drive with peace of mind for only rm88 p.a.000 plan / pelan 88 sum insured / jumlah diinsuranskan...
TRANSCRIPT
PENGECUALIANKeadaan sedia ada, kehamilan, bunuh diri, peperangan, melahirkan anak atau keguguran dan kerugian diakibatkan ketika kenderaan digunakan untuk perlumbaan, ujian kelajuan, sewa, perlumbaan rali jalanraya atau semasa pemandu di bawah pengaruh alkohol atau dadah atau memandu tanpa lesen sah.
NOTIS PENTING1. Borang cadangan ini hanya ringkasan saja. Maklumat terperinci
tentang perlindungan polisi boleh didapati di dalam polisi.
2. Menurut Akta Perkhidmatan Kewangan 2013, Seksyen 129, Jadual 9, Perenggan 5: Adalah menjadi kewajipan pengguna untuk mengambil penjagaan munasabah untuk tidak membuat salah nyataan kepada penanggung insurans berlesen semasa menjawab apa-apa soalan yang diperlukan yang berkaitan dengan keputusan penanggung insurans sama ada untuk menerima atau tidak risiko dan kadar dan terma yang hendak dipakai.
3. Liabiliti adalah tidak ditanggung sehingga cadangan ini diterima oleh Syarikat.
4. Sebarang pertukaran informasi yang telah diberi mesti dilaporkan kepada Syarikat serta merta jika tidak Syarikat berhak menolak sebarang liabiliti.
5. Sila berikan jawapan yang tepat kepada setiap soalan. Tanda sengkang adalah tidak memadai.
6. Lampiran Pemberitahuan Produk boleh didapati melalui laman web www.kurnia.com. Anda dinasihatkan untuk membaca Lampiran Pemberitahuan Produk sebelum anda memutuskan untuk mengambil mana-mana produk.
7. Pemegang Polisi adalah dinasihatkan untuk membuat penamaan di bawah Seksyen 130, Akta Perkhidmatan Kewangan 2013 dan boleh mendapatkan Borang Penamaan dari Ibu Pejabat, Cawangan atau Ejen kami.
8. AmGeneral Insurance Berhad dilesenkan di bawah Akta Perkhidmatan Kewangan 2013 dan dikawal selia oleh Bank Negara Malaysia.
9. Versi lengkap Notis Privasi AmGeneral Insurance Berhad boleh didapati di laman web kami di www.amgeneralinsurance.com untuk rujukan lanjut.
10. Sekiranya berlaku konflik atau percanggahan berhubung peruntukan teks Bahasa Inggeris dengan mana-mana Dokumen Kontrak dan apa-apa terjemahannya, maka teks Bahasa Inggeris akan diguna pakai.
EXCLUSIONSPre-existing conditions, pregnancy, suicide, war risks, childbirth or miscarriage and losses incurred while the vehicle is used for racing, speed-testing, hire, road rally or whilst the driver is under the influence of alcohol or drugs or driving without a valid licence.
IMPORTANT NOTICE 1. This proposal form is a brief description only. The full details of the
policy coverage are to be found in the policy.
2. Statement pursuant to Financial Services Act 2013, Section 129, Schedule 9, Para 5: It is the duty of the customer to take reasonable care not to make a misrepresentation to the licensed insurer when answering any question which the insurer may request that are relevant to the decision of the insurer whether to accept the risk or not and rates and terms to be applied.
3. Liability does not attach until the proposal has been accepted by the Company.
4. Any changes in the information given must be reported to the Company immediately otherwise the Company may reserve the right to decline all liability.
5. Please give a definite answer to each question, dashes are not sufficient.
6. Product Disclosure Sheet (PDS) can be obtained through our website www.kurnia.com. You are advised to read the PDS before you take out any product.
7. Policy Owners are advised to make a nomination pursuant to Section 130 of the Financial Services Act 2013 and can obtain a Nomination Form from our service counters at our Head Office, Branches or Agents.
8. AmGeneral Insurance Berhad is licensed under Financial Services Act 2013 and regulated by Bank Negara Malaysia.
9. A full version of the Privacy Notice of AmGeneral Insurance Berhad is available on our website at www.amgeneralinsurance.com for your further reference.
10. In the event of a conflict or discrepancy between the provisions of the English text of any of the Contract Documents and any translations thereof, the English text shall prevail.
TABLE OF BENEFITS / JADUAL FAEDAH
Item /Perkara Benefits / Faedah
Medical Expenses (per person) / Perbelanjaan Perubatan (setiap orang)
Corrective Dental and/or Cosmetic Surgery (per person) / Pembedahan Pembetulan Gigi dan/atau Pembedahan Kosmetik (setiap orang)
Ambulance Fees (per person) / Yuran Ambulan (setiap orang)
3
Taxi and Car Rental Expenses / Perbelanjaan Sewa Teksi dan Keretai. Taxi Expenses / Perbelanjaan Teksi ii. Car Rental Expenses up to RM150 per day / Perbelanjaan Sewa Kereta sehingga RM150 sehari(Maximum per incident and limited to 3 reimbursements a year) / (Maksimum setiap kejadian dan bayaran balik terhad kepada 3 kali setahun)
12
Referral Assistance Program Within Malaysia - Taxi and Car Rental Assistance, Arrangement for Hotel Accommodation, Arrangement for Emergency Evacuation, Referral to Service Centre and Car Rental Company and Emergency Message Transmission / Program Bantuan Rujukan Di Dalam Malaysia - Bantuan Sewa Teksi dan Kereta, Pengurusan untuk Penginapan Hotel, Pengurusan untuk Pemindahan Kecemasan, Rujukan ke Pusat Servis dan Syarikat Sewa Kereta dan Penghantaran Pesanan/Mesej Kecemasan
Compassionate Cover For Smash And Grab / Perlindungan Ehsan untuk Samun dan Pecah Tingkapi. Window and/or Windscreen Broken / Tingkap dan/atau Cermin Kereta Pecahii. Loss or Damage to Personal Effects and/or Loss of Cash / Kehilangan atau Kerosakan Barangan Peribadi dan/atau Kehilangan Wang Tunai
Car Loan Protection / Perlindungan Pinjaman Kereta
15
16
17
Private Vehicle / Kenderaan Persendirian
A Driver and up to 4 passengers / Seorang Pemandu dan sehingga 4 penumpang
Each additional passenger / Setiap penumpang tambahan
Note : Premiums stated are inclusive of 6% Goods and Services Tax / Nota : Premium yang dinyatakan adalah termasuk 6% Cukai Barang dan Perkhidmatan (GST)
88.00
8.48
137.80
12.72
243.80
24.38
349.80
37.10
Compassionate Flood Expenses (any one incident/in aggregate any one period of insurance) / Perbelanjaan Ehsan Akibat Banjir (maksimum setiap kejadian/agregat bagi setiap tempoh insurans)6
Compassionate Allowance for Vehicle Total Loss due to Vehicle Collision or Theft / Elaun Ehsan Bagi Kerugian Penuh/Menyeluruh Kenderaan Akibat Perlanggaran Atau Kecurian KenderaanPays an amount equivalent to 10% of Named Vehicle’s Motor Comprehensive or Third Party, Fire and Theft Sum Insured and benefit is only payable if the Motor Comprehensive or Third Party, Fire and Theft Policy is insured with AmGeneral (maximum per incident) / Membayar nilai bersamaan 10% daripada Jumlah Diinsuranskan ke atas Polisi Motor Komprehensif atau Pihak Ketiga, Kebakaran dan Kecurian bagi Kenderaan yang Dinamakan dan faedah akan dibayar jika Polisi Motor Komprehensif atau Pihak Ketiga, Kebakaran dan Kecurian diinsuranskan dengan AmGeneral (maksimum setiap kejadian)
11
Vehicle Breakdown Assistance and Towing Service Within Malaysia (per incident) - Including Unlimited Toll Charges incurred / Perkhidmatan Bantuan Kerosakan Kenderaan dan Perkhidmatan Tunda Di Dalam Malaysia (setiap kejadian) - Termasuk Caj Tol Tanpa Had9
Accidental Death (per person) / Kematian Akibat Kemalangan (setiap orang)1
Permanent Disablement (per person) / Hilang Upaya Kekal (setiap orang)2
Hospital Income (per person, up to maximum 60 days per year) / Pendapatan Hospital (sehingga maksimum 60 hari setiap tahun setiap orang)4
Bereavement Allowance (per person) / Elaun Pengkebumian (setiap orang)Sum Insured doubled if Insured suffers death due to Ebola, SARS, Japanese Encephalitis, Chikungunya, Malaria and Dengue (provided it is not a declared pandemic in Malaysia) / Jumlah Diinsuranskan berganda jika Pihak Diinsuranskan meninggal dunia akibat Ebola, SARS, Ensefalitis Jepun, Chikungunya, Malaria dan Denggi (dengan syarat ia bukan wabak yang diisytiharkan di Malaysia)
5
Car Replacement Expenses (up to RM150 per day, maximum per incident) / Perbelanjaan Gantian Kereta (sehingga RM150 sehari, maksimum setiap kejadian)10
Hotel Accommodation Expenses for vehicle breakdown in Malaysia up to RM150 per night (maximum per incident and limited to 3 reimbursements a year) / Perbelanjaan Penginapan Hotel bagi Kerosakan Kenderaan di Malaysia sehingga RM150 semalam (maksimum setiap kejadian dan bayaran balik terhad kepada 3 kali setahun)13
Hotel Accommodation Expenses for Vehicle Breakdown in Singapore up to RM150 per night (maximum per incident and limited to 3 reimbursements a year) / Perbelanjaan Penginapan Hotel bagi Kerosakan Kenderaan di Singapura sehingga RM150 semalam (maksimum setiap kejadian dan bayaran balik terhad kepada 3 kali setahun)14
Outstanding Credit Card Balance (applicable for Insured only, up to maximum) / Baki Kad Kredit Tertunggak (untuk Pihak Diinsuranskan sahaja, sehingga maksimum) 7
Double Indemnity During A National Public Holiday in Malaysia (per person) / Indemniti Berganda Ketika Cuti Umum Seluruh Malaysia (setiap orang)8
Plan / Pelan A
2,000 peraccident /
setiap kemalangan
Taxi / Teksi - 60Car Rental /
Sewa Kereta - 400
Included / Termasuk
1,500
8,000
5,000
1,000500
Unlimited distance / Tiada
had jarak
30,000
30,000
50 per day / sehari
750
600
400
300
500
60,000
Plan / Pelan 88
Sum Insured / Jumlah Diinsuranskan (RM)
1,500 peraccident /
setiap kemalangan
Not applicable / Tidak berkenaan
Not applicable / Tidak berkenaan
1,500
6,000
5,000
1,000500
Up to 600 km roundtrip /
sehingga 600km pergi balik
15,000
15,000
30 per day / sehari
750
450
Not applicable / Tidak berkenaan
Not applicable / Tidak berkenaan
300
30,000
3,000 peraccident /
setiap kemalangan
Taxi / Teksi - 60Car Rental /
Sewa Kereta - 400
Included / Termasuk
1,500
12,000
5,000
1,000500
Unlimited distance / Tiada
had jarak
Plan / Pelan B
75,000
75,000
75 per day / sehari
750
750
400
300
1,000
150,000
4,000 peraccident /
setiap kemalangan
Taxi / Teksi - 60Car Rental /
Sewa Kereta - 400
Included / Termasuk
1,500
18,000
5,000
1,000500
Unlimited distance / Tiada
had jarak
Plan / Pelan C
120,000
120,000
100 per day / sehari
750
900
400
300
1,500
240,000
Annual Premium / Premium Tahunan (RM)(RM) (RM) (RM)
1017
UW-NM-F415
www.kurnia.comKunjungi ejen & cawangan kami 1-800-88-6333 www.kurnia.comVisit our agents & branches
car loanprotection
smash andgrab cover
PERFECT RIDER PLUS
1-800-88-6333
Drive with peace ofmind for only RM88 p.a. Dengan hanya RM88 setahun,kini anda boleh pandu dengan tenang.
PERFECT RIDER PLUS PERFECT RIDER PLUSRoad accidents can happen anytime. Let PERFECT RIDER PLUS take care of your worries. While you are out driving or riding, boarding or alighting from the named vehicle, rest assured both driver and passengers are protected.
Unique Features
• Affordable Premium for as low as RM88 per year.
• 24 hours Vehicle Breakdown Assistance and Towing Service within Malaysia including Unlimited Toll Charges. For Assistance to contact 24 hours toll free number 1-800-88-6333.
• Children enjoy the same limit as adult on applicable benefits.
• Double Indemnity during a national public holiday in Malaysia.
• Bereavement Allowance - Sum Insured doubled if Insured (Policyholder) suffers death due to Ebola, SARS, Japanese Encephalitis, Chikungunya, Malaria and Dengue.
• Compassionate Allowance for Vehicle Total Loss due to Vehicle Collision or Theft (covered if Named Vehicle’s Motor Comprehensive or Third Party, Fire and Theft Insurance is insured with AmGeneral).
• Compassionate Flood Expenses.
• Compassionate Cover For Smash And Grab.
• Car Loan Protection.
Kemalangan jalan raya boleh berlaku pada bila-bila masa. Pilihlah PERFECT RIDER PLUS untuk menjaga kebimbangan anda. Semasa anda memandu atau menumpang, menaiki atau turun dari kenderaan yang dinamakan, yakinlah kedua-dua pemandu dan penumpang dilindungi.
Ciri-Ciri Unik
• Premium serendah RM88 setahun.
• 24 Jam Perkhidmatan Bantuan Kerosakan Kenderaan dan Perkhidmatan Tunda di dalam Malaysia, termasuk Caj Tol Tanpa Had. Panggilan ke talian bebas tol bernombor 1-800-88-6333 untuk Khidmat Bantuan.
• Kanak-Kanak menikmati had faedah sama seperti had faedah orang dewasa untuk faedah tertentu.
• Indemniti Berganda ketika cuti umum seluruh Malaysia.
• Elaun Pengkebumian - Jumlah Diinsuranskan berganda jika Pihak Diinsuranskan (Pemegang Polisi) meninggal dunia akibat Ebola, SARS, Ensefalitis Jepun, Chikungunya, Malaria dan Denggi.
• Elaun Ehsan bagi Kerugian Penuh/Menyeluruh Kenderaan Akibat Perlanggaran atau Kecurian Kenderaan (dilindungi jika Polisi Motor Komprehensif atau Pihak Ketiga, Kebakaran dan Kecurian Kereta Dinamakan diinsuranskan dengan AmGeneral).
• Perbelanjaan Ehsan Akibat Banjir.
• Perlindungan Ehsan untuk Samun dan Pecah Tingkap.
• Perlindungan Pinjaman Kereta.
Eligibility
• Private Vehicle Owners aged 17 years and above.
Kelayakan
• Pemilik Kereta Persendirian berumur 17 tahun dan ke atas.
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saya
/kam
i yan
g ak
an m
enje
jask
an p
rem
ium
yan
g pe
rlu d
ibay
ar a
tau
terh
adap
pen
erim
aan
risik
o ol
eh p
ihak
Sya
rikat
.I/W
e ag
ree
that
the
Com
pany
sha
ll ha
ve t
he r
ight
to
use
my/
our
data
and
per
sona
l inf
orm
atio
n fo
r th
e pu
rpos
e of
the
insu
ranc
e op
erat
iona
l pro
cess
w
hich
mig
ht in
clud
e tr
ansf
er o
f dat
a an
d pe
rson
al in
form
atio
n to
the
Com
pany
’s re
late
d co
mpa
nies
, sub
sidi
arie
s an
d/or
its
hold
ing
com
pany
, out
sour
cing
pa
rtne
rs, R
e-in
sure
rs a
nd s
olic
itor b
ut n
ot li
mite
d to
affi
liate
com
pani
es in
clud
ing
thei
r out
sour
cing
par
tner
s. /
Saya
/Kam
i ber
setu
ju b
ahaw
a pi
hak
Syar
ikat
be
rhak
unt
uk m
engg
unak
an d
ata
dan
mak
lum
at p
erib
adi s
aya/
kam
i bag
i tuj
uan
pem
pros
esan
ope
rasi
insu
rans
yan
g m
ungk
in te
rmas
uk p
emin
daha
n da
ta d
an
mak
lum
at p
erib
adi k
epad
a Sy
arik
at ya
ng se
kutu
den
gan
piha
k Sy
arik
at, a
nak-
anak
syar
ikat
dan
/ata
u sy
arik
at in
dukn
ya d
an se
mua
raka
n ko
ngsi
pem
beka
lan
luar
, Pe
nang
gung
Insu
rans
Sem
ula
dan
pegu
am ca
ra te
tapi
tida
k te
rhad
kep
ada
syar
ikat
-sya
rikat
seku
tu te
rmas
uk se
mua
raka
n ko
ngsi
pem
beka
lan
luar
.I/W
e fu
rthe
r agr
ee th
at th
e Co
mpa
ny, i
ts p
artn
ers
and
its re
late
d co
mpa
nies
, sub
sidi
arie
s an
d/or
its
hold
ing
com
pany
can
sha
re a
nd u
se m
y/ou
r dat
a an
d pe
rson
al in
form
atio
n fo
r th
e pu
rpos
e of
pro
mot
ing
the
Com
pany
’s an
d its
rel
ated
com
pani
es’,
subs
idia
ries’
and/
or it
s ho
ldin
g co
mpa
ny’s
prod
uct,
new
se
rvic
es a
nd s
uppo
rt r
equi
rem
ent;
and
mar
ketin
g ca
mpa
igns
and
act
iviti
es a
nd c
omm
erci
al t
rans
actio
ns. /
Say
a/Ka
mi s
eter
usny
a be
rset
uju
baha
wa
piha
k Sy
arik
at, r
akan
nia
gany
a da
n sy
arik
at-s
yarik
at se
kutu
, ana
k-an
ak sy
arik
at d
an/a
tau
syar
ikat
indu
k be
rhak
unt
uk b
erko
ngsi
dan
men
ggun
akan
dat
a da
n m
aklu
mat
pe
ribad
i say
a/ka
mi b
ertu
juan
unt
uk m
empr
omos
ikan
pro
duk,
per
khid
mat
an b
aru
dan
kepe
rluan
soko
ngan
; dan
akt
iviti
uru
s nia
ga k
omer
sil y
ang
dike
ndal
ikan
ol
eh p
ihak
Sya
rikat
dan
sem
ua sy
arik
at se
kutu
ana
k-an
ak sy
arik
at d
an/a
tau
syar
ikat
indu
k.
/
/
/
/
Dat
eTa
rikh
Sign
atur
e of
Pro
pose
r / T
anda
tang
an P
enca
dang
Yes
/ Ya
N
o / T
idak
For A
gent
/ St
aff U
se O
nly
/ Unt
uk E
jen
/ Kak
itang
an S
ahaj
aIn
Com
plia
nce
with
Sec
tion
16(2
) of t
he A
nti-M
oney
Lau
nder
ing,
Ant
i-Ter
roris
m F
inan
cing
and
Pro
ceed
s of
Unl
awfu
l Act
iviti
es A
ct 2
001,
I he
reby
cer
tify
that
th
e Pr
opos
er’s
orig
inal
NRI
C / B
usin
ess
Regi
stra
tion
Cert
ifica
te /
Pass
port
was
ver
ified
and
aut
hent
icat
ed b
y m
e at
the
Poin
t of S
ale.
/ M
enur
ut S
eksy
en 1
6(2)
Ak
ta P
ence
gaha
n Pe
ngub
ahan
Wan
g H
aram
, Pen
cega
han
Pem
biay
aan
Kega
nasa
n da
n H
asil
darip
ada
Aktiv
iti H
aram
200
1, sa
ya d
enga
n in
i men
gesa
hkan
bah
awa
Kad
Peng
enal
an (K
P) /
Sijil
Pen
daft
aran
/ Pa
spor
t asa
l Pen
cada
ng te
lah
disa
hkan
ket
ulen
anny
a ke
tika
urus
nia
ga d
ijala
nkan
.
Nam
e of
Age
nt /
Staff
/ N
ama
Ejen
/ Ka
kita
ngan
Sign
atur
e / T
anda
tang
anD
ate
/ Tar
ikh
NRI
C N
o. /
No.
KP
Ant
i-Mon
ey L
aund
erin
g, A
nti-T
erro
rism
Fin
anci
ng a
nd P
roce
eds o
f Unl
awfu
l Act
iviti
es A
ct 2
001
/ Akt
a Pe
nceg
ahan
Pe
ngub
ahan
Wan
g H
aram
, Pen
cega
han
Pem
biay
aan
Kega
nasa
n da
n H
asil
darip
ada
Aktiv
iti H
aram
200
1
Nam
e of
Pro
pose
r / N
ama
Penc
adan
g
Cove
r Not
e N
o. /
Polic
y N
o. /
No.
Siji
l Ins
uran
s / N
o. P
olis
i
VER
IFIC
ATIO
N /
PEN
GES
AHANAU
TO R
ENEW
AL
INST
RUCT
ION
/ AR
AHAN
PEM
BAH
ARU
AN A
UTO
MAT
IKI h
ereb
y au
thor
ise
AmG
ener
al In
sura
nce
Berh
ad to
deb
it m
y cr
edit
card
bei
ng p
aym
ent o
f pre
miu
m fo
r thi
s pro
posa
l and
all
futu
re p
olic
y re
new
al o
r suc
h ot
her
amou
nt a
s adv
ised
by
AmG
ener
al In
sura
nce
Berh
ad fr
om ti
me
to ti
me
unde
r thi
s Pol
icy.
Saya
mem
beri
kuas
a ke
pada
Am
Gen
eral
Insu
ranc
e Be
rhad
unt
uk m
ende
bitk
an a
kaun
kad
kre
dit s
aya
seba
gai b
ayar
an p
rem
ium
unt
uk c
adan
gan
ini d
an se
mua
pe
mba
haru
an p
olis
i di m
asa
hada
pan
atau
jum
lah
lain
yan
g di
nasi
hatk
an o
leh
AmG
ener
al In
sura
nce
Berh
ad d
ari s
emas
a ke
sem
asa.
Plea
se D
ebit
/ Si
la D
ebit
Cred
it Ca
rd N
o. /
No.
Kad
Kre
dit
Nam
e of
Car
dhol
der /
N
ama
Pem
egan
g Ka
d
Card
Exp
iry D
ate
/ Ta
rikh
Tam
at Te
mpo
h Ka
d
Card
Issu
ing
Bank
/ Ba
nk P
enge
luar
Kad
Not
e / N
ota:
Card
hold
er’s
rela
tions
hip
to In
sure
d m
ust b
e ei
ther
spou
se, p
aren
t or c
hild
. /
Card
hold
er’s
Sign
atur
e (a
s per
car
d)
Hub
unga
n pe
meg
ang
kad
kepa
da P
ihak
Diin
sura
nska
n m
estil
ah p
asan
gan
suam
i ist
eri, i
buba
pa a
tau
anak
. Ta
ndat
anga
n Pe
meg
ang
Kad
(sep
erti
di d
alam
kad
)
(mm
/yyy
y)
(bb/
tttt
)
--
-
-
Mas
ter
Visa
Not
e : P
rem
ium
s sta
ted
are
incl
usiv
e of
6%
Goo
ds a
nd S
ervi
ces T
ax /
Not
a : P
rem
ium
yang
din
yata
kan
adal
ah te
rmas
uk 6
% C
ukai
Bar
ang
dan
Perk
hidm
atan
(GST
)
!