Overseas Assurance Corporation (Malaysia) Berhad (102249-P)

(A member of Great Eastern Holdings Limited)

Level 18, Menara Great Eastern,
303, Jalan Ampang, 50450 Kuala Lumpur.
Telephone: 03-4259 7888 Facsimile: 03-4813 0055
Website: www.oac.com.my

N.MAIALAGAN A/L NARAYANASAMY

KM 2759 JLN DUA,

TMN SUTERA INDAH,
78000 MELAKA.
78000

MOTOR PRIVATE CAR POLICY

Policy No : VPC-V1627590-ML

VHML0457 Original Copy

Overseas Assurance Corporation (Malaysia) Berhad (102249-P)
(A member of Great Eastern Holdings Limited)

MOTOR SCHEDULE / JADUAL KENDERAAN BERMOTOR

Account No. / No. Akaun : VHML0457

Policy No. / No. Polisi : VPC-V1627590-ML
Insured Name / : N.MAIALAGAN A/L NARAYANASAMY
Nama Pihak Diinsuranskan
Postal Address / : KM 2759 JLN DUA,
Alamat Pos TMN SUTERA INDAH,
78000 MELAKA.
78000

Period of Insurance / : From 27/04/2017 to 26/04/2018

Tempoh Insurans Dari hingga
Any subsequent period for which the insurance shall pay and the Corporation may agree to
accept a renewal premium.
Sebarang tempoh selanjutnya di mana anda hendaklah membayar dan Syarikat kami hendaklah
bersetuju untuk menerima premium pembaharuan

PRIVATE CAR / KERETA PERSENDIRIAN

Risk / Risiko : 1
Business / Profession / Perniagaan / Perkerjaan : LORRY DRIVER
Cover / Perlindungan : COMPREHENSIVE
Risk Class / Kelas Risiko : PRIVATE CAR
Vehicle Registration No. / No. Pendaftaran Kenderaan : MCD1795
C.C. / Keupayaan Engin : 1597
Make & Body / Buatan & Badan : PROTON - PROTON EXORA 1.6 (A)
Year of Manufacture / Tahun Diperbuat : 2011
Engine No. / No. Enjin : S4PHRM5721
Chassis No. / No. Casis : PL1FZ6YRRCF070971
Log Book No. / No. Siri : 1385640
Seating Capacity / Muatan Tempat Duduk : 7
Estimated Value / Nilai Anggaran : RM 30000.00 (Vehicle / Kenderaan)
Excess / Lebihan : RM 0.00 Limits / Had

Premium / Premium : RM 1059.50

Loading / Tambahan 0.00% : RM 0.00
NCD / Diskaun Tanpa Tuntutan 0.00% : RM 0.00
WINDSCREEN WITH TINT : RM 180.00 RM 1200.00
ADD NAMED DRIVER : RM 0.00

: RM 1239.50
Goods and Services Tax (6.00%) / Cukai Barangan dan : RM 74.37
Perkhidmatan (6.00%)
Stamp Duty / Duti Setem : RM 10.00

Total Due / Jumlah Perlu Dibayar : RM 1323.87

Authorised Drivers / Pemandu yang diberi kuasa :

01N.MAIALAGAN A/L NARAYANASAMY 02SANTHI A/P VALU
Financial Interest / Kepentingan kewangan : AM ISLAMIC BANK BHD
Subject to the following endorsements incorporated herein and forming part the policy :
Tertakluk kepada Pengendorsan yang dimasukkan dan menjadi sebahagian polisi :
E015 HIRE PURCHASE
E030 REPLACEMENT PARTS
E089 WINDSCREEN WITH TINT OR WITHOUT TINT
E106 INSURER'S AUTHORISED WORKSHOP (INCLUDING ANY WINDSCREEN REPLACEMENTS AND REPAIRS)
CAP CAR ASSISTANCE PROGRAMME
E02F COMPULSORY EXCESS
E087 AGREED VALUE

Subject also to the Sanction Limitation and Exclusion Clause (SANC) and Goods and Services Tax (GST) stated in the Policy attached hereto.
 Signed on behalf of the Corporation
Tandatangan bagi Pihak Syarikat
Replacing / Penggantian
Policy No. / No. Polisi VPC-V1627590-ML
Cover Note / Nota Perlindungan J1920412
Issued On / Dikeluarkan Pada 26/04/2017
At / Di MALACCA
By / Oleh PRABHA457
_________________________________________
Authorised Signatory / Penandatangan Dibenarkan
Important : This Schedule should be read in conjunction with the standard form of policy to which this Schedule is attached.
Penting : Jadual ini hendaklah dibaca bersama dengan format polisi yang dilampirkan bersama Jadual ini.
Overseas Assurance Corporation (Malaysia) Berhad (102249-P)
(A member of Great Eastern Holdings Limited)

DEBIT NOTE
CLIENT'S COPY

GST Registration No : 001437466624

Number : J1920412
Trans. Date : 26/04/2017

N.MAIALAGAN A/L NARAYANASAMY

KM 2759 JLN DUA,
TMN SUTERA INDAH,
78000 MELAKA.
78000

Reason : RENEWAL BUSINESS

Type Of Policy : MOTOR PRIVATE CAR / KERETA PERSENDIRIAN
Policy No. : VPC-V1627590-ML
Period of Cover : From 27/04/2017 To 26/04/2018
Insured's Name : N.MAIALAGAN A/L NARAYANASAMY
Address : KM 2759 JLN DUA,
TMN SUTERA INDAH,
78000 MELAKA.
78000

Account : VHML0457
MALAYSIAN RINGGIT
Premium : 1,239.50
Goods and Services Tax (6.00%) : 74.37
Stamp Duty : 10.00
Total : 1,323.87

Total Due : 1,323.87

Note : Please attach a copy of this Debit Note together with your payment and all cheques should be made payable to Overseas Assurance Corporation
(Malaysia) Berhad. Please write your name and policy number at the back of the cheque.
Enclose herewith is :
Cheque/Money/Postal Order No. : Amount : RM
Name of Bank :
Overseas Assurance Corporation (Malaysia) Berhad (102249-P)
(A member of Great Eastern Holdings Limited)

DEBIT NOTE
AGENT'S COPY

GST Registration No : 001437466624

Number : J1920412
Trans. Date : 26/04/2017

N.MAIALAGAN A/L NARAYANASAMY

KM 2759 JLN DUA,
TMN SUTERA INDAH,
78000 MELAKA.
78000

Reason : RENEWAL BUSINESS

Type Of Policy : MOTOR PRIVATE CAR / KERETA PERSENDIRIAN
Policy No. : VPC-V1627590-ML
Period of Cover : From 27/04/2017 To 26/04/2018
Insured's Name : N.MAIALAGAN A/L NARAYANASAMY
Address : KM 2759 JLN DUA,
TMN SUTERA INDAH,
78000 MELAKA.
78000

Account : VHML0457
MALAYSIAN RINGGIT
Premium : 1,239.50
Goods and Services Tax (6.00%) : 74.37
Stamp Duty : 10.00
Total : 1,323.87

Total Due : 1,323.87

Note :
This section is for the Insured to acknowledge receipt of this policy/endorsement by signing at the indicated space below.
I/we hereby acknowledge receipt of this policy/endorsement.

_________________________________________
Anthorised Signature & company stamp (if any)
Name :
IC No. :
Date :
Overseas Assurance Corporation (Malaysia) Berhad (102249-P)
(A member of Great Eastern Holdings Limited)

CERTIFICATE OF INSURANCE / SIJIL INSURANS

Road trasport Act, 1987 (Malaysia)
PRIVATE CAR Motor Vehicles (Third Party Risks) Rules, 1959 (Malaysia)
Risk No: 0001 Motor Vehicles (Third Party Risks & Compensation) Act (Cap 189) Republic of Singapore
Motor Vehicles (Third Party Risks & Compensation) Rules 1960 (Republic of Singapore)
COMPREHENSIVE Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam
RM 30000.00 Akta Pengangkutan Jalan Raya 1987 (Malaysia)
Peraturan Kenderaan Bermotor (Risiko Pihak Ketiga) 1959 (Malaysia)
Kenderaan Bermotor (Risiko Keatas Pihak Ketiga dan Pampasan) Akta (Kap 189) Republik Singapura
Peraturan Kenderaan Bermotor (Risiko Keatas Pihak Ketiga dan Pampasan) 1960 (Republik Singapura) Insurans
Insurans Kenderaan Bermotor (Risiko Keatas Pihak Ketiga) Akta (Kap 90) Negara Brunei Darussalam

CERTIFICATE NO. / NO. SIJIL :

V1627590
1. Index Mark and Registration Number of Vehicle / Tanda Indeks dan No. Pendaftaran Kenderaan
MCD1795
PROTON - PROTON EXORA 1.6 (A)
2. Name of Policyholder / Nama Pemegang Polisi
N.MAIALAGAN A/L NARAYANASAMY
3. Effective date of the Commencement of Insurance for the purpose of Regulations, Ordinance or Enactment /
Tarikh mula Insurance berkuatkuasa bagi tujuan Peraturan, Ordinans atau Enakmen
27/04/2017
4. Date of Expiry of Insurance / Tarikh Tamat Insurans
26/04/2018
5. Persons or Classes of Persons entitled to drive* / Orang atau Kelas Orang yang layak memandu*
(a) The Policyholder
(b) Any other person who is driving on the Policyholder's order or with his permission.

6. Limitation as to use* / Had Penggunaan

Use only for social , domestic and pleasure purpose and for the Policyholder's business.
The policy does not cover
A) Use for hire or reward.
B) Use for racing pace-making, reliability trial or speed-testing
C) Use for the carriage of goods (other than samples) in connection with any trade or
business.
D) Use for any purpose in connection with the Motor Trade

ISSUED IN LIEU OF AND REPLACING POLICY NO.

V1627590
Limitations rendered inoperation 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 ditakwilkan tidak berkuatkuasa oleh Seksyen 95 Akta Pengangkutan Jalanraya (Malaysia),
1987 atau Seksyen 8 Kenderaan Bermotor (Risiko Keatas Pihak Ketiga Dan Pampasan) Akta (Kap 189) Republik Singapura atau Seksyen 7 Insurans
Kenderaan Bermotor (Risiko Keatas Pihak Ketiga) Akta (Kap 90) Negara Brunei Darussalam tidak termasuk dibawah tajuk ini.

I/WE HEREBY CERTIFY that the policy to witch this Certificate related is issued in accordance with the provisions of Part IV of the Road Transport Act, 1987 (Malaysia),
Motor Vehicles (Third Party Risks & Compensation) Act (Cap 189) Republic of Singapore and the Motor Vehicles Insurance (Third Party Risks) Act (Cap 90) Negara Brunei
Darussalam. / SAYA/KAMI DENGAN INI MEGESAHKAN bahawa Polisi yang berkaitan dengan Sijil ini dikeluarkan selaras dengan peruntukan Bahagian IV Akta
Pengangkutan Jalanraya 1987 (Malaysia), Kenderaan Bermotor (Risiko Keatas Pihak Ketiga Dan Pampasan) Akta (Kap 189) Republik Singapura dan Insurans Kenderaan
Bermotor (Risiko Keatas Pihak Ketiga) Akta (Kap 90) Negara Brunei Darussalam.

Signed on behalf of the Corporation

Tandatangan bagi Pihak Syarikat

___________________________
Authorised Signatory
 Tax Invoice/Invois Cukai

GST Registration No. : 001437466624

No. Cukai Barangan Dan Perkhidmatan

Tax Invoice No./ No. Invois Cukai : FL1700050075

Transaction Date/ Tarikh Transaksi : 26/04/2017

Policyholder Name : N.MAIALAGAN A/L NARAYANASAMY

/ Nama Pemegang Polisi Insurans
KM 2759 JLN DUA,
Address/ Alamat : TMN SUTERA INDAH,
78000 MELAKA.
78000

Particulars Of Supply/Butir-butir Pembekalan

Type Of Policy/ Jenis Polisi : MOTOR PRIVATE CAR / KERETA PERSENDIRIAN

Policy No/ No. Polisi : VPC-V1627590-ML

From 27/04/2017 To 26/04/2018
Period Of Insurance/ Tempoh Perlindungan : Dari 27/04/2017 Hingga 26/04/2018

Premium/ Premium RM 1,239.50

Goods and Services Tax (6.00%) / Cukai Barangan RM 74.37

Dan Perkhidmatan (6.00%)

Stamp Duty// Duti Setem RM 10.00

Total// Jumlah RM 1,323.87

This Tax Invoice is issued by

Invois Cukai ini dikeluarkan oleh

Overseas Assurance Corporation (Malaysia) Berhad (102249-P)

Level 18, Menara Great Eastern,
303, Jalan Ampang,
50450 Kuala Lumpur, Malaysia

Tel : (603)4259 7888 Fax : (603)4813 0055

Customer Services Careline : (603)4259 8900
Email : enquiry@oac.com.my
Website : www.oac.com.my