COVER NOTE

Participant MR. RANDASAN @ LANDASAN BIN JUMPAH SMK ELOPURA 2 W.D.T 136 90009 SANDAKAN Sabah Malaysia

STAMP DUTY PAID

Certificate No. : TGPC-PA246642-03-BRTHKKB Replacing Cover Note No. : Account No. : T5600241 Agent Name : SHAMRIN BIN SURIP Product Type : Motor Private Car Period of Takaful from 09/05/2013 To 08/05/2014 (both Dates Inclusive). Any subsequent period for which the Participant shall pay and the Takaful Operator shall agree to accept a renewal contribution.

NRIC No Business/Occupation

: 641110-12-5251 :

Business Reg No

Vehicle Information JPJ Document No : 12037274 Vehicle Reg No : SS765H Log Book No : A0580356 Make : PERODUA Model : Kembara EX Engine No : F059302 Cover Type : Comprehensive Chassis No : PM2J104G002059045 Vehicle Type : Private Car Year of Manufacture : 2003 License Type : Normal Vehicle Cubic Capacity : 1296 Use For : Private Use Seating Capacity :5 Financial Interest : Authorised Driver 1. RANDASAN @ LANDASAN BIN JUMPAH_______641110-12-5251 Subject to the following warranties, endorsements and clauses incorporated herein and forming part of the Certificate. Clause Code Clause Name E002 ENDORSEMENT 2 EXCESS DAMAGE CLAIM E002F ENDORSEMENT 2(f) COMPULSORY EXCESS E030 ENDORSEMENT 30 REPLACEMENT PARTS E100 ENDORSEMENT 100 EXCLUSION OF LEGAL LIABILITY TO PASSENGERS (PRIVATE CAR ONLY) E106 ENDORSEMENT 106 TAKAFUL OPERATOR'S AUTHORISED WORKSHOP

Vehicle Estimated Value Gross Contribution Less: No Claim Discount 25.00 % Named Driver

RM RM RM RM RM

15,000.00 491.83 - 122.96 0.00 368.87 0.00 0.00 10.00

Less_:_Discount/Rebate 0 % Add__:_Service Tax Stamp Duty

RM RM RM

TOTAL AMOUNT DUE

RM

378.87

Excess

RM

0.00

IMPORTANT NOTICE This Takaful Certificate (including this schedule) is issued to you based on the information transmitted to us/our agents/representatives by you. If you find any of the information stated herein is inconsistent with your disclosure, kindly provide us with the correct information for revision, and if we do not hear from you within fourteen (14) days from the commencement date of your certificate, we shall deem that the information is correct. In line with the provisions of S.28 of the Takaful Act 1984, we shall have the right to invalidate your certificate and/or deny your claim should we later discover that your disclosure was not made in good faith and/or was fraudulently and/or falsely and/or deceivingly made. Issue Date Issued At Issued By : : : 09/05/2013 BRTHKKB SHAMRIN BIN SURIP

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