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Etiqa-Cancellation FORM

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DR. MOHAMED IMRAN MOHAMED ARIFF
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231 views1 page

Etiqa-Cancellation FORM

Uploaded by

DR. MOHAMED IMRAN MOHAMED ARIFF
Copyright
© © All Rights Reserved
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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Etiqa Insurance & Takaful,

Tower B, Dataran Maybank,


No. 1 Jalan Maarof,
59000 Kuala Lumpur 2 August 2024
Date: ___________________

Dear Sir,

REQUEST CANCELLATION FOR VEHICLE INSURANCE/TAKAFUL

Referring to the request above,


MOHAMED IMRAN BIN MOHAMED ARIFF
2. I (name) _________________________________________, NRIC/Passport number
770921-08-7659
_____________________ would like to cancel my insurance/takaful with registration number
WA7868B
_________________ and policy number _________________.
SOLD my CAR
3. Reason for cancellation is ______________________________________________________.
MAYBANK
Any refund/ pro rate refund (if any), please credit it to my bank (bank name) ______________ with
1140121-80023
account number ______________________

Your concern and cooperation is highly appreciated.

Thank you.

Regards,

______________________ (signature)

( MOHAMED IMRAN BIN) MOHAMED


(Full name) ARIFF

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