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UW-PW-S009(E)(MT)

REV: B
"Please call KAA Toll Free 1-800-88-3833 for breakdown or accident assistance" RTD Code:08
PRIVATE CAR EX GOODS
PRIVATE CAR SCHEDULE / JADUAL KERETA PERSENDIRIAN M.X.1

The Insured / Pemegang Polisi Policy No. / No. Polisi


BVB0032939 01-01
MD KHAIRUL AFZAN BIN MOHAMAD
Account No. / No . Akaun
NO 566 G59800-00
JALAN S2 G10 Type of Cover / Jenis Perlindungan
GARDEN AVENUE COMPREHENSIVE
SEREMBAN 2 Period of Insurance / Tempoh Insurans
70300 SEREMBAN From / Dari 00:00:01 AM 05-09-2018 To / Hingga 04-09-2019
Bus. Regn. No / Premium / Premium RM 724.29
Occupation / Pekerjaan No Pendaftaran Perniagaan All Rider / Semua Penunggang 0.00
MANAGER -
724.29
NCD / Diskaun Tanpa Tuntutan 55.00% 398.36
I.C. No. / No.Kad Pengenalan Wef / Berkuatkuasa dari 05-09-2018
810101115873 325.93
Optional Cover T
Hire Purchase Owner / Pemilik Sewa Beli Gross Premium / Premium Kasar 325.93
Rebate / Rebat 10% 32.59
-
293.34
Make & Type of Body / Buatan & Jenis Badan
PERODUA MYVI EZI / 4D HATCHBACK Service Tax / Cukai Perkhidmatan 6.0 % 17.6
Stamp Duty / Duti Setem 10.00

Registration No. / Excess / Lebihan Regn. Card No. / No.Kad


No.Pendaftaran Pendaftaran
0.00
CCF8910 -

Carrying or Seating Tonnage / C.C./ Watt Sum Insured / Jumlah


Capacity Incl. Driver / Tan / Keupayaan Enjin Diinsuranskan (RM)
Muatan Tempat Duduk 1298.00 CC
Termasuk Pemandu
Year of Manufacture / 17,000.00
5 Tahun Diperbuat
(Agreed Value)
2008

Engine /Motor No. / No . Enjin / Motor


E88B98D
Chassis No. / No. Casis Trailer / Treler
PM2M301S002235680 -
Only The Extensions, Endorsement And / Or Warranties Indicated Below Apply To
This Policy. / Hanya Lanjutan, Endorsemen dan / atau Warranti sepertimana yang
dinyatakan di bawah ini boleh diguna pakai dalam polisi ini.
2, 87 (AGREED VALUE)

Endorsement 87 (Agreed Value) will not apply in the event any changes to the sum
insured is made after policy inception

Subject to IMPORTANT NOTICE: Your duty as the Owner of the vehicle as attached. Total Due / Jumlah Berbayar RM 320.94
Authorised Driver / Pemandu yang Diberi Kuasa:
THE POLICYHOLDER|810101115873, NOR AIZA AMIZAN BINTI MOHAMAD|850903115476

Geographical Area : Malaysia , Republic of Singapore and Negara Brunei Darussalam. / Kawasan Geografi : Malaysia, Republik Singapura dan
Negara Brunei Darussalam.
Limitations as to Use / Authorised Driver : As described in the Certificate of Insurance. / Had Penggunaan / Pemandu Yang Diberi Kuasa : Seperti
yang tercatat dalam Sijil Insurans.
Replacing Cover Note No./ - Issued By / Dikeluarkan Oleh : For / untuk
Gantian No. Nota AMGENERAL INSURANCE BERHAD AmGeneral Insurance Berhad
Perlindungan MENARA SHELL,
Renewal of Policy No./ - NO. 211, JALAN TUN
Pembaharuan No.Polisi SAMBANTHAN
Date of Proposal or 02-09-2018 Tel : 03-22683333
Declaration / Fax : 03-21713030
Tarikh Cadangan atau
Pengisytiharan Authorised Signature /
Date of Issue / Time 02-09-2018 09:32:09 PM Tandatangan Yang Diberi Kuasa
Tarikh Dikeluarkan / Waktu
Note: / Nota: No refund of premium for any cancellation of policy if premium is charged on minimum premium / Tiada bayaran balik premium bagi sebarang pembatalan polisi sekiranya premium
yang dikenakan adalah premium minima.

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09BVE8PM810943-1

CERTIFICATE OF INSURANCE / SIJIL INSURANS


AKTA PENGANGKUTAN JALAN RAYA 1987 (MALAYSIA) RTD Code :08
PERATURAN KENDERAAN BERMOTOR (RISIKO KEATAS PIHAK KETIGA) 1959 (MALAYSIA)
ORIGINAL COPY / AKTA KENDERAAN BERMOTOR (RISIKO KEATAS PIHAK KETIGA DAN PAMPASAN) (KAP 189) REPUBLIK SINGAPURA
SALINAN ASAL PERATURAN KENDERAAN BERMOTOR (RISIKO KEATAS PIHAK KETIGA DAN PAMPASAN 1960 (REPUBLIK SINGAPURA)
AKTA INSURANS KENDERAAN BERMOTOR (RISIKO KEATAS PIHAK KETIGA) (KAP 90) NEGARA BRUNEI DARUSSALAM

Certificate No. / No. Sijil


BVB0032939 01-01 Excess : RM 0.00 Sum Insured : RM 17,000.00 (Agreed Value)
1. Index Mark and Registration Number of Vehicle / Tanda Indeks dan No. Pendaftaran Kenderaan
CCF8910 NCD : 55.00% Wef : 05-09-2018
2. Name of Insured / Nama Pemegang Polisi
MD KHAIRUL AFZAN BIN MOHAMAD
3. Period of Insurance / Tarikh Insurans
From / Dari 00:00:01 AM 05-09-2018 To / Hingga 04-09-2019
4. 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/her permission.
a) Pemegang Polisi.
b) Sesiapa yang memandu atas arahan Pemegang Polisi atau dengan kebenarannya.
Provided that the person driving is permitted in accordance with the licensing or other laws or regulations to drive the Motor Vehicle or has been so permitted and is not
disqualified by order of a Court of Law or by reason of any enactment or regulation in that behalf from driving the Motor Vehicle. / Dengan syarat orang yang dibenarkan
memandu itu menurut perlesenan atau undang-undang atau peraturan lain bagi memandu kenderaan bermotor dan telah dibenarkan dan tidak hilang kelayakan atas perintah
Mahkamah Undang-undang atau atas sebab mana-mana enakmen atau peraturan berkenaan pemanduan kenderaan bermotor.
5. Limitations as to use / Had Penggunaan*
Use only for social, domestic and pleasure purposes and for the insured`s business. The policy does not cover :-
Use for hire or reward, racing, pace-making, reliability trial, speed-testing the carriage of goods other than samples in connection with any trade
or business.
Digunakan hanya untuk tujuan sosial, domestik dan persiaran dan untuk perniagaan Pemegang Polisi.
Polisi ini tidak melindungi kegunaan untuk sewaan atau ganjaran, perlumbaan, mengkadar kelajuan, ujian kebolehpercayaan, ujian kelajuan,
membawa barangan selain daripada sampel yang berkaitan dengan apa-apa pekerjaan atau perniagaan.
* Limitations rendered inoperative 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 Akta Kenderaan Bermotor (Risiko Keatas Pihak
Ketiga Dan Pampasan) (Kap 189) Republik Singapura dan Seksyen 7 Akta Insurans Kenderaan Bermotor (Risiko Keatas Pihak Ketiga) (Kap 90) Negara Brunei Darussalam
tidak termasuk dibawah tajuk ini.

I/WE HEREBY CERTIFY that the policy to which this certificate relates is issued in accordance with the provisions of Part IV of the Road Transport Act,
1987 (Malaysia), Motor Vehicles (Third Party Risks and 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 MENGESAHKAN bahawa polisi yang melaluinya sijil ini dikeluarkan adalah
selaras dengan peruntukan Bahagian IV Akta Pengangkutan Jalan, 1987 (Malaysia), Akta Kenderaan Bermotor (Risiko Keatas Pihak Ketiga dan
Pampasan) (Kap 189) Republik Singapura dan Akta Insurans Kenderaan Bermotor (Risiko Keatas Pihak Ketiga) (Kap 90) Negara Brunei Darussalam.

IMPORTANT NOTICE: Your duty as the Owner of the vehicle. Failure to comply to the below may result your
claim to be declined.
(1) The insured will have to take all reasonable care to secure the vehicle from loss or damage.
(2) Report to the police for all incidents. For road accident, you have to report to the police within 24 hours. for / untuk AmGeneral Insurance Berhad
(3) Notify us in writing within 7 days after the incident and complete the claim form in full and return it to us (Incorporated in Malaysia / Ditubuhkan di Malaysia)
with the related documents within 21 days from your notification's date. Approved Insurers / Penanggung Insurans Yang Dibenarkan
(4) You must obtain our consent in writing before you repair your vehicle or incur any expenses.
(5) For private car own damage claim - In the event of claim, repairs must be conducted by our
approved repairer.
(6) When incident happen, you need to collect these details :
(a) all drivers e.g full name, residential address and contact number
(b) all vehicles e.g. make and model, registration number, and insurance details
(c) date, time and location of the incident
(d) description of the incident and
(e) report to us immediately
(f) report to us for any claims made by another person against you and send us the notices and Authorised Signature /Tandatangan Yang Diberi Kuasa
letters within 14 days from the receipt of the documents.
(7) Do not negotiate or settle any claims made against you, unless you have our consent in writing.
(8) We will have full discretion in the conduct, defence and/or settlement of any claim.
Agent Code / Kod Ejen: G59800-00
N.B. (i) We have the right to cancel this policy by giving you 14 days’ notice in writing by
registered post to your last known address in our records.
(ii) Betterment – In the event your vehicle is aged above 5 years, this policy is subject to rate of betterment.
(iii) You need to read this policy carefully, and if any error or incorrect description is found herein, or
if the cover is not in accordance with your wishes, you should inform us immediately and return this policy to us for alteration.

Important Notice / Kenyataan Penting :


* For environmental conservation, we have adopted paper less printing concept. Please log on to our website to view the Bahasa Malaysia language policy wordings, terms and conditions and exclusion.
For further enquires, please contact your insurance intermediary or our Customer Contact Centre. /Untuk pemeliharaan alam sekitar, kami telah mengaplikasikan konsep tanpa percetakan. Sila layari laman
web kami untuk rujukan da / atau mencetak kandungan polisi, terma-terma, syarat-syarat dan pengecualian dalam Bahasa Melayu. Untuk pertanyaan lanjut, sila hubungi ejen insurans anda atau Pusat
Khidmat Pelanggan kami.
* You are advised to read and understand the summary of this product as contained in the Product Disclosure Sheet on our website. /Anda dinasihati supaya membaca dan memahami ringkasan produk ini
seperti yang tertera di dalam Lampiran Pemberitahuan Produk yang boleh didapati dilaman web kami.

Page 2 02-09-2018 09:35:46 PM


Invoice
Invois

Invoice No. : SST-09-18-00003363 Date : 02-09-2018


No. Invois Tarikh

Name : MD KHAIRUL AFZAN BIN MOHAMAD


Nama

Insurer Address : NO 566


Alamat JALAN S2 G10
GARDEN AVENUE
SEREMBAN 2
70300 - SEREMBAN

Agent Name : AMGENERAL INSURANCE BERHAD Account No. : G59800-00


Nama Ejen No. Akaun

Policy/Endorsement No. : BVB0032939 Cover Note No. : BVB0032939


No. Polisi/Endorsemen No. Nota

Class of Policy : PRIVATE CAR EX GOODS


Jenis Insurans

Period of Insurance : From 05-09-2018 To 04-09-2019


Tempoh Insurans

No. / No Description / Deskripsi Total / Jumlah (RM)


1 Gross Premium / Premium Kasar 325.93
2 Rebate / Rebat 10% 32.59
3 Service Tax / Cukai Perkhidmatan 6% 17.60
4 Stamp Duty / Duti Setem 10.00
5 Total Payable (OTC) / Jumlah Berbayar Di Kaunter 320.95
6 Total Payable / Jumlah Berbayar 320.94

AmGeneral Insurance Berhad

This is computer generated. No signature is required.


Ini adalah cetakan komputer . Tandatangan tidak diperlukan.
INSURED NAME : MD KHAIRUL

VEHICLE NO : CCF8910

COVER NOTE NO : BVB0032939

PRIVACY CLAUSE

1.0 PRIVACY CLAUSE

1.1 You confirm that you have read, understood and agree to be bound by the Privacy Notice of AmGeneral Insurance
which is available at our website and the clauses herein, as may relate to the processing of your personal
information. For the avoidance of doubt, you agree that the said Privacy Notice shall be deemed to be incorporated
by reference into this policy.
1.2 In the event you provide personal and/or financial information relating to third parties, including information relating
to your next-of-kin and dependents, for the purpose of operating the Insurance Policy with AmGeneral or otherwise
subscribing to AmGeneral's products and services, you:
a. confirm that you have obtained their consent or are otherwise entitled to provide the information to
AmGeneral and for AmGeneral to use it in accordance with this Insurance Policy;

b. agree to ensure that the personal and financial information of the said third parties is accurate and
update AmGeneral in writing in the event of any change to the said personal and financial information;
and
c. agree to AmGeneral's right to terminate the Insurance Policy should such consent be withdrawn by any
of the said third parties
1.3 Even after you have provided AmGeneral with any information, you have the option to withdraw the consent given
earlier. In such instances, AmGeneral will have the right to not provide or discontinue the provision of the
Insurance Policy that is/are linked with such information.
1.4 You agree that the Company and its related companies may contact you about products and services and offers,
which the Company and its related companies believe may be of interest to you, through various channels of
communication.
1.5 In the event you do not wish to consent to use your personal data to receive marketing of products and services by
the Company and its related companies, you may contact AmGeneral as per below details or you may contact
AmGeneral's nearest branch to you:

Customer Service Executive, Customer Contact Centre


Telephone No E-Mail

AmAssurance 1-300-80-3030 customer@amassurance.com.my


Kurnia Insurans 1-800-88-6333 customer@kurnia.com

1.6 AmGeneral reserves the right to amend this Section from time to time at AmGeneral's sole discretion by providing
notice to you.
VEHICLE INSURED VALUE
1.0 IF YOU HAVE SELECTED THE AGREED VALUE OPTION
1.1 Your vehicle is insured based on an agreed value.
1.2 In the event of total loss, the maximum amount that we will pay is up to the sum insured as shown in the schedule.
2.0 IF YOU HAVE SELECTED THE MARKET VALUE OPTION
2.1 Your vehicle is insured based on market value.
2.2 In the event of total loss, the maximum amount that we will pay is up to the market value of the vehicle which will
be determined at the time of loss or the sum insured as shown in the schedule; whichever is lesser. You may refer
to Section 10 : 'Definitions' or Endorsement 113 of the policy wording for the detailed definition of market value.
2.3 It is important to insure your vehicle with the appropriate market value. Below are the effects of over-insurance and
under-insurance when an incident happens and giving rise to a claim:
a. Over-insurance : When a claim arises, the maximum amount that we will pay you is up to the market
value of your vehicle even if your vehicle's sum insured is higher than the market value.
b. Under-insurance : When claim arises, we will only bear part of the loss in proportion to the difference
between the market value and the sum insured. The balance has to be borne by you if
the under-insured amount is more than 10% of the market value.

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PRIVACY NOTICE

Personal Data Protection Act 2010 (“PDPA”)

In line with PDPA, AmBank Group is committed to protect and safeguard customers’ Personal Data when entering into any
commercial transaction with AmBank Group.

Throughout this Privacy Notice, the following are the definitions of the terms used:

 AmBank Group refers to AMMB Holdings Berhad and all its subsidiaries and associate companies including but not limited to
AmBank (M) Berhad, AmBank Islamic Berhad, AmInvestment Bank Berhad, AmFunds Management Berhad, AmFutures Sdn
Bhd, AmIslamic Funds Management Sdn Bhd, AmCards Services Berhad, AmGeneral Insurance Berhad, AmMetLife
Insurance Berhad and AmMetLife Takaful Berhad.

 Personal Data refers to any information in respect of commercial transactions which is being processed and recorded that
relates directly or indirectly to a Data Subject, who is identified or identifiable from that information. This includes any Sensitive
Personal Data and expression of opinion about the Data Subject but does not include any information that is processed for the
purpose of a credit reporting business carried on by a credit reporting agency under the Credit Reporting Agencies Act 2010.
Examples of Personal Data include customer’s name, identity card or passport number, address, occupation, contact details,
account details or financial information.

 Sensitive Personal Data refers to any Personal Data consisting of information as to the physical or mental health, condition,
political opinions, religious beliefs or other beliefs of a similar nature.

 Unless expressly defined herein and where the context requires, all capitalized expressions shall have the same meaning
ascribed to it in the PDPA.

Purpose of Collecting Personal Data

In rendering services to customers, AmBank Group may be required to process customers’ Personal Data for any of the following
purposes:

(a) Assessment of customers’ eligibility or suitability for AmBank Group’s products applied for and verification of identity or
financial standing through credit reference checks;
(b) Notification and/or update on new features or development of products and services;
(c) Competitions, promotions, campaigns, offers and etc. from AmBank Group or third party business partners which customers
have participated;
(d) Account management and maintenance including regular updates, consolidation and improving accuracy of records;
(e) Research for analytical purposes based on transactions/use of products and services for better understanding of current and
future financial/investment needs;
(f) Enforcement of AmBank Group’s rights to recover any debt owing, including transfer or assignment of rights, interests and
obligations;
(g) Any other purpose(s) that is required or permitted by any law, regulation, standard, guideline and/or by relevant regulatory
authorities.

Sources of Personal Data

In providing Personal Data related to third parties to AmBank Group (such as next of kin or nominees), the provider of such
Personal Data confirms that consent has been obtained or that he/she is entitled to provide the Personal Data of those parties.

(a) Information provided in application forms when using AmBank Group’s products or services, when transacting accounts, when
using online or electronic services, when taking part in customer surveys, competitions, promotions and during performance of
financial reviews;
(b) Verbal, written and/or electronic communications with AmBank Group or its authorised agents;
(c) Third parties connected to customers, such as their employer, joint account holder, security providers and guarantor(s), other
partners in a partnership, or through AmBank Group’s corporate customers or corporate security providers where the customer
is a director, shareholder, officer or authorised signatory/person;
(d) Images captured by closed circuit television (CCTV) cameras at AmBank Group’s branches, office premises or third party
premises (where self-service terminals are located), when visiting AmBank Group branches or office premises or self-service
terminals at third party premises;
(e) Credit reporting agencies and publicly available sources such as through searches at relevant government authorities or
agencies; and/or
(f) Any other sources which customers have given consent for the intended purposes.

Disclosure of Personal Data

AmBank Group may be required to disclose customers’ Personal Data to the following third parties:

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PRIVACY NOTICE

(a) Its agents, service providers, vendors, financial institution(s) and /or professional advisers who assist us in processing,
administering, outsourcing, fulfilling transactions or providing services to customers on its behalf, or to fulfill value added
services that customers have requested;
(b) Its external professional advisors and consultants who provide services to it, for the purposes of its business, operational, legal
and regulatory requirements;
(c) any person(s) authorised or appointed by customers to give instructions to AmBank Group on customers’ behalf such as
customers’ agents, accountants, auditors, lawyers, financial advisers, brokers and intermediaries;
(d) any guarantor(s), security provider(s) or any person(s) intending to settle any moneys outstanding under the facility(ies)
granted by AmBank Group to customers;
(e) any third party(ies) arising from the restructuring of facility(ies) granted to you, sale of debts, acquisition or sale of any
company by AmBank Group provided that the recipient uses customers’ data for the same purpose(s) as it was originally
supplied to and/or used by AmBank Group;
(f) merchants and electronic fund transfer facilitators related to any credit/debit card(s) issued to customers by AmBank Group;
(g) any rating agency(ies), credit reporting agencies, insurer(s), insurance broker(s), re-insurers, loss adjusters, or direct/indirect
provider(s) of credit protection and in the event of default of a facility granted to customers, to debt collection agencies; and/or
(h) with other entities within AmBank Group for products and services that may be of interest to customers;
(i) any competent authority(ies) and/or regulator(s), for the performance of their functions;
(j) any information-sharing systems for fraud prevention and detection, including but not limited to Fraud Intelligence System
(FIS), an information-sharing system which utilizes analytical techniques for fraud prevention and detection, which is operated
by Insurance Services Malaysia Berhad (or any other company engaged for the operation of the FIS from time to time); and/or
(k) any association, federation or any other regulated body incorporated in the interest of insurance industry.

Rights of Data Subject

Obligatory and voluntary Personal Data may differ for various products and services as indicated in the application forms.
Customers may notify AmBank Group in writing to withdraw consent or to cease/begin processing Personal Data, giving AmBank
Group a reasonable period of time to carry out such request.

However, in the event the customer chooses to withdraw consent during an existing contractual agreement with AmBank Group
which may result in its inability to continue the relationship, AmBank Group reserves the right to continue processing customer’s
personal data in accordance with contractual or the applicable operational, audit, investigation, legal, regulatory, tax or accounting
obligations until all obligations are fulfilled.

Customers can access and/or make changes to their Personal Data by completing the Personal Data Request Form available at
AmBank Group branches or website subject to relevant processing fees, where applicable and AmBank Group shall notify
customers the reasons if such request cannot be acceded to. Customers may visit AmBank Group’s nearest branch or contact the
following for enquiries:

Customer Service Executive, Customer Contact Centre


Telephone No E-Mail
AmAssurance 1-300-80-3030 customer@amassurance.com.my
Kurnia Insurans 1-800-88-6333 customer@kurnia.com

Security of Personal Data

AmBank Group places great importance in ensuring the security and confidentiality of its customers’ Personal Data. As such,
AmBank Group regularly reviews and implements up-to-date technical and organisational security measures when processing
customers’ Personal Data. Further information on security controls is available at our Website Security Statement at
www.ambankgroup.com.

Retention of Personal Data

Customers’ Personal Data will be retained in accordance with this Privacy Notice and/or the terms and conditions of agreement(s)
with AmBank Group for the duration of the relationship or for such period as may be necessary to protect the interest of both
AmBank Group and the customers. Such retention is also necessary as required by law or in accordance with relevant internal
policies.

Revisions to Privacy Notice

This Privacy Notice may be revised from time to time and notice of such revision shall be posted on website and/or other means of
communication deemed suitable by AmBank Group.

(Last updated: 12 May 2017)

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