemprosesan Data Peribadi anda oleh Kumpulan Syarikat Sompo dan
Kumpulan Syarikat Berjaya (di dalam atau di luar Malaysia) untuk tujuan yang dinyatakan di dalam Notis Privasi kami. Sila rujuk kepada Notis Privasi
kami yang boleh didapati di laman web kami di www.berjayasompo.com.my untuk maklumat lanjut. Anda boleh menghubungi kami untuk mendapatkan
atau mengemas kini Data Peribadi anda atau untuk sebarang pertanyaan atau maklum balas.

NOTIS PENTING:
1. Menurut Jadual 9 Akta Perkhidmatan Kewangan 2013:
Jika anda memohon insurans ini sepenuhnya untuk tujuan yang tidak berkaitan perdagangan, perniagaan atau profesion anda, anda mempunyai
kewajipan untuk mengambil langkah yang munasabah untuk tidak salah nyata dalam menjawab soalan-soalan yang ditanya oleh kami dan anda
dikehendaki untuk mendedahkan apa-apa perkara lain yang anda tahu akan mempengaruhi keputusan kami dalam menerima risiko dan
menentukan kadar dan terma yang dikenakan dan apa-apa perkara yang munasabah yang boleh dijangka, jika tidak ia boleh menyebabkan
pembatalan kontrak insurans, keengganan atau pengurangan ganti rugi, perubahan terma atau penamatan kontrak insurans anda. Kewajipan
pendedahan hendaklah diteruskan sehingga kontrak insurans anda dimeterai, diubah atau diperbaharui dengan kami.
2. Untuk kepentingan alam sekitar, dokumen-dokumen polisi tidak akan dicetak (kecuali sekiranya perlu atau atas permintaan) tetapi boleh dikeluarkan
dan diserahkan kepada anda di dalam bentuk elektronik atau disediakan dan dipaparkan kepada anda atas talian melalui laman web rasmi kami di
www.berjayasompo.com.my Sila rujuk laman web kami untuk sebarang perubahan atau maklumat terkini berkenaan polisi insurans anda yang boleh
dimaklumkan dan diterbitkan dari masa ke semasa. Untuk maklumat lanjut, sila menghubungi khidmat pelanggan kami di 1-800-889-933.
3. Anda dikehendaki untuk membaca Jadual Polisi ini bersamaan dengan Kandungan Polisi untuk terma dan syarat polisi insurans anda, termasuk had
perlindungan, pengecualian-pengecualian dan pengendorsan, dimana terpakai. Sila rujuk kepada Kandungan Polisi dalam laman web kami di
Bahagian Perpustakaan (https://www.berjayasompo.com.my/page/download-library#p-2) yang boleh dimuat-turun oleh anda untuk salinan dan
penelitian anda. Sekiranya anda tidak dapat memasuki laman web kami atau merujuk atau memperolehi Kandungan Polisi tersebut, sila berhubung
dengan kami atau ejen kami dengan segera untuk bantuan supaya kami dapat memberikan salinan kepada anda. Anda juga boleh membuat
permintaan untuk mendapatkan satu salinan cetak dari mana-mana cawangan pejabat kami di seluruh negara.

Page 2 20-10-2024 07:01:02 AM

***THIS IS A COMPUTER GENERATED DOCUMENT. NO SIGNATURE IS REQUIRED.***
THIS DOCUMENT SHALL NOT BE INVALIDATED SOLELY ON THE GROUND THAT IT IS NOT SIGNED.
***INI ADALAH DOKUMEN YANG DIKELUARKAN OLEH KOMPUTER. TANDATANGAN TIDAK DIPERLUKAN.*** DOKUMEN
INI TIDAK HARUS DITAKSAHKAN SEMATA-MATA ATAS ALASAN IA TIDAK DITANDATANGANI.

12PMPN782001-1 Renewal of Policy No. : V2367107

Page 3 20-10-2024 07:01:02 AM

 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 : MX1

CERTIFICATE NO. / NO. SIJIL : MD490228

1. Index Mark and Registration Number of Vehicle / Tanda Indek dan Nombor Pendaftaran Kenderaan : JKH4954

2. Name of Policyholder / Nama Pemegang Polisi : FAUZIE BIN ZAINNI

3. Effective Date of the Commencement of Insurance for purposes of the Regulations, Ordinance or Enactment : 01-11-2024 12:00:01 AM
Tarikh berkuatkuasa bagi Permulaan Insuran Untuk tujuan Peraturan, Ordinan atau Enakmen
4. Date of expiry of the Insurance / Tarikh Tamat Insuran : 31-10-2025
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 further, that the person driving is permitted in accordance with the licensing or other laws or regulations to drive the Car or has been so permitted
and is not disqualified by an order of a Court of Law or by reason of any enactment or regulation in that respect from driving the Car.
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, pacemaking, reliability trial, speed-testing, 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 kegunaan untuk sewaan atau ganjaran, perlumbaan, mengkadar kelajuan, ujian kebolehpercayaan, ujian
kelajuan, 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 to be 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.

The benefits payable under eligible certificate/policy/product is/are protected by PIDM up to limits. Please refer to PIDM’s TIPS Brochure or contact Berjaya
Sompo Insurance Berhad or PIDM (visit www.pidm.gov.my).

Manfaat-manfaat yang dibayar di bawah sijil/polisi/produk yang layak adalah dilindungi oleh PIDM sehingga had perlindungan. Sila rujuk Brosur Sistem
Perlindungan Manfaat Takaful dan Insurans PIDM atau hubungi Berjaya Sompo Insurance Berhad atau PIDM (layari www.pidm.gov.my).

***THIS IS A COMPUTER GENERATED DOCUMENT. NO SIGNATURE IS REQUIRED.***

THIS DOCUMENT SHALL NOT BE INVALIDATED SOLELY ON THE GROUND THAT IT IS NOT SIGNED.
***INI ADALAH DOKUMEN YANG DIKELUARKAN OLEH KOMPUTER. TANDATANGAN TIDAK DIPERLUKAN.***
DOKUMEN INI TIDAK HARUS DITAKSAHKAN SEMATA-MATA ATAS ALASAN IA TIDAK DITANDATANGANI.

12PMPN782001-1

Page 4 20-10-2024 07:01:02 AM

 Service Tax License No : W10-1808-31004734

INVOICE

FAUZIE BIN ZAINNI Invoice No : UTRK-03902795-1024

NO 48 A JALAN PERDANA
KAMPUNG MUHIBBAH Date : 20-10-2024
86600 PALOH
JOHOR

Intermediary No. : 10008653

Class : MOTOR

Particulars

Policy No : MD490228

Period of Insurance : 01-11-2024 To 31-10-2025

Currency : RINGGIT MALAYSIA

Gross Premium : 227.36

227.36

Total Excluding Service Tax : 227.36

Service Tax (8.00%) : 18.19

Stamp Duty : 10.00

Total Amount Payable : 255.55

The benefits payable under eligible certificate/policy/product is/are protected by PIDM up to limits. Please refer to PIDM’s TIPS Brochure or contact
Berjaya Sompo Insurance Berhad or PIDM (visit www.pidm.gov.my).

This is a computer generated document. No signature is required.

Page 5 20-10-2024 07:01:02 AM

Stamp Duty Paid EASY RIDER
Setem Hasil Dibayar POLICY SCHEDULE / JADUAL POLISI
The benefits payable under eligible certificate/policy/product is/are protected by PIDM up to limits. Please refer to PIDM’s TIPS Brochure or contact Berjaya
Sompo Insurance Berhad or PIDM (visit www.pidm.gov.my).

Manfaat-manfaat yang dibayar di bawah sijil/polisi/produk yang layak adalah dilindungi oleh PIDM sehingga had perlindungan. Sila rujuk Brosur Sistem
Perlindungan Manfaat Takaful dan Insurans PIDM atau hubungi Berjaya Sompo Insurance Berhad atau PIDM (layari www.pidm.gov.my).
The Insured / Pihak Diinsuranskan e-Policy No./ Master Policy No
RA192988
FAUZIE BIN ZAINNI No. e-Polisi/ No Polisi Induk
NO 48 A JALAN PERDANA
KAMPUNG MUHIBBAH Intermediary No. / Name BP - 10008653
86600 PALOH No. Wakil Insurans / Nama SALNIZA ENTERPRISE
JOHOR Date of Proposal or Declaration
Tarikh Tandatangan Cadangan atau 20-10-2024 07:00:51 AM
Akuan

NRIC/Business Reg. No. Period Insurance / Tempoh Insurans

781201-01-5079
No. KP/Pendaftaran Perniagaan From/Dari 01-11-2024 12:00:01 AM To /Hingga 31-10-2025

Date of Birth Basic Premium RM 78.00

01-12-1978 Premium Asas
Tarikh Lahir

Age Additional Premium RM 0.00

45
Umur Premium Tambahan
Registration No.
JKH4954
No. Pendaftaran Kenderaan
Gross Premium RM 78.00
Make & Model Premium Kasar
TOYOTA AVANZA
Buatan & Model

Year of Manufacture
2007 Service Tax (8.00%) RM 6.24
Tahun Diperbuat
Cukai Perkhidmatan (8.00%)
Seating Capacity /
Muatan Tempat Duduk 7
Stamp Duty RM 10.00
Setem Hasil
Insurance Plan
PLAN 1
Pelan Insurans
TOTAL PREMIUM / JUMLAH RM 94.24
PREMIUM

Territorial Limit : Anywhere within Malaysia, Republic of Singapore, Negara Brunei Darussalam and Thailand.
Had Wilayah : Mana-mana tempat di Malaysia, Republik Singapura, Negara Brunei Darusalam dan Thailand.

***THIS IS A COMPUTER GENERATED DOCUMENT. NO SIGNATURE IS REQUIRED.***

THIS DOCUMENT SHALL NOT BE INVALIDATED SOLELY ON THE GROUND THAT IT IS NOT SIGNED.
***INI ADALAH DOKUMEN YANG DIKELUARKAN OLEH KOMPUTER. TANDATANGAN TIDAK DIPERLUKAN.***
DOKUMEN INI TIDAK HARUS DITAKSAHKAN SEMATA-MATA ATAS ALASAN IA TIDAK DITANDATANGANI.

20-10-2024 07:01:02 AM
Subject to the following Optional Benefit Extension, Warranties and Clauses as printed herein or attached hereto: -
Tertakluk kepada Manfaat Pilihan Yang Diperluaskan, Waranti dan Fasal berikut yang tercatit dibawah atau dilampirkan bersama ini:-
Code / Kod Description / Deskripsi

ETMDE TERRORISM MASS DESTRUCTION EXCLUSION CLAUSE

Notwithstanding any provision to the contrary it is hereby declared and agreed that this Policy shall exclude
Terrorism but only as the sole result of the utilization of Nuclear, Chemical or Biological weapons of mass
destruction howsoever these may be distributed or combined. Definitions :-

1. Terrorism shall mean an act, or acts, of any person, or group(s) of persons, committed for political, religious,
ideological or similar purposes with the intention to influence any government and/or to put the public, or any
section of the public,in fear. Terrorism can include, but not limited to, the actual use of force or violence and/or the
threat of such use. Furthermore the perpetrators of Terrorism can either be acting alone, or on behalf of, or in
connection with any organisation(s) or governments(s).

2. Utilization of Nuclear weapons of mass destruction shall mean the use of any explosive nuclear weapon or
devise or the emission, discharge, dispersal, release or escape of fissile material emitting a level of radioactivity
capable of causing incapacitating disablement or death amongst people or animals

3. Utilization of Chemical weapons of mass destruction shall mean the emission, discharge, dispersal, release or
escape of any solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing
incapacitating disablement or death amongst people or animals.

4. Utilization of Biological weapons of mass destruction shall mean the emission, discharge, dispersal, release or
escape of any pathogenic (disease producing) micro-organism(s) and/or biologically produced toxin(s)(including
genetically modified organisms and chemically synthesised toxins) which are capable of causing incapacitating
disablement or death amongst people or animals.

ESLEC SANCTION LIMITATION AND EXCLUSION CLAUSE

No Insurer shall be deemed to provide cover and no Insurer shall be liable to any claim or provide any benefit
hereunder to the extent that the provision of such cover, payment of such claim or provision of such benefit would
expose that Insurer to any sanction, prohaibition or restriction under United Nations resolutions or the trade or
economic sanctions laws or regulations of the European Union, United Kingdom or United States of America.

GENERAL EXCLUSIONS / PENGECUALIAN AM

The policy does not cover war, terrorism, strike, riot and civil commotion, suicide, childbirth or miscarriage, insanity (unless caused solely and directly by
accidental means covered under the policy), illness, while the driver is under the influence of alcohol or narcotics, vehicle used for hire, racing, road rally,
peacemaking, speed-testing or illegal business pursuit and driver not holding a valid driving licence. Full lists of exclusions are obtainable from BERJAYA
SOMPO INSURANCE BERHAD (62605-U) upon application. / Polisi ini tidak melindungi peperangan, tindakan keganasan, mogok, rusuhan dan
kekecohan awam, membunuh diri, kelahiran anak atau keguguran, hilang akal (melainkan disebabkan semata-mata dan secara langsung oleh cara-cara
kemalangan yang dilindungi di bawah polisi ini), penyakit,semasa pemandu dibawah pengaruh alkohol atau narkotik, kenderaan digunakan untuk sewa,
perlumbaan, rali, perlumbaan yang bergerak pada kelajuan yang cepat, ujian kelajuan atau kegiatan perniagaan haram dan pemandu tidak memegang
lesen memandu yang sah.
Senarai lengkap pengecualian boleh diperolehi daripada BERJAYA SOMPO INSURANCE BERHAD (62605-U) atas pemohonan.
Subject to the terms, conditions and exclusions stated in the Policy Wording. / Tertakluk kepada terma-terma, syarat-syarat dan pengecualian yang tertera
di dalam Polis.
This Schedule should be read in conjunction with the Original Policy subject to the Original Policy terms and conditions thereof including the Endorsements
issued prior to this renewal and all amendments incorporated herein for the above period of insurance.

Jadual ini harus dibaca bersama dengan Polisi Asal dan tertakluk kepada terma-terma dan syarat-syarat di dalam Polisi asal termasuk endosan yang
dikeluarkan sebelum pembaharuan dan semua pembetulan yang dimasukkan untuk tempoh perlindungan diatas.

COVERAGE DESCRIPTIONS (PER PERSON) SUM INSURED PER PERSON

[MANFAAT PERLINDUNGAN] (SEORANG) [JUMLAH DIINSURANSKAN SEORANG]
1. DEATH (PER PERSON) RM 25,000.00
KEMATIAN (SETIAP ORANG)
2. PERMANENT DISABLEMENT (PER PERSON) RM 25,000.00
KETIDAKUPAYAAN KEKAL (SETIAP ORANG)
3. MEDICAL EXPENSES (PER PERSON) RM 1,000.00
PERBELANJAAN PERUBATAN (SETIAP ORANG)
4. DAILY HOSPITAL INCOME (PER PERSON) ( MAXIMUM 60 DAYS) RM 30.00
PENDAPATAN HOSPITAL HARIAN (SETIAP ORANG) (MAKSIMUM 60
HARI)
5. AMBULANCE FEES (PER ACCIDENT) RM 150.00
YURAN AMBULANS (SETIAP KEMALANGAN)
6. BURIAL/CREMATION EXPENSES (PER PERSON) RM 1,000.00
PERBELANJAAN PENGEBUMIAN / PEMBAKARAN MAYAT (SETIAP
ORANG)

20-10-2024 07:01:02 AM
 Service Tax License No : W10-1808-31004734

INVOICE

FAUZIE BIN ZAINNI Invoice No : UTRK-03902796-1024

NO 48 A JALAN PERDANA
KAMPUNG MUHIBBAH Date : 20-10-2024
86600 PALOH
JOHOR

Intermediary No. : 10008653

Class : EASY RIDER

Particulars

Policy No. : RA192988

Period of Insurance : 01-11-2024 To 31-10-2025

Currency : RINGGIT MALAYSIA

Gross Premium : 78.00

78.00

Total Excluding Service Tax : 78.00

Service Tax (8.00%) : 6.24

Stamp Duty : 10.00

Total Amount Payable : 94.24

The benefits payable under eligible certificate/policy/product is/are protected by PIDM up to limits. Please refer to PIDM’s TIPS Brochure or contact
Berjaya Sompo Insurance Berhad or PIDM (visit www.pidm.gov.my).

This is a computer generated document. No signature is required.

20-10-2024 07:01:02 AM
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