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    Endorsement Motor Form

    Uploaded by

    Syahril Adzim Md Rejab
    This document appears to be an endorsement form from Takaful Ikhlas Berhad for motor vehicle takaful (Islamic insurance). It requests details of the participant and vehicle, allows for changes to vehicle details or cancellation/extension of coverage, and includes sections for instructions, refund information, authorization, and declaration. The participant is asked to provide bank account information for refunds, authorize a third party to collect documents, and declare that the certificate has been lost or misplaced if cancelling coverage.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Endorsement Motor Form

    Uploaded by

    Syahril Adzim Md Rejab
    632 views1 page
    This document appears to be an endorsement form from Takaful Ikhlas Berhad for motor vehicle takaful (Islamic insurance). It requests details of the participant and vehicle, allows for changes to vehicle details or cancellation/extension of coverage, and includes sections for instructions, refund information, authorization, and declaration. The participant is asked to provide bank account information for refunds, authorize a third party to collect documents, and declare that the certificate has been lost or misplaced if cancelling coverage.

    Original Description:

    TAKAFUL

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    This document appears to be an endorsement form from Takaful Ikhlas Berhad for motor vehicle takaful (Islamic insurance). It requests details of the participant and vehicle, allows for changes to vehicle details or cancellation/extension of coverage, and includes sections for instructions, refund information, authorization, and declaration. The participant is asked to provide bank account information for refunds, authorize a third party to collect documents, and declare that the certificate has been lost or misplaced if cancelling coverage.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    632 views1 page

    Endorsement Motor Form

    Uploaded by

    Syahril Adzim Md Rejab
    This document appears to be an endorsement form from Takaful Ikhlas Berhad for motor vehicle takaful (Islamic insurance). It requests details of the participant and vehicle, allows for changes to vehicle details or cancellation/extension of coverage, and includes sections for instructions, refund information, authorization, and declaration. The participant is asked to provide bank account information for refunds, authorize a third party to collect documents, and declare that the certificate has been lost or misplaced if cancelling coverage.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    TAKAFUL IKHLAS BERHAD (593075 U)

    IKHLAS Point, Tower 11A, Avenue 5,


    Bangsar South, No. 8, Jalan Kerinchi, 59200 Kuala Lumpur
    Tel: 03-2723 9999 Fax: 03-2723 9998 Call Centre: 03-2723 9696
    website : www.takaful-ikhlas.com.my
    A wholly-owned subsidiary of MNRB Holdings Berhad

    BAHAGIAN
    D : PENGISYTIHARAN
    / DECLARATION
    BORANG
    ENDOSMEN
    MOTOR
    BAHAGIAN D : PENGISYTIHARAN / DECLARATIO
    MOTOR
    ENDORSEMENT FORM

    BAHAGIAN A : BUTIRAN PESERTA / DETAILS OF PARTICIPANT


    Nama Peserta
    Participants Name

    No. Telefon
    Telephone No.

    No. Kenderaan
    Vehicle No.

    Tempoh Perlindungan
    Period of Cover

    No. Sijil
    Certificate No.

    Tarikh
    Date

    BAHAGIAN B : PINDAAN BUTIRAN KENDERAAN / CHANGES OF VEHICLE DETAILS


    Nama Peserta
    Participant Name

    No. Kenderaan
    Vehicle No.

    Tahun Dibuat
    Year of Make

    No. Enjin
    Engine No.

    CC/Tan
    CC/Tonnage.

    Lain-Lain
    Others

    BAHAGIAN C : ARAHAN & PERHATIAN / INSTRUCTION & ATTENTION


    Pengeluaran Surat Pengesahan NCD (Tempatan/Luar Negara)
    Issue an NCD Confirmation Letter (Local/Oversea)

    Slip Pembatalan Cukai Jalan JPJ (Wajib bagi pembatalan Sijil)


    JPJ Roadtax Cancellation Slip (Compulsory for Cancellation of Cert.)

    Menarik balik kelayakan NCD daripada sijil berkuatkuasa


    Withdraw NCD entitlement from certificate w.e.f.

    Sijil asal Takaful


    Original Certificate of Takaful

    _________________________________________________
    Pindahan kelayakan NCD kepada No. Kenderaan berkuatkuasa
    Transfer NCD entitlement to a Vehicle (veh.) No. w.e.f.

    Salinan Kad Pengenalan


    Photocopy of NRIC

    ____________________ Veh. No _____________________


    *Batal Sijil berkuatkuasa dari
    *Cancel Certificate w.e.f

    Salinan Geran Kenderaan


    Photocopy of Vehicle Registration Card

    ________________________________________________
    Melanjutkan tempoh perlindungan Takaful sehingga
    Extend the period of Takaful cover until

    Borang Kebenaran Kad Kredit


    Credit Card Authorization Form

    _________________________________________________
    *Adalah dimaklumkan bahawa peraturan terkini untuk pembatalan sijil Takaful Motor PERLU disertakan dengan Slip Pembatalan Cukai Jalan JPJ atau
    Salinan Geran yang telah disahkan batal oleh JPJ ataupun pengesahan pindahan hakmilik kepada pemilik baru.
    *Kindly be informed that latest ruling for Motor Takaful cancellation MUST be attached with JPJ Roadtax Cancellation Slip or Photocopy of Vehicle card that
    have been verified by JPJ or completed transfer of ownership.

    BAHAGIAN D : PEMULANGAN & KUATKUASA / REFUND & AUTHORIZATION


    Selaras dengan garis panduan Bank Negara Malaysia yang menggalakkan pembayaran secara elektronik (e-Payment), kami memohon kerjasama anda untuk
    melengkapkan butiran akaun bank bagi melaksanakan pembayaran pemulangan NCD dan pembatalan sijil.
    In line with the guideline Bank Negara Malaysia which encourages payment via electronics (e-Payment), we appreciate your cooperation to complete your
    bank account details to refund your NCD and certificate cancellation.
    Nama Bank
    No. Akaun Bank (Aktif)
    Bank Name _____________________________________________ Bank Account No. (Active) _______________________________________________
    Saya/Kami dengan ini memberi kuasa (Sila lengkapkan Nama dan No. kad pengenalan dibawah) untuk mengambil surat NCD bagi pihak saya/kami
    I/We hereby authorized ____________________________ NRIC No. _______________________________ to collect the NCD letter on my/our behalf.

    BAHAGIAN E : PENGISYTIHARAN / DECLARATION


    Selaras dengan Peraturan Risiko Kenderaan Bermotor Pihak Ketiga, Saya/Kami dengan ini mengisytiharkan bahawa Sijil Takaful berkenaan yang dikeluarkan kepada
    saya/kami dengan no. sijil di atas telah hilang atau tersalah letak dan kenyataan ini adalah benar sepanjang pengetahuan saya/kami.
    Saya/Kami bertanggungjawab sepenuhnya atas apa-apa tuntutan atau pertikaian yang timbul akibat kehilangan Sijil dan memberi jaminan untuk mengecualikan pihak
    Syarikat dalam hal ini.
    In compliance with the Motor Vehicle Third Party Risk Regulation, I/We hereby declared that the related Certificate of Takaful issued to me/us under the above certificate
    number has been lost or mislaid and this statement is true to the best of my/our knowledge.
    I/We further assume responsibility for any claim or dispute arising out of the lost Certificate and undertake to indemnify the Company in this respect.
    ________________________________________
    Tandatangan Peserta /
    Signature of Participant
    NRIC No.(

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