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Kurnia Insurans (Malaysia) Berhad (44191-P) : E-Policy / Endorsement Submission Sheet (Motor)

Kurnia Insurans (Malaysia) Berhad submitted an e-policy/endorsement sheet for 3 motor insurance policies on June 1, 2011. The sheet included policy details such as insured names, vehicle types, premium amounts, and payment details totaling RM1084.17. Payment was made via cheque and payment authorization instruction from the insured parties. The agent's stamp and signature confirmed submission of the document.

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Yuen Thou
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324 views1 page

Kurnia Insurans (Malaysia) Berhad (44191-P) : E-Policy / Endorsement Submission Sheet (Motor)

Kurnia Insurans (Malaysia) Berhad submitted an e-policy/endorsement sheet for 3 motor insurance policies on June 1, 2011. The sheet included policy details such as insured names, vehicle types, premium amounts, and payment details totaling RM1084.17. Payment was made via cheque and payment authorization instruction from the insured parties. The agent's stamp and signature confirmed submission of the document.

Uploaded by

Yuen Thou
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BR-CN-F21

REV: B

Kurnia Insurans (Malaysia) Berhad (44191-P)


e-POLICY / ENDORSEMENT SUBMISSION SHEET (MOTOR)
Date 01-06-2011
Account No. A01400-00
Agency Name SUMMIT POINT TRADING
Agent Name
Batch No. K1759764E

Date of C/Note No. Insured Name C/N Type Vehicle Vehicle No. Gross Total NCD% Comm. S/Tax Transfer S/Duty Nett Premium Status Replacement
Issue Type Payable Fee No.
23-05-2011 JVB4323033 ONG LEE TING R PC WLU8548 241.74 251.74 55.00 24.17 0.00 0.00 10.00 227.57 SUBMITTED

26-05-2011 JVB4336392 YEE MEI YEN R PC WRJ7983 443.53 453.53 38.33 44.35 0.00 0.00 10.00 409.18 SUBMITTED

26-05-2011 JVB4336393 CHONG YEN PENG R PC WKX7893 486.02 496.02 25.00 48.60 0.00 0.00 10.00 447.42 SUBMITTED

Grand Total 1171.29 1201.29 117.12 0.00 0.00 30.00 1084.17

No. Payment Mode Cheque No. / Card No. / Payment Description ePAI Status/Approval Code Amount (RM)
1 Cheque HSBC929968 251.75

2 PAI FORM - Payment 5400********0256 832.42


Authorization Instruction
Total Amount Received (RM) 1084.17

Agent's Stamp & Signature

* Credit Card, Signatory must be Cardmember and signature as per Card Account.

Page 1 01-06-2011 / 01:55:46 PM

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