This bank account number is used for payout purposes (if any). The account number must belong to the policy/contract/certificate owner/holder. Please ...
Ringgit (RM). A grace period of thirty (30) days from the company's acceptance letter date is allowed for the payment of the premiums. If the premium is not paid within the days of grace and no notice in writing has been received by the company, the
4.3. Prior to the underwriting acceptance date, only accidental death or accidental total and permanent disability (TPD) coverage, up to a maximum of RM250,000 or the in-force sum assured, whichever is lower, shall be payable in the event that death
As I have settled the housing loan with CIMB Bank/CIMB Islamic Bank (“the Bank” ), I hereby request to surrender my MRTA/MRTT certificate with the following details. I further understand that this surrender application is subject to the final approva
As I have settled the housing loan with CIMB Bank/CIMB Islamic Bank (“the Bank” ), I hereby request to surrender my. MRTA/MRTT certificate with the following details. I further understand that this surrender application is subject to the final approv
3.1 This policy is issued in consideration of the life assured's proposal form and the payment of premium as ... and such material information will form part of this master policy between us and you and/or the life assured. ... been issued, the life
nomination form to us by email directly to [email protected] or fax to ( 603) 2698 7035. 8. Renewability. The e-certificate will be renewable monthly subject to the premium payment and the terms and conditions in the master policy. The e-cer
Dec 31, 2007 ... Before the income statement and balance sheet of the Company were made out, the Directors took reasonable steps to ascertain that proper action had been taken in relation to the writing off of bad debts and the making of allowance fo
Cash Value Life Insurance Advantages VSA 2A2.22 ed. 09-12 Page 1 of 1 VSA, LP The information, general principles and conclusions presented in this report are subject
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Insurance Company Limited ... Policy Cancellation (Surrender Form) Rethink! Surrendering this policy would mean surrendering its benefits too. LIFE INSURANCE
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8) If you have lost or destroyed your policy please complete this section by placing an 'X' in the box. Instructions for completing Request for Policy Surrender
Urusniaga insurans hayat adalah berdasarkan pada falsafah perkongsian risiko. Urusniaga sedemikian amat penting dan harus ... simpanan pemunya polisi dan nama baik penanggung insurans hayat. 5. Penanggung insurans hayat mesti .... surat-menyurat, aka
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FORM 1 APPLICATION FOR ITALIAN CITIZENSHIP JURE SANGUINIS THE UNDERSIGNED Last/First/Middle Name: _____ City of Birth:
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Sun Life Malaysia Assurance Berhad* (197499-U) Sun Life Malaysia Takaful Berhad* (689263-M) Level 11, 338 Jalan Tuanku Abdul Rahman, 50100 Kuala Lumpur Telephone (603) 2612 3600 Facsimile (603) 2698 7035 Customer Careline 1300-88-5055 sunlifemalaysia.com
APPLICATION FOR CASH SURRENDER VALUE (NON INVESTMENT-LINKED FUND PRODUCT) / PERMOHONAN UNTUK NILAI SERAH TUNAI (BUKAN PRODUK DANA BERKAITAN-PELABURAN) SECTION A: POLICY/CONTRACT/CERTIFICATE INFORMATION / SEKSYEN A: MAKLUMAT POLISI/KONTRAK/SIJIL Policy/Contract/Certificate number / Nombor polisi/kontrak/sijil
Policy/Contract/Certificate owner/holder’s name / Nama pemilik/pemegang polisi/kontrak/sijil
NRIC number / Nombor kad pengenalan –
Other identification number / Nombor pengenalan lain
–
Bank name / Nama bank
Bank account number / Nombor akaun bank
This bank account number is used for payout purposes (if any). The account number must belong to the policy/contract/certificate owner/holder. Please provide a copy of the bank passbook/statement for our verification purposes. / Nombor akaun bank ini akan digunakan untuk tujuan bayaran (jika ada). Nombor bank akaun ini mesti merupakan akaun pemilik/pemegang polisi/kontrak/sijil tersebut. Sila sertakan satu salinan buku akaun bank atau penyataan bank untuk tujuan pengesahan. Life assured/Person covered’s name / Nama orang yang diinsuranskan/orang yang dilindungi
NRIC number / Nombor kad pengenalan –
Other identification number / Nombor pengenalan lain
–
Telephone Number / Nombor telefon Mobile phone / Telefon bimbit
Home / Rumah
–
Office / Pejabat
–
–
Email / Emel
Address / Alamat
Postcode / Poskod *Is the policy/contract/certificate assigned to any party? / *Adakah polisi/kontrak/sijil diserah hak kepada mana-mana pihak?
Yes / Ya
No / Tidak
Assignee’s Name / Nama Pemegang Serah Hak
NRIC number / Nombor kad pengenalan baru –
Telephone No. /Nombor telefon Mobile phone / Telefon bimbit –
Other identification number / Nombor pengenalan lain
–
Home / Rumah
Office / Pejabat
–
–
Version 1.3 July 2015
Address / Alamat
Postcode / Poskod
* A joint venture between Sun Life Assurance Company of Canada and Renggis Ventures Sdn Bhd
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PSCG10004009
SECTION B: SURRENDER QUESTIONNAIRE / SEKSYEN B: SOAL-SELIDIK PENYERAHAN Please tick [] where appropriate / Sila tandakan [] pada kotak yang berkenaan. Poor service from the company/operator / Tidak puas hati dengan perkhidmatan daripada syarikat/operator. Poor service from our authorise representative / Tidak puas hati dengan perkhidmatan daripada wakil yang diberi kuasa kami. Financial problem / Masalah Kewangan. Others / Sebab-sebab lain To replace with new policy/contract/certificate from / Diganti dengan polisi/kontrak/sijil baru daripada:
Sun Life Malaysia
Other company/operator / Syarikat/operator lain
Others / Lain-lain
Not satisfied with the existing policy/contact/certificate’s benefit / Tidak puas hati dengan kemudahan polisi/kontrak/sijil sekarang. Which is / iaitu: Other reasons / Sebab-sebab lain. Details / Nyatakan dengan terperinci:
SECTION C: DECLARATION / SEKSYEN C: PENGAKUAN I /We enclose herewith the policy/contract/certificate documents and hereby declare that:- / Saya/Kami sertakan bersama dokumen polisi/kontrak/sijil dan dengan ini mengisytiharkan bahawa:1. The above mentioned policy/contract/certificate documents has not been assigned or reassigned to any party other than to the above assignee(s). / Dokumen polisi/ kontrak/sijil yang tersebut di atas tidak pernah diserah hak atau diserah hak semula kepada mana-mana pihak selain Pemegang Serah Hak di atas. 2. I/We have not been adjudged bankrupt. / Saya/Kami tidak pernah diisytiharkan muflis. 3. I/We have agreed that upon receipt of cash surrender value from Sun Life Malaysia Assurance Berhad/Sun Life Malaysia Takaful Berhad [“the Company”], I/We shall discharge the Company/Operator from all liabilities and obligations in respect of the policy/contract/certificate. / Saya/Kami telah bersetuju bahawa sebaik sahaja menerima nilai serah tunai daripada Sun Life Malaysia Assurance Berhad/Sun Life Malaysia Takaful Berhad [“Syarikat”],saya/kami membebaskan Syarikat/Operator ini daripada semua tanggungan dan kewajipan yang berkaitan dengan polisi/kontrak/sijil ini. 4. I/We have read and understood the application form and the same was interpreted to me/us. / Saya/Kami telah membaca dan memahami isi kandungan borang ini dan telah diterjemahkan kepada saya/kami. 5. I/We hereby declare that I/we had fully and clearly understand and well informed on the losses of all the benefit under the policy/contract/certificate upon surrendering. / Saya/Kami dengan ini mengaku bahawa saya/kami telah memahami secara keseluruhan dan jelas dan diterang dengan jelas terhadap kerugian dalam manfaat yang terdapat dalam polisi/kontrak/sijil pada masa penyerahan polisi/kontrak/sijil. 6. I/We understand and agree that any of my/our personal information collected or held by the Company (whether contained in this application or otherwise obtained) may be held, used, and disclosed by the Company to individuals or organisations related to or associated with the Company or any selected third party (within or outside of Malaysia, including reinsurance/retakaful and claims investigation companies and industry associations/federations) for the purpose of processing this application and providing subsequent service for this and to communicate with me/us for such purposes. I/We understand that I/ we am/are entitled to obtain access to and to request correction of any personal information held by the Company and that such request can be made to the Company’s Customer Careline at 1300-88-5055. I/We will keep the Company updated of any change to such personal information as soon as possible. / Saya/ Kami memahami dan bersetuju bahawa sebarang maklumat peribadi saya/kami yang diperolehi atau disimpan oleh Syarikat (sama ada terkandung dalam permohonan ini atau diperolehi dengan cara lain) boleh disimpan, digunakan dan didedahkan oleh Syarikat kepada individu atau organisasi yang berkaitan dengan Syarikat atau mana-mana pihak ketiga yang terpilih (di dalam atau di luar Malaysia termasuk syarikat-syarikat insurans/takaful semula dan siasatan tuntutan serta persatuan/persekutuan industri) untuk tujuan pemprosesan permohonan ini dan memberikan perkhidmatan seterusnya untuk ini serta berhubung dengan saya/kami bagi tujuan tersebut. Saya/Kami memahami bahawa saya/kami berhak mendapat akses kepada maklumat tersebut dan meminta sebarang pembetulan dibuat ke atas mana-mana maklumat peribadi yang disimpan oleh Syarikat dan permintaan tersebut boleh dibuat kepada talian Khidmat Pelanggan Careline Syarikat di 1300-88-5055. Saya/Kami akan memaklumkan Syarikat mengenai sebarang perubahan kepada maklumat peribadi secepat mungkin. Date / Tarikh D D
Location at / Bertempat di
Signature of policy/contract/certificate owner/holder Tandatangan pemilik/pemegang polisi/kontrak/sijil
D D
–
M M –
Name / Nama New NRIC number / Other identification number / Nombor kad pengenalan baru / Nombor pengenalan lain Y Y Y Y
Date / Tarikh
Signature of witness / Tandatangan saksi Name / Nama New NRIC number / Other identification number / Nombor kad pengenalan baru / Nombor pengenalan lain Date / Tarikh
