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    Servicing - Amendment Form (ATP) 2

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    Nur Yuhanis
    This document is an amendment form submitted by Nur Yuhhanis Binti Abu Hassan to update her contact information for her insurance proposal/application. Specifically, she is requesting to change her email address from [email protected] to [email protected] and have her quotation sent to the new email. She declares that the information provided is complete and true and will form the basis of her contract with the insurance company. She consents to her personal information being collected and used for processing her application.

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    Servicing - Amendment Form (ATP) 2

    Uploaded by

    Nur Yuhanis
    21 views1 page
    This document is an amendment form submitted by Nur Yuhhanis Binti Abu Hassan to update her contact information for her insurance proposal/application. Specifically, she is requesting to change her email address from [email protected] to [email protected] and have her quotation sent to the new email. She declares that the information provided is complete and true and will form the basis of her contract with the insurance company. She consents to her personal information being collected and used for processing her application.

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    This document is an amendment form submitted by Nur Yuhhanis Binti Abu Hassan to update her contact information for her insurance proposal/application. Specifically, she is requesting to change her email address from [email protected] to [email protected] and have her quotation sent to the new email. She declares that the information provided is complete and true and will form the basis of her contract with the insurance company. She consents to her personal information being collected and used for processing her application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    21 views1 page

    Servicing - Amendment Form (ATP) 2

    Uploaded by

    Nur Yuhanis
    This document is an amendment form submitted by Nur Yuhhanis Binti Abu Hassan to update her contact information for her insurance proposal/application. Specifically, she is requesting to change her email address from [email protected] to [email protected] and have her quotation sent to the new email. She declares that the information provided is complete and true and will form the basis of her contract with the insurance company. She consents to her personal information being collected and used for processing her application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Sun Life Malaysia Assurance Berhad*

    Registration No: 199001005930 (197499-U)


    Sun Life Malaysia Takaful Berhad*
    Registration No: 200501012215 (689263-M)

    Level 11, 338 Jalan Tuanku Abdul Rahman, 50100 Kuala Lumpur
    Telephone: (603) 2162 3600 [email protected]
    Client Careline: 1300-88-5055 sunlifemalaysia.com

    AMENDMENT FORM / BORANG PINDAAN

    IMPORTANT NOTE / NOTA PENTING


    You are to disclose in this form, fully and faithfully, all the facts which you know or ought to know, otherwise the policy issued hereunder may be void. /
    Anda dikehendaki memberitahu di dalam borang ini, secara penuh dan ikhlas segala fakta yang anda ketahui atau yang patut anda ketahui. Jika tidak,
    polisi yang diterbitkan menurut dokumen di bawah ini mungkin menjadi batal.

    Name / Nama
    NUR YUHANIS BINTI ABU HASSAN
    ___________________________________________________________________________________________________________

    Proposal/Application No. / No. Cadangan/Permohonan Age / Umur Gender / Jantina

    L8931619
    __________________________________________________ ____________ Male / Lelaki Female / Perempuan X
    NRIC No. / No. KP

    940408145378
    _________________________________________ New / Baru ___________________________________________ Old / Lama

    17/5/2023 as follows: / Saya dengan ini bersetuju untuk meminda


    I hereby agree to amend my proposal/application form dated ____________
    17/5/2023 seperti berikut:
    borang cadangan/permohonan saya yang bertarikh ____________
    1. To change my email address from [email protected] to
    [email protected]
    2. Requesting to send my quotation to new email
    DECLARATION / DEKLARASI

    I hereby declare that the above particulars and answers are complete and true and that together with the other information provided by
    me will form the basis of the contract between me and the Insurance Company/Operator.

    I agree that any of my personal information collected or held by Sun Life Malaysia Assurance Berhad/Sun Life Malaysia Takaful
    Berhad ("you") in this document is provided with my consent for it to be held, used, and disclosed by you to individuals or organisations
    associated with you or any selected third party (within or outside of Malaysia, including retakaful and claims investigation companies
    and industry associations/federations) to process my application as stated in this document, and to communicate with me for purposes
    of processing such application. I understand that I am entitled to obtain access to and to request correction of any personal information
    held by you and that such request can be made to your Client Careline at 1300-88-5055.

    Saya dengan ini mengaku bahawa butir-butir dan jawapan-jawapan di atas adalah lengkap dan betul dan bersama-sama dengan
    maklumat lain yang telah saya berikan akan menjadi asas kontrak di antara saya dan Syarikat Insurans/Operator.

    Saya bersetuju bahawa sebarang maklumat peribadi saya yang diperolehi atau disimpan oleh Sun Life Malaysia Assurance
    Berhad/Sun Life Malaysia Takaful Berhad ("anda") didalam dokumen ini, adalah boleh diberikan atau disimpan, digunakan dan
    didedahkan oleh anda kepada individu atau organisasi yang berkaitan dengan anda atau mana-mana pihak ketiga yang terpilih (di
    dalam atau di luar Malaysia termasuk syarikat-syarikat takaful semula dan siasatan tuntutan serta persatuan/persekutuan industri)
    untuk memproses permohonan saya sepertimana tertera di dalam dokumen ini, serta berhubung dengan saya bagi tujuan
    pemprosesan permohonan tersebut. Saya memahami bahawa saya berhak mendapat akses kepada maklumat tersebut dan meminta
    sebarang pembetulan dibuat ke atas mana-mana maklumat peribadi yang disimpan oleh anda dan permintaan tersebut boleh dibuat
    kepada talian Khidmat Pelanggan Careline anda di 1300-88-5055.

    ___________________________________________________________ __________________________________________
    Signature of proposer/applicant / Tandatangan pencadang /pemohon Signature of witness / Tandatangan saksi
    Name / Nama : Name / Nama : Tengku Ibrahim Bin Tengku Mohd Amin
    NRIC No. / No. KP : NRIC No. / No. KP : 941124-14-5821
    Date / Tarikh : Date / Tarikh : 11/5/2023

    A joint venture between Sun Life Assurance Company of Canada and Renggis Ventures Sdn Bhd Page 1 of 1

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