OFFICIAL RECEIPT

Date : 05/11/2017
J0064019-RECEIPT-0000001

MDM. LING JING SZE

MR. SONG CHAN WE
SUBLOT 265
TAMAN LI HUA Receipt No : J0064019-01
JALAN TUN HUSSEIN ONN
97000 BINTULU
SARAWAK

POL NO. STATUS MODE DUE TYPE AMOUNT(RM)

30401029 In Force Monthly Premium Received 300.00

(IL2016006401-3)
Total Paid 300.00

JXYONG PRINTED ON 2017-11-06-14.40.22.

Amount received is inclusive of GST@6%, if applicable.

Cashier/Agent No: JXYONG / 725549

Please keep the receipts as proof of payment.

This is a computer printout, no signature is required.

 INTERIM COVER

Tokio Marine Life Insurance Malaysia Bhd.(“the Company”) shall provide Interim Cover on the
death of the Life Assured whereby the Interim Cover shall commerce on the date of receipt of
full payment for the first modal premium required, evidenced by the official receipt issued by the
Company or any other form of statement based on the payment method used. This Interim
Cover shall cease on:
i. the date of commencement of policy or rejection of the proposal; or
ii. the date when the premium paid is refunded by the Company due to whatsoever reason; or
iii. the ninetieth (90th) day following the date of receipt of the first modal premium payment.
whichever is earliest.

This Interim Cover provided shall be subject to the following terms & conditions:

1. This Interim Cover is only applicable for death caused directly and solely by “Accident”.
“Accident” means a sudden, unintentional, unexpected, unusual and specific event that
occurs at an identifiable time and place which shall, independently of any other cause, be
the sole cause of the death.

2. The amount payable under this Interim Cover will be the basic sum assured as applied for
excluding all riders and supplementary benefits, subject to a maximum of RM500,000 on
the same Life Assured.

3. This Interim Cover shall not be payable for death resulting from:
i. any Accident occurring before the Company receive first full modal premium required;
or
ii. any form of illness or disease of whatever nature and however caused; or
iii. attempted suicide (whether sane or insane); or
iv. self-inflicted injury or injury sustained while under the influence of drugs or
intoxicating alcohol; or
v. injury sustained while engaging in hazardous speed or endurance contest; or
vi. any airborne activities (except when travelling as a fare paying passenger or a crew
member of an aircraft operated by an international airline and licensed for passenger
service over a regular scheduled commercial route); or
vii. submarine voyage; or
viii. military, police, naval or aeronautical service; or
ix. violation of law or resistance to arrest.

PAYMENT OTHER THAN CASH

When a payment is made other than in cash, this receipt will only be valid after the
payment is successfully credited to the Company.

PAYMENT FOR NEW APPLICATION AND LAPSED POLICY

The issuance of this receipt for the premium payment stated overleaf shall not constitute
an acceptance on the part of the Company for the application of new insurance
cover or reinstatement of a lapsed insurance cover. The new insurance cover or
reinstatement of a lapsed insurance cover shall only be effective upon the approval of the
Company with the issuance of the Policy, endorsement or reinstatement documents.