CL-PD-F008 (TP-N.

CON)
REV : B

Your Ref : TP1

Our Ref : K-3-17-VKD37198
Date : 12 January 2018 WITHOUT PREJUDICE

SHAFULLAZMAN BIN JAHYA

JALAN STESYEN KERETAPI
BUKIT KETRI BESERI
02450 KANGAR
PERLIS

Dear Sir/Madam,

ACCIDENT INVOLVING VEHICLE NUMBER KDF8188 AND PMP9891 ON 26 NOVEMBER 2017

We refer to your claim against our insured vehicle no. KDF8188.

Strictly without admission of liability, we are prepared to offer the sum of RM 1,200.00 as full and final settlement.

The basis of our breakdown is as follows:

Compensation for Assessed Repair Time RM 1,200.00

Grand Total RM 1,200.00

Please note that our offer is subject to the Discharge Voucher duly witnessed by Commissioner for Oath.

Kindly confirm acceptance by signing the attached Third Party Discharge Voucher and return the said DULY-
STAMPED copy together with 5 pieces of POST-REPAIR photograph of your vehicle depicting the following in
order to enable us to attend to the needful:

1. General View (front and rear) – 2 pcs

2. Speedometer – 1 pc
3. Chassis Number – 1 pc
4. Engine Number – 1 pc

All monies payable hereunder is inclusive of the Goods and Services Tax ("GST") and the rights and obligations in
respect of any treatment of GST, including but not limited to the deduction, addition and / or adjustment in respect
of such GST shall be in accordance with the relevant legislative requirements, as and when such legislative
requirements take effect.

Thank you.

Yours faithfully,
AmGeneral Insurance Berhad

Marziana Bt Mohd Fuzi

Third Party Property Damage - Claims

Tel : 03-22656288
Email : marziana-fuzi@amgeneralinsurance.com
Sub : N

THIS IS A COMPUTER GENERATED DOCUMENT AND DOES NOT REQUIRE A SIGNATURE.

 CL-PD-F009
REV : B
Original Date : 11 January 2018
K-3-17-VKD37198
V8153423
12 January 2018

In consideration of the payment of the sum of (RM 1,200.00) MALAYSIAN RINGGIT ONE THOUSAND TWO

HUNDRED ONLY by AmGeneral Insurance Berhad, Insurers of Vehicle No.: KDF8188. I/We, the

undersigned, hereby accept such sum in full settlement of all claims, present or future, that I/We have or may

have against the said insurers, owner and/or driver of vehicle no. KDF8188 in connection with or in any way

arising from the motor accident occurring on 26 November 2017 at involving my/our PMP9891, It is

understood that the above payment is an amicable settlement without in any way constituting any admission

of liability whatsoever on the part of the said insurers, owner and/or driver of vehicle No.: KDF8188 . I/We

further declare that the said insurers, owner, and/or driver of vehicle No.: KDF8188 shall not be liable for my

further claims or claims whatsoever in connection with the above accident.

All monies payable hereunder is inclusive of the Goods and Services Tax ("GST") and the rights and

obligations in respect of any treatment of GST, including but not limited to the deduction, addition and / or

adjustment in respect of such GST shall be in accordance with the relevant legislative requirements, as and

when such legislative requirements take effect.

Witnessed by the Commisioner for Oath (Signature of Claimant)

Name : __________________ Claimant Name : ____________________________

____________________________

Date : ___________________
Claimant Address : ____________________________
____________________________
____________________________
STAMP ____________________________
DUTY
RM10