Date/ Tarikh: Cancellation of Insurance/ Pembatalan Insurans Kindly tick the box for the insurance you wish the cancel / Sila tandakan polisi insurans yang anda ingin batalkan Credit Shield Select Credit Shield Premier Credit Shield Plus/Basic Please complete the form and mail/fax/email to the address/fax no/email address as follows: Sila lengkapkan borang in dan kirim/faks/emel kepada alamat/no faks/alamat emel berikut: AIA Bhd. Customer Servicing – Credit Life Wisma AIA 99, Jalan Ampang 50450 Kuala Lumpur FAX NO / NO FAKS: 603-2056 3891 EMAIL ADDRESS/ ALAMAT EMEL:
[email protected] Name / Nama:_________________________________________________________ Credit Card Number / Nombor Kad Kredit: __________________________________ IC Number/ Nombor IC:__________________________________________________ Tel Number/ No Telefon: ________________________________________________ I would like to terminate the above insurance coverage with effect from _____________ (dd/mm/yyyy) due to the following reason(s). Saya ingin membatalkan perlindungan insurans di atas berkuatkuasa dari_____________(hh/bb/tttt) dengan sebab-sebab yang berikut. I do not need this insurance and would like to cancel within the free look period of 30 days. Saya tidak memerlukan insurance ini dan ingin membuat pembatalan dalam tempoh bertenang 30 hari. I find it expensive Saya dapati ianya mahal I have other insurance coverage Saya mempunyai perlindungan insurans yang lain Others (please specify): Lain-lain (hanya nyatakan):
…………………………………………………….. Name/ Nama: NRIC No/ No NRIC:
