Allianz General Insurance Company (Malaysia) Berhad 200601015674 (735426-V)

No. 62 , Ground Floor,JALAN Barrack 34000 TAIPING

Tel No: 05-8068688/8068976 Fax No: 05-8088975 E-Mail: -

RTD CODE : 13
ORIGINAL COPY
THE SCHEDULE STAMP DUTY PAID
JADUAL DUTI SETEM DIBAYAR

M.X.1 RAHMAH PACKAGE - PRIVATE CAR EXCLUDING GOODS

INSURED SURIANI BINTI ABDUL RANI

Date of Issue/Time 07-11-2023
PEMUNYA
Tarikh Dikeluarkan/Waktu 3.54.19 PM
ADDRESS NO 47, JALAN PJU8/1, DAMANSARA PERDANA
ALAMAT 46050 PETALING JAYA E-Cover Note No. AETP0827175
No. Nota Perlindungan
SELANGOR
Account No. TP96604
No. Akaun
Premium 781.51

PERIOD OF INSURANCE (a) From 07-11-2023 (both dates inclusive)

Dari (termasuk kedua-dua tarikh)
TEMPOH INSURANS
To 06-11-2024 NCD 38.33 % 299.55
Hingga 210216071123W931
(b) Any subsequent period for which the Insured shall pay Extra Coverage (Inclusive of Package) 0.00
and the Company shall agree to accept a renewal Perlindungan Tambahan
premium.
Sebarang tempoh selanjutnya di mana Anda hendaklah
membayar, dan Kami hendaklah bersetuju menerima
premium pembaharuan.
OCCUPATION/TYPE OF BUSINESS OTHERS
PERNIAGAAN/PEKERJAAN

HIRE PURCHASE OWNERS/EMPLOYER'S LOAN

SEWA BELI/PINJAMAN MAJIKAN GROSS PREM 481.96
Service Tax 28.92
PARTICULARS OF VEHICLE Risk Excess / LEBIHAN 0.00
BUTIR-BUTIR KENDERAAN Voluntary Excess / LEBIHAN 0.00 STAMP DUTY 10.00
TOTAL DUE 520.88
Make and Type of Body / Buatan dan Jenis Badan Registration No./Trailer No. / No. Pendaftaran/No. Treler
PERODUA ALZA EZ 4 SP AUTOMATIC - 1495 BLV4332
PERODUA ALZA WAGON 4DOOR EZ (A) 1.5I-HIGH
AMOUNT PAYABLE
(ROUNDED) 520.90
Engine/Motor No. Engine C.C/Horse Power/Tonnage/Watt
No. Enjin/Motor Cc Enjin/Kuasa Kuda/Tan/Watt
Act. 152.10
G33A00N 1495.00 CC Akta
Chassis No. Seating Capacity Year of Manufacture Sum Insured 20,000.00
No. Casis Muatan Tempat Duduk Tahun Dibuat Jumlah Diinsuranskan
PM2M502G002112267 7 2012
NRIC No./Bus. Regn. No HP/Phone No. & e-mail Regn. Card No. Type of Cover
No. Kad Pengenalan/No. Pendaftaran Perniagaan No. Telefon Bimbit/Telefon & e-mel No. Kad Pendaftaran Jenis Perlindungan
780115116020 00-0392131717 NA COMPREHENSIVE
[email protected]
EXTRA COVERAGE
RAHMAH PACKAGE
COMPASSIONATE FLOOD COVER
HOSPITAL INCOME
DEATH / PERMANENT
DISABLEMENT
24-HOUR EMERGENCY TOWING
This Policy is subject to the following endorsements as printed in this Policy or added thereon or attached thereto:-
Polisi ini adalah tertakluk kepada pengendorsan yang telah dicetak atau ditambah atau dimasukkan kedalamnya.
A213 RAHMAH PACKAGE (NON-TARIFF)
COMPASSIONATE FLOOD COVER (UP TO RM 3,000)
DEATH / PERMANENT DISABLEMENT OCCURING WITHIN 180 DAYS OF THE ACCIDENT (SUM INSURED RM5000 PER
PERSON)
HOSPITAL INCOME (RM50 PER DAY)
ENDT.1 - EXCESS ALL CLAIMS
ENDT.113 - REFERENCE TO MOTOR VEHICLE MARKET VALUATION SYSTEM
ENDT.87 - AGREED VALUE CLAUSE
PCB1 - 24-HOUR EMERGENCY TOWING : 150 (KM)

NAMED DRIVERS
1. THE POLICYHOLDER
2. MOHAMAD RIZAL BIN MOHD RADZI

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Allianz General Insurance Company (Malaysia) Berhad 200601015674 (735426-V)
No. 62 , Ground Floor,JALAN Barrack 34000 TAIPING
Tel No: 05-8068688/8068976 Fax No: 05-8088975 E-Mail: -

Geographical Area : Malaysia, Republic of Singapore and Negara Brunei Darussalam. Issued By / Dikeluarkan oleh
HARAPAN BJ SDN BHD / TP96604-15
Kawasan Geografi : Malaysia, Republik of Singapura dan Negara Brunei Darussalam
D-17-05, MENARA MITRALAND, NO 13A, JALAN PJU5/1,
Limitations as to Use/ Authorised Driver : As described in the Certificate of Insurance. PJU 5 KOTA DAMANSARA
Had Penggunaan / Pemandu Yang Diberi kuasa : Seperti yang tercatat dalam Sijil Insurans 47810, PETALING JAYA
TEL: -
HP: 6016-6999129
FAX:
Allianz Road Rangers Contact Center: 1800 22 5542

Please ensure All accidents are reported to the Police within 24 hours Allianz General Insurance Company (Malaysia) Berhad 200601015674 (735426-V)
Pastikan semua kemalangan hendaklah dilaporkan kepada pihak Polis dalam masa 24 jam.
Issued in lieu of and Cancelling/Replacing Cover Note/Policy No. -
Dikeluarkan Sebagai Pembatalan/Penggantian/No. Nota Perlindungan/ No. Polisi -
Date of Signature of Proposal & Declaration 07-11-2023
Tarikh Tandatangan Cadangan dan Akuan

Important Notice : Policy print out can be obtained from our branch offices located nationwide or from your servicing agents.
Kenyataan Penting : Cetakan polisi boleh diperolehi daripada pejabat cawangan kami di seluruh negara ataupun daripada ejen Allianz Anda.
ALPHA-2396604-002512337-4

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Allianz General Insurance Company (Malaysia) Berhad 200601015674 (735426-V)
No. 62 , Ground Floor,JALAN Barrack 34000 TAIPING
Tel No: 05-8068688/8068976 Fax No: 05-8088975 E-Mail: -

Lodging of Complaints
We are committed to maintaining high levels of service, honesty, integrity and trustworthiness. If you have any reason to
be dissatisfied with any of our products or services, we would like to hear from you. Your feedback is very important to us
as we are always looking for ways to improve and serve you better.
To provide us with your feedback, you may contact us via the following channels:

Write to: Phone : 1-300-22-5542

Customer Feedback Center Facebook Messenger : @AllianzMalaysia
Allianz Arena Email : [email protected]
Ground Floor Block 2A Website/Live Chat : www.allianz.com.my
Plaza Sentral
Jalan Stesen Sentral 5
Kuala Lumpur Sentral
50470 Kuala Lumpur

Avenues to Seek Redress

You may submit your complaint to the Ombudsman for Financial Services (OFS) if you are not satisfied with our final
response or decision, in the event that your complaint is within the scope of the OFS as well as the following monetary
thresholds:
(1) Insurance claims not exceeding RM250,000.00; and
(2) Motor third party property damage claims not exceeding RM10,000.00.
The OFS can be contacted at the following address:
Ombudsman for Financial Services Phone : 03-2272 2811
Level 14, Main Block, Menara Takaful Malaysia Fax : 03-2272 1577
No 4, Jalan Sultan Sulaiman Email : [email protected]
50000 Kuala Lumpur Website : www.ofs.org.my
If your complaint does not fall within the purview of the OFS, you may refer your complaint to Laman Informasi Nasihat
dan Khidmat (LINK) of Bank Negara Malaysia (BNM) at the following address:
Write to (BNMTELELINK) : Phone : 1-300-88-5465
Pengarah Fax : 03-2174 1515
LINK & Pejabat BNM Email : [email protected]
Bank Negara Malaysia Website : www.bnm.gov.my
P.O. Box 10922
50929 Kuala Lumpur
Walk-in (BNMLINK):
Ground Floor, Block D
Bank Negara Malaysia
Jalan Dato' Onn
50480 Kuala Lumpur

You may check with our Customer Feedback Center on the types of complaints handled by the OFS or BNM before
submitting your complaint.

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Allianz General Insurance Company (Malaysia) Berhad 200601015674 (735426-V)
No. 62 , Ground Floor,JALAN Barrack 34000 TAIPING
Tel No: 05-8068688/8068976 Fax No: 05-8088975 E-Mail: -

RTD CODE : 13

CERTIFICATE OF INSURANCE
SIJIL INSURANS
ORIGINAL COPY M.X.1
SALINAN ASAL
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 AND COMPENSATION) RULES 1960 (REPUBLIC OF SINGAPORE)
MOTOR VEHICLES (THIRD PARTY RISKS) ACT (CAP 90) NEGARA BRUNEI DARUSSALAM

CERTIFICATE NO. AETP0827175 NCD 38.33%

No.Sijil Diskaun Tanpa Tuntutan

1. Index Mark and Registration Number of Vehicle : BLV4332 1495.00 CC PERODUA ALZA EZ 4 SP AUTOMATIC -
Tanda Indeks Dan Nombor Pendaftaran Kenderaan
2. Name of Policyholder : : SURIANI BINTI ABDUL RANI
Nama Pemegang Polisi
3. Effective date of the Commencement of : 07-11-2023
Insurance for the purposes for the Regulations,
Ordinance or Enactment
Tarikh efektif permulaan insuran untuk kegunaan Ordinan
4. Date of Expiry of the Insurance : 06-11-2024
Tarikh Luput Insuran
5. Persons or Classes of Persons entitled to drive
Orang atau Kelas Pihak Yang Dibenarkan Memandu
a) THE POLICYHOLDER b) ANY OTHER PERSON WHO IS DRIVING ON THE POLICYHOLDER'S ORDER OR WITH HIS PERMISSION.

PROVIDED THAT THE PERSON IS PERMITTED IN ACCORDANCE WITH THE LICENSING OR OTHER LAWS OR REGULATIONS 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 OF REGULATIONS IN THAT BEHALF FROM DRIVING THE MOTOR
VEHICLE.
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, speed testing, the carriage of goods other than samples in connection with any trade or business or use for any
purpose in connection with the motor trade.

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.

This Certificate is not transferable to a new owner of the Vehicle.

If for any reason the Insurance is terminated during its currency this Certificate must be returned to the Company or if this Certificate has been lost or destroyed a Statutory Declaration to
that effect must be made. Failure to comply with this obligation is an offence under the compulsory Insurance Legislation.
This Certificate must be returned if the insurance is suspended during its currency.

IMPORTANT
If you are involved in an accident causing injury to any person or damage to any property or other vehicle you must :
(a) Try to obtain names and address of any witness to the accident.
(b) Report to the Company immediately.
(c) Refer to the Company immediately all communications received from the Police Authorities.
(d) Sent to the Company immediately all letters from Third Parties unanswered.
(e) Not pay money to any Party involved in the accident without the Company's written permission.

* 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.
Had yang tidak beroperasi oleh Seksyen 95 Akta Pengangkutan Jalan 1987 (Malaysia) atau Seksyen 8 Akta Kenderaan Bermotor (Gantirugi dan Risiko Pihak Ketiga) (Cap 189) Republik Singapura atau
Seksyen 7 Akta Singapura atau Seksyen 7 Akta Insurans Kenderaan Bermotor (Risiko Pihak Ketiga) (Cap 90) Negara Brunei Darussalam adalah tidak termasuk di bawah tajuk ini.

I/We certify that the Policy to which the Certificate is issued in accordance with the provisions of Part IV of the Road Transport Act, 1987 (Malaysia), Motor Vehicles (Third Party Risks and
Compensation) Act (Cap 189) Republic of Singapore and the Motor Vehicles Insurance(Third Party Risks) Act (Cap 90) Negara Brunei Darussalam.
Saya/kami bersetuju bahawa Polisi di mana Sijil ini dikeluarkan tertakluk di bawah proviso Bahagian IV Akta Pengangkutan Jalan 1987. (Malaysia) Akta Kenderaan Bermotor (Risiko Pihak Ketiga &
Gantirugi) (Cap 189) Republik Singapura dan Akta Kenderaan Bermotor (Risiko Pihak Ketiga) (Cap 90) Negara Brunei Darussalam.

Agent Code : TP96604 ALLIANZ GENERAL INSURANCE COMPANY (MALAYSIA) BERHAD 200601015674 (735426-V)
Kod Ejen

ALPHA-2396604-002512337-4

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