TAKAFULIKHLAS SDN BHD exo)
Dh oe. enguran Msayian Re
No 17, Loreng Dung, Damansara Heights
Looked No, 11098, 50090 Kuala Lumpur
Tel 022084 1000 Fax 02-2004 0021
Website: ww taketh. com my
IKHLAS
Ee Umi CeneO)
etee oe)
Pengeluaran dan penesimaan Borang Tuntutan ini bukan pengakuan berianggungjawab oleh pihak Syarikat dan sekirenya Kenyataan dan
pengisytharen pelsu dibuat untuk menyokong tuntutan ri, maka tuntutan ini ace batal dan tidak sah,
NO. SIL / ci
RTIFICATE NO.
4. Nama Peuntut/ Nome of Cain
2. No.KadPengenalan Banu
3. Alamet
Poskod!Posteod| Bandar Town
4. No. Telefon! Te Pejebat/ Office [
Rumah /Houso |)
Bibi a
5. Mel / EMail: AEE
6 Pekeqaan
7. Nama dan No. Akaun Bank Peserta, Contoh: MB80O01
Eaten nena
1. Tarkh Kejacian|
Date OF Oca
Cie
ea)
petang
2. Aamat Kediaman Yang Musnah
(i TTT
'._Huraian Bagaimane Kejacian Kerosakan Bevlaku
Deserition OF How
“4. Untuk Tujuan Aga Bangunan Didiami Semasa Kerosakan?
mpose The Premise Was Occupied at The
Sila Tandal/|ika Berkeraan/ Pease
Kediaman Pecniagaan
idence LI
5. Berepakah Jumiah Nila Harta Benda Pada Masa Kojadian
erosakan?
What Was
1 Total Value Of The Prop Time
‘. Bangunan
[8 ekandung
|e. Stokainiegs
6. Adakan Kerugin Dilapor Di Baal Pals?
Was The Loss Reported To The Pole Station?
er) Tae
| vika Ya, Balai Pols Man:
|__ir'Yes, Whioh Potce Si
No. Laporan Polis
conan 71 Aakan Ando Perk Tunggal Hata Benda Yang Rosak? | Sia Tanda \/| Jka Berkenaon/ Please Tick's/ cable
YO pO
Car
co
1, Lain-lain Pink Yang Mempunyal Kepentingan Dalam Harta
Benda (Contohnya Pemegang Pajakan IGacaian)
Other Intorested Party In The Property
(69. ChangeewMongegces!
2. Laintcin Taka Inourans Yang Melindungl Hora Benda | Syarkat Tekafl/insurans
Tersebut Takafud
Other Takotu / nsurances in Force On The Property No. Si
‘Niailnsurans Saat ji
Sum Covered
3. Pemahkah Anda Menuntut Seberang Gantrugi Temhadap | sia Tanda I Jka Berkenaan | Maklumat /Pariculare
Bengunan ini Alau Lein-lain Bangunan Dari Mana-mana | Piegsa
Potrebbero piacerti anche
- American Gods: The Tenth Anniversary EditionDa EverandAmerican Gods: The Tenth Anniversary EditionValutazione: 4 su 5 stelle4/5 (12954)
- The Picture of Dorian Gray (The Original 1890 Uncensored Edition + The Expanded and Revised 1891 Edition)Da EverandThe Picture of Dorian Gray (The Original 1890 Uncensored Edition + The Expanded and Revised 1891 Edition)Valutazione: 4 su 5 stelle4/5 (9054)
- Never Split the Difference: Negotiating As If Your Life Depended On ItDa EverandNever Split the Difference: Negotiating As If Your Life Depended On ItValutazione: 4.5 su 5 stelle4.5/5 (3310)
- The Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good LifeDa EverandThe Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good LifeValutazione: 4 su 5 stelle4/5 (5813)
- The Iliad: A New Translation by Caroline AlexanderDa EverandThe Iliad: A New Translation by Caroline AlexanderValutazione: 4 su 5 stelle4/5 (5734)
- The Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good LifeDa EverandThe Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good LifeValutazione: 4.5 su 5 stelle4.5/5 (20096)
- Pride and Prejudice: Bestsellers and famous BooksDa EverandPride and Prejudice: Bestsellers and famous BooksValutazione: 4.5 su 5 stelle4.5/5 (20479)
- The Picture of Dorian Gray: Classic Tales EditionDa EverandThe Picture of Dorian Gray: Classic Tales EditionValutazione: 4 su 5 stelle4/5 (9763)
- The Odyssey: (The Stephen Mitchell Translation)Da EverandThe Odyssey: (The Stephen Mitchell Translation)Valutazione: 4 su 5 stelle4/5 (7771)
- Art of War: The Definitive Interpretation of Sun Tzu's Classic Book of StrategyDa EverandArt of War: The Definitive Interpretation of Sun Tzu's Classic Book of StrategyValutazione: 4 su 5 stelle4/5 (3321)
- The Iliad: The Fitzgerald TranslationDa EverandThe Iliad: The Fitzgerald TranslationValutazione: 4 su 5 stelle4/5 (5646)
- Habit 6 Synergize: The Habit of Creative CooperationDa EverandHabit 6 Synergize: The Habit of Creative CooperationValutazione: 4 su 5 stelle4/5 (2499)
- Wuthering Heights (Seasons Edition -- Winter)Da EverandWuthering Heights (Seasons Edition -- Winter)Valutazione: 4 su 5 stelle4/5 (9974)
- How To Win Friends And Influence PeopleDa EverandHow To Win Friends And Influence PeopleValutazione: 4.5 su 5 stelle4.5/5 (6538)
- The 7 Habits of Highly Effective PeopleDa EverandThe 7 Habits of Highly Effective PeopleValutazione: 4 su 5 stelle4/5 (2571)
- Anna Karenina: Bestsellers and famous BooksDa EverandAnna Karenina: Bestsellers and famous BooksValutazione: 4 su 5 stelle4/5 (7503)
- Wuthering Heights Complete Text with ExtrasDa EverandWuthering Heights Complete Text with ExtrasValutazione: 4 su 5 stelle4/5 (9955)
- Habit 1 Be Proactive: The Habit of ChoiceDa EverandHabit 1 Be Proactive: The Habit of ChoiceValutazione: 4 su 5 stelle4/5 (2559)
- The 7 Habits of Highly Effective PeopleDa EverandThe 7 Habits of Highly Effective PeopleValutazione: 4 su 5 stelle4/5 (353)
- Habit 3 Put First Things First: The Habit of Integrity and ExecutionDa EverandHabit 3 Put First Things First: The Habit of Integrity and ExecutionValutazione: 4 su 5 stelle4/5 (2507)
- The 7 Habits of Highly Effective People: The Infographics EditionDa EverandThe 7 Habits of Highly Effective People: The Infographics EditionValutazione: 4 su 5 stelle4/5 (2487)
