COVER NOTE

Participant EN. YUSOF BIN HARUN 1984, JALAN 1A/4 BANDAR BARU SG BULOH 47000 SG BULOH Selangor Malaysia

STAMP DUTY PAID

Certificate No. : TGPC-PB445045-BRTWKUL Replacing Cover Note No. : Account No. : 0002727 Agent Name : MUSTAFFA KAMAL BIN DAUD Product Type : Motor Private Car Period of Takaful from 16/10/2011 To 15/10/2012 (both Dates Inclusive). Any subsequent period for which the Participant shall pay and the Takaful Operator shall agree to accept a renewal contribution.

NRIC No Business/Occupation Vehicle Information JPJ Document No Vehicle Reg No Make Model Engine No Chassis No Year of Manufacture Cubic Capacity Seating Capacity Financial Interest

: 560321-11-5075 :

Business Reg No

: 7476530 : WBX200 : PROTON : Perdana 2.0 : 4G63P-DR9116 : PL1E55ARRTB012775 : 1996 : 1999 :5 :

Vehicle Estimated Value Gross Contribution Less: No Claim Discount 55.00 % Named Driver

RM RM RM RM RM

11,000.00 618.58 - 340.22 10.00 288.36 0.00 0.00 10.00

Log Book No

: 421070 Less_:_Discount/Rebate 0 % Add__:_Service Tax Stamp Duty

Cover Type Vehicle Type License Type Use For

: Comprehensive : Private Car : Normal Vehicle : Private Use

RM RM RM

TOTAL AMOUNT DUE

Excess Excess Damage Claims

RM

298.36

RM

0.00

Authorised Driver 1. FARAH NUR ADHIRA________________________920401-14-5000 2. FATIN NUR AFFIRA BINTI YUSOF________________________910129-14-5466 3. YUSOF BIN HARUN________________________560321-11-5075 Subject to the following warranties, endorsements and clauses incorporated herein and forming part of the Certificate. Clause Code Clause Name E002 ENDORSEMENT 2 EXCESS DAMAGE CLAIM E002F ENDORSEMENT 2(f) COMPULSORY EXCESS E030 ENDORSEMENT 30 REPLACEMENT PARTS E100 ENDORSEMENT 100 EXCLUSION OF LEGAL LIABILITY TO PASSENGERS (PRIVATE CAR ONLY) E106 ENDORSEMENT 106 TAKAFUL OPERATOR'S AUTHORISED WORKSHOP

IMPORTANT NOTICE This Takaful Certificate (including this schedule) is issued to you based on the information transmitted to us/our agents/representatives by you. If you find any of the information stated herein is inconsistent with your disclosure, kindly provide us with the correct information for revision, and if we do not hear from you within fourteen (14) days from the commencement date of your certificate, we shall deem that the information is correct. In line with the provisions of S.28 of the Takaful Act 1984, we shall have the right to invalidate your certificate and/or deny your claim should we later discover that your disclosure was not made in good faith and/or was fraudulently and/or falsely and/or deceivingly made. Signed for and on behalf of the Company Issue Date Issued At Issued By : : : 29/09/2011 BRTWKUL MOHD SHAHRIL B LOCKMAN Authorised Signatory Etiqa Takaful Berhad

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