Date : 02/09/2022

MR SAIDIN BIN AWANG

LOT 12585, JALAN MERBAU
KG MAK CHILI PAYA
24000 CUKAI
TERENGGANU

WELCOME TO THE ETIQA FAMILY

Certificate No. : TPT-C6014833-B1
Plan Name : DOMESTIC TRIPCARE 360 TAKAFUL - DOMESTIC
Period of Takaful : 29/09/2022 - 02/10/2022

We are pleased to extend our warmest welcome to you for being a part of our family.

We enclose herewith the following document for your action:-

Certificate Schedule
This important document summarizes the details of your certificate and we suggest that you keep this document for
reference. kindly be informed that the details stated in the certificate schedule is based on the information you have
declared to us at the time of application. We advise that you check the document carefully and it there is any
discrepancy, please inform us immediately. Our consultant will be glad to serve you.

For any enquiries on the above or any of your products, feel free to call Etiqa Oneline at 1 300 13 8888 or email us at
[email protected]. In case of any claim, you may call our Claims Careline at +603 2161 0270 for fast and efficient claim
service. Again, we welcome you to the Etiqa family.

Thank you.

Yours sincerely,
Etiqa General Takaful Berhad
NO SIJIL PERLINDUNGAN / CERTIFICATE OF COVER NO:
Talian Khidmat Bantuan / Helpline No. +603 2785 6565 C6014833

TRIPCARE 360 TAKAFUL

Notis Penting /Important Notice

1. Sekiranya anda memerlukan sebarang bantuan atau maklumat perjalanan, kecemasan perubatan semasa perjalanan, atau untuk makluman tuntutan, sila hubungi
kami di Talian Khidmat Bantuan Perjalanan dan Perubatan 24 Jam If you require any assistance or information on travel, medical emergency during the trip, or on
claims notification, please call our 24-Hour Travel and Medical Assistance Helpline No.

2. Di dalam sijil perlindungan ini, melainkan jika dinyatakan sebaliknya, perkataan 'saya, kami, anda' adalah bermaksud peserta di mana yang berkenaan / In this
certificate of cover, unless stated otherwise, the words 'I/we, you/your, me/us and my/our' means participant wherever applicable.

3. Anda boleh membatalkan sijil anda pada bila-bila masa dengan memberikan kami notis bertulis. Semasa pembatalan, segala pembayaran balik sumbangan akan
berdasarkan syarat-syarat yang ditetapkan di dalam sijil / You may cancel your certificate at any time by giving us a written notice. Upon cancellation, any refund of
contribution would be based on the conditions stipulated in the certificate.

4. Sekiranya anda mempunyai sebarang pertanyaan atau memerlukan maklumat lanjut, sila hubungi 1300 13 8888 di dalam Malaysia atau e-mel ke [email protected].
Jika anda mempunyai aduan, pertikaian atau maklum balas, sila hubungi Unit Aduan Etiqa General Takaful di e-mel [email protected], hubungi talian
1300 13 8888 dalam Malaysia atau di talian +603 2780 4500 daripada luar Negara, faksimile di +603 2297 1919, atau secara pos kepada Unit Pengurusan Aduan,
Tingkat 6, Menara B, Dataran Maybank, No. 1, Jalan Maarof, 59000 Kuala Lumpur / If you have an enquiry or require further information, please contact 1300 13 8888
within Malaysia or e-mail at [email protected]. If you have a complaint, dispute, or feedback, please contact Etiqa General Takaful Complaints Unit on email at
[email protected], telephone within Malaysia on 1300 13 8888 or from overseas on +603 2780 4500, facsimile on +603 22971919, or by post at
Complaints Management Unit, Level 6, Tower B, Dataran Maybank, No.1, Jalan Maarof, 59000 Kuala Lumpur.

5. Bagi pertikaian berkaitan dengan keputusan Etiqa General Takaful, secara alternatif, anda boleh menghubungi Ombudsman Perkhidmatan Kewangan (dahulu dikenali
sebagai Biro Pengantaraan Kewangan) melalui e-mel [email protected], hubungi talian +603 2272 2811, faksimile di +603 2272 1577, atau melalui pos ke Tingkat
14, Blok Utama, Menara Takaful Malaysia, No. 4, Jalan Sultan Sulaiman, 50000 Kuala Lumpur. Sebagai alternatif, pertanyaan atau maklumat am lanjut boleh didapati
daripada Program Pendidikan Pengguna melalui penerbitan mereka yang terdapat pada www.insuranceinfo.com.my. Pertanyaan, aduan, pertikaian dan maklum balas
boleh juga dihantar ke Bank Negara Malaysia melalui e-mel ke [email protected], hubungi talian 1300 88 5465, faksimile di +603 2174 1515, atau secara pos
kepada Pengarah, Jabatan LINK & Pejabat Wilayah, Bank Negara Malaysia, Jalan Datoâ Onn, 50480 Kuala Lumpur /For a dispute with a decision of Etiqa General
Takaful, you may alternatively contact the Ombudsman for Financial Services (formerly known as Financial Mediation Bureau) on e-mail at [email protected],
telephone on +603 2272 2811, facsimile on +603 2272 1577, or by post at Level 14, Main Block, Menara Takaful Malaysia, No 4, Jalan Sultan Sulaiman, 50000 Kuala
Lumpur. Alternatively, more general enquiries or information may be obtained from the Consumer Education Programme via their publications available at
www.insuranceinfo.com.my. Enquiries, complaints, disputes, and feedback may also be sent to Bank Negara Malaysia by email at [email protected],
telephone on 1300 88 5465, facsimile on +603 2174 1515, or by post to Director, Jabatan LINK & Pejabat Wilayah, Bank Negara Malaysia, Jalan Datoâ Onn, 50480
Kuala Lumpur.

6. Sekiranya berlaku kemalangan, sila beritahu Etiqa General Takaful segera secara bertulis atau menghubungi Bantuan Tuntutan Etiqa di 1300 88 1007. Sila lawati
laman web kami di www.etiqa.com.my untuk memuat turun borang tuntutan. Sila lengkapkan dan serahkan borang tuntutan secepat mungkin bersama-sama dengan
dokumen-dokumen yang berkaitan untuk menyokong tuntutan tersebut ke cawangan kami yang berhampiran dengan anda / In the event of accident, please
immediately notify Etiqa General Takaful in writing or call Etiqa Claims Assist at 1300 88 1007. Please visit our website at www.etiqa.com.my to download the claim
form. Please then complete the claim form, and submit together with related documents, to your nearest branch.

Butir-butir Orang Yang Dilindungi / Details of Covered Person

Nama Orang Utama Yang Dilindungi / Name of Main Covered Person: Nombor Kad Pengenalan / Nombor Pasport:
IC Number / Passport Number:
SAIDIN BIN AWANG 690304-11-5079

Orang Lain Yang Dilindungi / Other Covered Persons:

Nama Penuh Nombor Kad Pengenalan/ Hubungan
No. Full Name Nombor Passport Relationship
IC Number / Passport Number
1 SAIDIN BIN AWANG 690304-11-5079 PRINCIPAL
NO SIJIL PERLINDUNGAN / CERTIFICATE OF COVER NO:
C6014833

Butir-Butir Perlindungan / Details of Coverage

1. Tempoh Takaful / Period of Takaful Dari / From: 29/09/2022 Hingga / To: 02/10/2022

2. Negara-negara dilawati / Country(ies) to visit: Kawasan / Area: 1 2 3 4

Kawasan 1 (Domestik) / Area 1 (Domestic) Malaysia

Kawasan 2 (Negara Asia seperti yang dinyatakan) / Area 2 Bangladesh, Bhutan, Brunei, Cambodia, China, Hong Kong, India, Indonesia, Japan, Laos, Macau,
(Selected Asian Countries) Maldives, Myanmar, Pakistan, Philippines, Sikkim, Singapore, South Korea, Sri Lanka, Taiwan,
Thailand, Timor Leste dan Vietnam. / Bangladesh, Bhutan, Brunei, Cambodia, China, Hong Kong,
India, Indonesia, Japan, Laos, Macau, Maldives, Myanmar, Pakistan, Philippines, Sikkim, Singapore,
South Korea, Sri Lanka, Taiwan, Thailand, Timor Leste and Vietnam.

Kawasan 3 / Area 3 Seluruh Dunia kecuali Malaysia, Nepal, USA dan Kanada / Worldwide excluding Malaysia, Nepal,
USA and Canada.

Kawasan 4 / Area 4 Seluruh Dunia termasuk Nepal, USA dan Kanada (kecuali Malaysia) /Worldwide including Nepal,
USA and Canada (excluding Malaysia)

Nota/Note: Negara-negara yang dikecualikan /Excluded countries

i.Perjalanan dalam, ke atau melalui negara-negara atau kawasan-kawasan yang tertakluk kepada peperangan, konflik, atau kuarantin bagi penyakit berjangkit /Travel in, to
or through countries or regions which are subject to war, conflict, or quarantine for contagious disease
ii.Perjalanan dalam, ke atau melalui Iraq, Korea Utara, Palestin, Syria atau Ukraine / Travel in, to or through Iraq, North Korea, Palestine, Syria or Ukraine

3. Jenis Sijil / Type of Certificate:: Satu Perjalanan / Per Trip

4. Jenis Pelan / Type of Plan: Domestik / Domestic
5. Jenis Skim / Type of schema: Individu / Individual
6. Sumbangan yang dibayar / Contribution Paid : RM 25.58 ( termasuk Duti Setem / inclusive of Stamp Duty )
7. Aktiviti-aktiviti berbahaya /Extreme Sports : Yes No

8. Perlindungan COVID-19 /COVID-19 Cover : Yes No

Arahan Pembayaran / Payment Instruction
Jenis Akaun / Account Type: ______________________________ Nombor Akaun / Account Number: ______________________________

Jenis Kad Kredit / Credit Card Type: ______________________________ No. Kad Kredit / Credit Card No: ______________________________

______________________________
Tarikh Tamat / Expiry Date:
Bulan / Month Tahun / Year
Akuan Oleh Orang Yang Dilindungi / Declaration by Covered Person
1. Saya/Kami mengaku tidak melakukan perjalanan untuk tujuan mendapatkan rawatan perubatan atau perjalanan yang bertentangan dengan nasihat mana-mana ahli
perubatan /I am / We are not travelling for the purpose of obtaining medical treatment or travelling against the advice of any medical practitioner.

2. Saya/Kami bersetuju untuk mendedahkan kepada Etiqa General Takaful secara berterusan, sepenuhnya dan dengan jujur, tentang apa-apa perkara yang mungkin
berlaku di antara masa penyerahan permohonan ini sehingga masa sijil dikeluarkan, yang memerlukan jawapan dalam permohonan ini atau soal selidik perlu diubah
atau kadar dan terma perlu diubah, atau yang mana saya/kami tahu bahawa ianya adalah relevan kepada Etiqa General Takaful dalam membuat keputusan sama ada
menerima atau tidak risiko ini, atau seorang yang munasabah dalam keadaan itu mungkin dijangka untuk tahu ianya adalah relevan /I/We agree to continue to disclose
to Etiqa General Takaful fully and truthfully any matter which may arise between the time of submission of this application to the time of issuance of the certificate,
which would require the answers in this application or questionnaires be amended, or the rates and terms to be varied, and which I/we know to be relevant to Etiqa
General Takaful's decision on whether to accept the risk, or a reasonable man in the circumstances could be expected to know to be relevant.

3. Saya/Kami telah membaca dan memahami isi kandungan permohonan ini termasuk semua amaran dan notis di dalamnya. Saya/kami sepenuhnya, dengan benar dan
secara sukarela menjawab semua soalan dalam permohonan ini dan soal selidik, jika ada, selepas sepenuhnya memahami soalan-soalan tersebut / I/We have read
and understood the contents of this application including all warnings and notices therein. I/we have fully, truthfully and voluntarily answered all the questions in this
application and questionnaires, if any, after having fully understood the questions.

4. Saya/Kami bersetuju bahawa semua jawapan diberikan oleh saya/kami. Jika apa-apa jawapan atau kenyataan berkaitan dengan permohonan ini adalah bukan tulisan
saya/kami, saya/kami mengaku bahawa saya/kami telah menyemak jawapan atau pernyataan ini atau yang sama telah dibacakan kepada kami, dan saya/kami
mengesahkan bahawa jawapan atau kenyataan ini adalah lengkap, betul dan benar, dan saya/kami terikat dengan jawapan saya/kami. Saya/kami mengesahkan
bahawa saya/kami tidak memberikan ejen Etiqa General Takaful apa-apa maklumat lain kecuali yang terdapat dalam jawapan saya/kami dalam permohonan ini /I/We
agree that all the answers are mine/ours and/or given by me/us. If any answers or statements in connection with this application are not in my/our own handwriting,
I/we declare that I/we have checked these answers or statements or the same have been read to us, and I/we have certified that these answers or statements are
complete, correct and true and I/we am/are bound by my/our answers. I/we confirm that I/we have not provided Etiqa General Takaful's agent with any other
information except that found in my/our answers in this application.
NO SIJIL PERLINDUNGAN / CERTIFICATE OF COVER NO:
C6014833
5. Saya/Kami mengesahkan bahawa saya/kami memahami sepenuhnya bahawa jawapan saya/kami dan/atau kenyataan yang diberikan dalam permohonan ini atau soal
selidik dan apa-apa dokumen lain yang berkaitan dilengkapkan oleh saya/kami, akan menjadi sebahagian daripada kontrak dan Etiqa General Takaful akan
bergantung kepada dokumen tersebut dalam memutuskan sama ada untuk menerima permohonan saya/kami / I/We confirm that I/we fully understand that my/our
answers and/or statements given in this application or questionnaires and any other relevant documents completed by me/us, shall be an integral part of the contract
and that Etiqa General Takaful will completely rely on them in deciding whether to accept my/our application.

6. Saya/Kami bersetuju bahawa jika mana-mana jawapan saya/kami atau pernyataan atau maklumat yang diberikan oleh saya/kami didapati palsu atau mengelirukan,
atau jika saya/kami gagal mendedahkan seperti yang dikehendaki di atas, Etiqa General Takaful bebas untuk menamatkan sijil atau menjalankan mana-mana remedi
yang disediakan untuk Etiqa General Takaful mengikut Jadual 9 Akta Perkhidmatan Kewangan Islam 2013 / I/We agree that if any of my/our answers or statements or
information given by me/us is found to be false or misleading, or if I/we have failed to disclose as required above, Etiqa General Takaful is at liberty to terminate the
certificate or exercise any of the remedies available to Etiqa General Takaful according to Schedule 9 of the Islamic Financial Services Act 2013.

7. Saya/Kami memahami dan bersetuju bahawa perlindungan takaful yang saya/kami pohon hendaklah hanya berkuat kuasa pada tarikh KONTRAK SIJIL
DIKELUARKAN oleh Etiqa General Takaful mengikut resit sumbangan penuh yang dikeluarkan oleh Etiqa General Takaful. Jika sumbangan awal dibayar melalui cek,
saya/kami faham bahawa perlindungan takaful hanya akan bermula selepas cek telah dijelaskan / I/We understand and agree that the takaful coverage I/we have
applied shall only take effect on the date the TAKAFUL CERTIFICATE HAS BEEN ISSUED by Etiqa General Takaful which follows receipt by Etiqa General Takaful of
the full contribution. If the initial contribution is paid via cheque, I/we understand that the takaful coverage will only commence after the cheque has been cleared.

8. Saya/Kami seterusnya mengaku bahawa ejen Etiqa General Takaful telah menyampaikan dan sepenuhnya menjelaskan kepada saya/kami dalam bahasa yang
saya/kami faham bahawa maklumat yang terkandung dalam Helaian Pendedahan Produk dan risalah (jika ada) berkenaan dengan produk ini dan manfaatnya, ciri-ciri
seperti yang dinyatakan di dalamnya dan saya/kami membuat pengakuan ini dengan penuh pengetahuan dan sedar bentuk dan kesan maklumat yang disampaikan
kepada saya/kami / I/We further declare that Etiqa General Takaful's agent has presented and fully explained to me/us in the language that I/we understand the
information contained in the Product Disclosure Sheet and brochure (if any) in respect of the products and its benefit(s), features as described therein and I/we make
this declaration with full knowledge and awareness the nature and effect of the information presented to me/us.

9. Saya/Kami bersetuju untuk menyertai skim Takaful am ini berdasarkan prinsip Takaful. Saya/Kami bersetuju dengan konsep Tabarru' (derma) bagi tujuan bantuan
bersama peserta lain dan dengan sumbangan ini, saya/kami berhak mendapat perlindungan Takaful yang dinyatakan dalam terma-terma dan syarat-syarat kontrak
Takaful ini / I/We agree to participate in this General Takaful scheme based on the principle of Takaful. I/We agree to the concept of Tabarru' (donation) for the
purposes of mutual support of other participants and with this contribution, I/We are entitled to the Takaful cover expressed in the terms and conditions of this Takaful
contract.

10. Saya/Kami bersetuju untuk membayar Fi Wakalah (seperti yang ditunjukkan dalam Helaian Pendedahan Produk dan seperti yang dinyatakan di dalam Sijil Takaful)
kepada Etiqa General Takaful, sebagai potongan daripada sumbangan,untuk menampung perbelanjaan mengurus dan mengagihkan skim Takaful Am / I/We agree to
pay the Wakalah Fee (as shown in the Product Disclosure Sheet and as mentioned in the Takaful Certificate) to Etiqa General Takaful, as a deduction from
contributions, to cover the expenses of managing and distributing the General Takaful scheme.
Saya/Kami faham bahawa pada akhir setiap tahun kewangan, lebihan (jika ada) daripada Dana Takaful Am (Dana) akan ditentukan oleh Etiqa General Takaful.
Saya/Kami bersetuju bahawa 50% daripada lebihan yang boleh diagih (jika ada) akan dibayar kepada Etiqa General Takaful kerana mengendali dan menguruskan
Dana tersebut berdasarkan kontrak Ju'alah, dan baki 50% akan dikongsi di kalangan peserta yang sijil belum ditamatkan dan yang tidak membuat sebarang tuntutan
dalam tahun kewangan / I/We understand that at the end of each financial year, the surplus (if any) from the General Takaful Fund (Fund) will be determined by Etiqa
General Takaful. I/We agree that 50% of the distributed surplus (if any) will be paid to Etiqa General Takaful for operating and managing the Fund based on the
contract of Ju'alah, and the balance of 50% will be shared amongst participants whose certificates have not terminated and who have not made any claim within the
financial year.
Saya/Kami seterusnya bersetuju bahawa jika lebihan atau apa-apa jumlah yang dibayar kurang dari Ringgit Malaysia Sepuluh (RM10.00) ia akan dimasukkan ke
dalam tabung kebajikan yang akan digunakan sebagai 'amal jariah' bagi pihak peserta. / I/We further agree that if the surplus or any sum payable is less than Ringgit
Malaysia Ten (RM10.00) it will be credited into charity fund which will be utilized as 'amal jariah' on behalf of the participants.

Tandatangan Orang Utama Yang Dilindungi// Disaksikan oleh Ejen Takaful / Witnessed by Takaful Agent
Pemegang Akaun/ Pemegang Kad Kredit
Signature of Main Covered Person /
Account Holder / Credit Card Holder

Kod Ejen / Agent Code: N0032122

Tarikh / Date: 02/09/2022

For and on behalf of

Etiqa General Takaful Berhad
UNDERWRITING INFORMATION

IMPORTANT NOTICE - APPLICABLE TO ALL CONSUMER PRODUCTS

Takaful wholly for purposes unrelated to your trade, business or profession)
Where You have applied for this Takaful wholly for purposes unrelated to Your trade, business or profession, You had a duty to take reasonable care
not to make a misrepresentation in answering the questions in the Application Form (or when You applied for this Takaful) i.e. You should have
answered the questions fully and accurately. Failure to have taken reasonable care in answering the questions may result in avoidance of Your
contract of Takaful, refusal or reduction of Your claim(s), change of terms or termination of Your contract of Takaful in accordance with the remedies in
Schedule 9 of the Islamic Financial Services Act 2013. You were also required to disclose any other matter that You knew to be relevant to our
decision in accepting the risks and determining the rates and terms to be applied.

You also have a duty to tell Us immediately if at any time after Your contract of Takaful has been entered into, varied or renewed with Us any of the
information given in the Application Form (or when You applied for this Takaful) is inaccurate or has changed.

PERSONAL DATA PROTECTION ACT (PDPA)

Personal Data shall have the same meaning as described to it as under section 4 of the Personal Data Protection Act 2010.
Personal Data refers to the personal data furnished by the Person Covered, the Participant, or an authorized third party related to the Certificate of
Takaful.
Personal Data does not include information on an individual which is in the public domain.

Your and Our Data Protection Obligations and Rights

We shall be able to process Personal Data according to the section 4 of the Personal Data Protection Act 2010. We shall be able to disclose Personal
Data provided by You, as the context may require, to:
1)Etiqa General Insurance Berhad, Etiqa General Takaful Berhad, Etiqa Life International (L) Ltd or Etiqa Offshore Insurance (L) Ltd;
2)Other entities within the Maybank Group;
3)Our authorized agents and service providers with whom We have contractual agreements for some of Our functions, services and activities;
4)Other insurance or Takaful companies and distribution partners (such as, banks, Islamic banks, insurance brokers, Takaful brokers, reinsurance
companies, Retakaful companies);
5)Industry trade associations such as Life Insurance Association of Malaysia (LIAM), Persatuan Insurans Am Malaysia (PIAM) and Malaysian Takaful
Association (MTA);
6)Our merchants and strategic partners;
7)Any parties authorized by You (from time to time); or
8)Enforcement regulatory and governmental agencies as permitted or required by law, authorized by any order of court or to meet obligations to
regulatory authorities.
You will keep Us updated in respect of all such Personal Data as soon as is practicable.
We shall not be liable for any direct or indirect loss or damage due to any inaccuracy or incompleteness in the Personal Data provided to Us.
We may from time to time request that You provide other Personal Data required for the purposes of this Master Certificate.
Prior to providing Us with the Personal Data of an Covered Person, or another individual, You must inform that individual of Our privacy notice.
For the detailed privacy notice on how We collect, use, process, protect and disclose Personal Data, please visit Our branches, contact Etiqa Oneline
at 1300 13 8888, or refer to Our website at www.etiqa.com.my

CHANGES IN TAXATION, REGULATIONS AND LEGISLATION

We may vary the terms of the Certificate of Takaful if there are changes in taxation, regulations or legislation, or a directive is issued by any
government authority, which imposes responsibilities on either party or which affects any of the terms of the Certificate of Takaful. The changes will be
determined by Us to be appropriate and equitable. We will notify the effected Participant or Persons Covered in writing, when the terms in the
Certificate of Takaful need to be changed.

Issue Date : 02/09/2022/10:40 PM For and on behalf of

Etiqa General Takaful Berhad
Issue At : Bandar Baru Klang
Issue By : v0032122

Visit www.etiqa.com.my or our nearest branch to obtain the full policy wordings.
Help preserve the country's natural resources.
Invoice No: ETBG2022UWFL02213149
Date: 02/09/2022

INVOICE

ETIQA GENERAL TAKAFUL BERHAD (201701025031)

LEVEL 19 TOWER C
DATARAN MAYBANK
NO 1 JALAN MAAROF
59000 KUALA LUMPUR
(SST Reg No: W10-1808-31012539))

To Account Number: N0032122

SAIDIN BIN AWANG
LOT 12585, JALAN MERBAU
KG MAK CHILI PAYA
CUKAI
24000 TERENGGANU

Description Total (RM)

Type of Certificate: DOMESTIC TRIPCARE 360 TAKAFUL
Certificate Number: C6014833
Period of Takaful: 29/09/2022 - 02/10/2022

Contribution 14.70
Total (Excluding SST) 14.70
SST payable @ 6.00% 0.88
Stamp Duty 10.00

Total Amount Payable 25.58

This is a computer generated document. Therefore, no signature is required

PRODUCT DISCLOSURE SHEET Etiqa General Takaful Berhad (“We/Us/Our”)
Read this Product Disclosure Sheet before you decide to take up the
TRIPCARE 360 TAKAFUL
TRIPCARE 360 TAKAFUL. Be sure to also read the general terms and
Date : 18/12/2021
conditions.

1. What is this product about?

This product provides benefits to the covered person on the occurrence of specific events that may arise during domestic or international travel, for
business or leisure. It includes death or permanent disability due to accident, medical expenses arising due to accident or illness, various travel
inconveniences, losses or damages to baggage and/or personal effects, personal liability, and emergency services. The covered person may also
choose to participate in an additional benefit which extends the coverage when the covered person participates in the adventurous activities and
COVID-19 benefit. The full terms and conditions related to these benefits are set out in the takaful certificate.
2. What are the Shariah concepts applicable?
Wakalah
This product applies the wakalah (agency) concept, whereby the participants appoint us to act on their behalf to invest and manage the General
Takaful Fund (Fund). The participants also agree to authorize us to delegate our rights, duties and obligations to any third party as we deem fit for
the purpose of achieving the objective to invest and manage the Fund, provided that, in the event of any such delegation, we will remain liable and
responsible for all such rights, duties and obligations towards the participant. As an agent, we are entitled to receive a wakalah fee as a service
charge. The wakalah fee is as follows:

Item (% of contribution)
• Commission paid to the agent 25%
• Management expenses 20%
Total Wakalah Fee 45%
Tabarru’
This plan also applies the tabarru’ (contribution) concept, whereby the participants agree to donate or contribute their contributions to the Fund for
the purpose of mutual aid and assistance to the participants based on the pre-agreed events, in case of need. At the end of each financial year, any
distributable surplus in the Fund, less repayment of historic deficits, makes allowance for contingency provisions, and is subject to the surplus policy
approved by our Shariah Committee is shared 50% among the participants whose certificates have not terminated and who have not made any
claims within the financial year, and 50% to us for operating and managing the Fund, based on the contract of ju’alah. Ju’alah is a wage contract that
specifies the share of the distribution of surplus on this basis. If the surplus is less than RM10.00, it will be credited to charitable fund which will be
utilized as ‘Amal Jariah’ on behalf of the participant. The charitable fund will be distributed to eligible recipients as approved by our Shariah Committee
for charitable purposes.
3. What are the coverages / benefits provided?
The benefits vary by specific event and the level of plan cover selected, as set out in the following table:
Benefit Amount (RM) per Person by Level of Cover
Summary of Benefits (per any one accident/incident, per trip) International
Domestic
Silver Gold Platinum
Maximum Aggregate Limit of Liability is RM 5,000,000 per any one accident/incident. If the aggregate amount of all the benefits payable under
this contract exceeds this limit, the benefit payable to each covered person shall be proportionately reduced such that the total of all benefits paid
does not exceed this limit.
Section A – Death or permanent disability
a. Adult 50,000 100,000 300,000 500,000
b. Child 10,000 40,000 100,000 100,000
c. Senior Citizen 50,000 100,000 300,000 500,000
d. Family – maximum payable under Family plan 150,000 300,000 900,000 1,500,000
Due to accident
Section B – Medical expenses, in excess of RM100 Due to accident or illness
only
B1. Medical related expenses (up to) 50,000 100,000 300,000 500,000
B2. Follow-up treatment expenses (up to) 5,000 5,000 10,000 30,000
Not
B3. Alternative treatment expenses (up to) Not Covered Not Covered 1,000
Covered
B4. Compassionate care (up to) Not Covered 5,000 5,000 5,000
B5. Child care / guard and return of child(ren) (up to) Not Covered 5,000 5,000 5,000
B6. Daily hospital income / hospital confinement allowance
150 per day 150 per day 250 per day 350 per day
(maximum of 20 days)
Section C – Travel inconveniences
C1. Trip cancellation (up to) Not Covered Not Covered 20,000 50,000
C2. Trip curtailment (up to) Not Covered Not Covered 20,000 50,000
C3. Travel delay (for at least 2 hours delay, up to) 100 1,000 2,000 5,000
C4. Baggage delay (for at least 6 hours delay) 500 500 1,000 2,000

1 PMG/EGTB/TRIPCARE360/PDS/ENG/AGENCY/2111V1.5
Benefit Amount (RM) per Person by Level of Cover
Summary of Benefits (per any one accident/incident, per trip) International
Domestic
Silver Gold Platinum
C5. Missed travel connection (for at least 6 hours delay) Not Covered 400 500 600
C6. Hijacking inconvenience (RM250 for each completed 24 hours delay) Not Covered Not Covered Up to 500 Up to 1,000
Section D – Losses or damages to baggage, personal effects, personal money and/or travel documents, in excess of RM100
D1. Baggage and/or personal effects (up to) 1,000 1,000 3,000 5,000
D2. Personal money (up to) Not Covered Not Covered 500 1,000
D3. Travel documents Not Covered Not Covered 1,000 1,500
D4. Home care (up to) 500 1,000 1,000 1,000
Section E – Personal liability (up to) 200,000 200,000 1,000,000 2,000,000
Due to accident
Section F – Emergency services Due to accident or illness
only
F1. Emergency medical evacuation and repatriation (up to) 500,000 500,000 1,000,000 1,500,000
F2. Repatriation, burial and cremation of mortal remains (up to) 500,000 500,000 1,000,000 1,500,000
Section G – Adventurous activities (optional benefit)
Cover the covered person in respect of Death or Permanent Disability under
Section A and Medical Expenses under Section B.
Not Covered Available Available Available
Note: Please refer to the takaful certificate for the full list of Adventurous
activities.
Section H – COVID-19 (optional benefit for International ‘Per Trip’ Plan Only)
H1. Trip cancellation due to COVID-19 (up to) Not covered 5,000 5,000 5,000
H2. Trip disruption due to COVID-19 (up to) Not covered 5,000 5,000 5,000
H3. Medical expenses overseas due to COVID-19 (up to) Not covered 300,000 300,000 300,000
H4. Emergency medical evacuation and repatriation due to COVID-19 (up to) Not covered 100,000 100,000 100,000
H5. Repatriation, burial and cremation of mortal remains due to COVID-19
Not covered 100,000 100,000 100,000
(up to)
Note: 1. For Section H, if the insured person aged 61 to 70 years old, the Benefit Amount for Medical expenses overseas, Emergency medical
evacuation and repatriation and, Repatriation, burial and cremation of mortal remains due to COVID-19 are 50% of the limit shown
in the table above.
2. For Family Plan under item B1 – B3, B6, C1 – C6, D1 – D4, E and H1 – H5, the Benefit Amount in total for all covered persons is
250% of the limit shown in the table above.
3. Claims assistance is available through our 24-Hour Travel and Medical Assistance Helpline on telephone number +603 2785 6565.
4. Please refer to the takaful certificate for further details of the above benefits.
4. How much contribution do I have to pay?
The total contribution that you have to pay depends on the covered persons (individual, individual & spouse, or family), current age of the covered
persons, level of cover (domestic, or international silver/gold/platinum), area covered, and the duration of the trip. Cover is available per trip, or on an
annual basis. For the annual basis, the duration of cover is for 1 year and the certificate can be renewed annually.
The contributions payable in Ringgit Malaysia (RM) are as set out in the following tables:
INDIVIDUAL
Plan Adult (18 to 70 years)
Domestic International
Silver Gold Platinum
No. of Days Area 1
Area 2 Area 3 Area 4 Area 2 Area 3 Area 4 Area 2 Area 3 Area 4
1-5 14.70 21.40 28.55 38.55 34.90 46.55 62.80 46.15 61.55 83.10
6 - 10 22.20 31.65 42.20 57.00 51.60 68.80 92.90 68.25 91.00 122.90
11 - 18 31.70 50.00 66.65 90.00 81.55 108.70 146.75 107.85 143.75 194.10
19 - 30 36.75 58.45 77.95 105.20 95.30 127.10 171.55 126.05 168.10 226.90
Each
Not covered 15.65 20.85 28.15 25.50 34.00 45.90 33.75 45.00 60.75
additional week
Annual Not covered 163.05 198.40 236.45 265.80 323.45 385.55 351.55 427.80 509.95
Adventurous
Not covered 18.60 18.60 18.60 55.75 55.75 55.75 92.90 92.90 92.90
activities

2 PMG/EGTB/TRIPCARE360/PDS/ENG/AGENCY/2111V1.5
INDIVIDUAL
Plan Senior Citizen (71 to 80 years)
Domestic International
Silver Gold Platinum
No. of Days Area 1
Area 2 Area 3 Area 4 Area 2 Area 3 Area 4 Area 2 Area 3 Area 4
1-5 47.75 69.60 92.80 125.20 113.40 151.20 204.20 150.00 200.00 270.00
6 - 10 72.15 102.90 137.20 185.20 167.70 223.70 301.90 221.90 295.80 399.40
11 - 18 103.05 162.50 216.70 292.50 265.00 353.30 476.90 350.40 467.30 630.80
19 - 30 119.45 190.00 253.30 342.00 309.80 413.00 557.60 409.70 546.30 737.50
Each
Not covered 50.90 67.80 91.50 82.90 110.60 149.30 109.70 146.20 197.40
additional week
Annual Not covered 529.80 644.70 768.50 863.90 1,051.20 1,253.00 1,142.60 1,390.40 1,657.30
Adventurous
Not covered
activities

INDIVIDUAL & SPOUSE

Plan Adult (18 to 70 years)
Domestic International
Silver Gold Platinum
No. of Days Area 1
Area 2 Area 3 Area 4 Area 2 Area 3 Area 4 Area 2 Area 3 Area 4
1-5 28.10 40.90 54.50 73.60 66.65 88.85 120.00 88.15 117.55 158.70
6 - 10 42.40 60.45 80.60 108.85 98.60 131.45 177.45 130.40 173.85 234.70
11 - 18 60.55 95.50 127.35 171.90 155.70 207.60 280.30 205.95 274.60 370.70
19 - 30 70.20 111.65 148.85 200.95 182.05 242.70 327.65 240.80 321.05 433.40
Each
Not covered 29.90 39.85 53.80 48.75 64.95 87.70 64.45 85.95 116.00
additional week
Annual Not covered 311.40 378.90 451.65 507.70 617.80 736.40 671.50 817.10 974.00
Adventurous
Not covered 35.50 35.50 35.50 106.50 106.50 106.50 177.45 177.45 177.45
activities

FAMILY
Adult (18 to 70 years) and Child(ren) who are unmarried, unemployment, at least 45 days of age and not more
Plan than 18 years of age (or not more than 23 years of age if studying full-time in a recognized tertiary institution) on the
effective date of takaful.
Domestic International
Silver Gold Platinum
No. of Days Area 1
Area 2 Area 3 Area 4 Area 2 Area 3 Area 4 Area 2 Area 3 Area 4
1-5 35.25 52.55 70.10 94.60 87.30 116.40 157.10 116.30 155.05 209.35
6 - 10 53.20 75.30 100.45 135.60 125.10 166.80 225.20 166.65 222.25 300.00
11 - 18 76.00 119.50 159.35 215.10 198.50 264.65 357.30 264.45 352.65 476.05
19 - 30 88.10 150.20 200.25 270.35 249.45 332.60 449.00 332.35 443.15 598.25
Each
Not covered 38.75 51.70 69.80 64.40 85.85 115.90 85.80 114.40 154.45
additional week
Annual Not covered 387.90 472.00 562.65 644.25 783.95 934.50 858.35 1,044.50 1,245.05
Adventurous
Not covered 46.45 46.45 46.45 139.35 139.35 139.35 232.30 232.30 232.30
activities

Contribution for COVID-19 Benefit (Optional Benefit for International ‘Per Trip’ Plan Only)
INDIVIDUAL Adult (18 to 70 years)
Plan International
Area 2 Area 3 Area 4
1-5 70.00 75.00 100.00
6 - 10 85.00 95.00 125.00
11 - 18 105.00 125.00 170.00
19 - 30 140.00 165.00 225.00
Each additional week 25.00 30.00 40.00

3 PMG/EGTB/TRIPCARE360/PDS/ENG/AGENCY/2111V1.5
INDIVIDUAL & SPOUSE Adult (18 to 70 years)
Plan International
Area 2 Area 3 Area 4
1-5 125.00 130.00 175.00
6 - 10 155.00 170.00 230.00
11 - 18 190.00 220.00 300.00
19 - 30 245.00 300.00 405.00
Each additional week 40.00 55.00 75.00

FAMILY
Adult (18 to 70 years) and Child(ren) who are unmarried,
unemployment, at least 45 days of age and not more than 18 years of
Plan age (or not more than 23 years of age if studying full-time in a
recognized tertiary institution) on the effective date of takaful.
International
Area 2 Area 3 Area 4
1-5 175.00 180.00 245.00
6 - 10 210.00 235.00 315.00
11 - 18 265.00 310.00 415.00
19 - 30 340.00 415.00 560.00
Each additional week 55.00 75.00 100.00

Area of travel
Area 1 (Domestic) Malaysia
Area 2 (Selected Bangladesh, Bhutan, Brunei, Cambodia, China, Hong Kong, India, Indonesia, Japan, Laos, Macau, Maldives, Myanmar,
Asian countries) Pakistan, Philippines, Sikkim, Singapore, South Korea, Sri Lanka, Taiwan, Thailand, Timor Leste and Vietnam.
Area 3 Worldwide excluding Malaysia, Nepal, USA and Canada.
Area 4 Worldwide including Nepal, USA and Canada (excluding Malaysia).

Note: All contributions (if applicable) will be subjected to relevant charges or taxes, as deemed necessary by the Malaysia tax authorities. It is
important to keep any receipt that you receive as proof of payment of contributions.
5. What are the fees and charges that I have to pay?
Type Amount
Service Tax – applicable for Domestic Plan only 6% of the contribution
Stamp Duty RM10.00

6. What are some of the key terms and conditions that I should be aware of?
Importance of Disclosure
a. Pursuant to Paragraph 5 of Schedule 9 of the Islamic Financial Services Act 2013, if you are applying for this takaful wholly for purposes
unrelated to your trade, business or profession, you have a duty to take reasonable care not to make a misrepresentation in answering the
questions in the application form (or when you apply for this takaful). You must answer the questions fully and accurately.
b. Failure to take reasonable care in answering the questions may result in avoidance of your contract of takaful, refusal or reduction of your
claim(s), change of terms or termination of your contract of takaful.
c. The above duty of disclosure shall continue until the time your contract of takaful is entered into, varied or renewed with us.
d. In addition to answering the questions in the application form (or when you apply for this takaful), you are required to disclose any other matter
that you know to be relevant to our decision in accepting the risks and determining the rates and terms to be applied.
e. You also have a duty to tell us immediately if at any time after your contract of takaful has been entered into, varied or renewed with us any of
the information given in the application form (or when you applied for this takaful) is inaccurate or has changed.
Trip Duration – The duration for each trip shall not exceed 30 consecutive days under the domestic plan, and 90 consecutive days under the
international plan. All trips must commence in Malaysia.
Cash Before Cover – The contribution due must be paid to us or our authorized agent before the effective date of the certificate.
Claims – If an accident occurs which give rise to a claim, you must notify us as soon as possible, within 30 days from the date of accident.
Note: This list is non-exhaustive. Please refer to the takaful certificate for the full list of terms and conditions.
7. What are the major exclusions under the certificate?
General Exclusions
a. Pre-existing conditions;
b. Self-inflicted injury, attempted suicide, mental disorder;
c. Complications of pregnancy, sexually transmitted disease, HIV, alcohol or drugs;
d. Air travel other than as a fare paying passenger on a regular scheduled or licensed chartered aircraft;
e. Engaging in hazardous occupations, sports or activities unless such activities have been covered under the adventurous activities (optional
benefit) that covered person has participated;
f. Travel in, to or through countries or regions which are subject to war, conflict, or quarantine for contagious disease;
g. Travel in, to or through Cuba, Iran, Iraq, North Korea, Palestine, Syria or Ukraine;
h. Participation in illegal activities such as provoked assault;
i. Actions taken by governmental authorities;
j. Travelling for hajj pilgrimage; and

4 PMG/EGTB/TRIPCARE360/PDS/ENG/AGENCY/2111V1.5
k. COVID-19 (except You have taken up COVID-19 Additional Benefit).
Section B (Medical Benefits)
a. Experimental, investigative, cosmetic, plastic, non-essential, and non-emergency procedures;
b. Where the trip is against the advice of a medical practitioner or for the purpose of seeking medical attention;
c. Communicable diseases which require quarantine by law;
d. Any congenital condition; and
e. Treatment related to the eyes and teeth.
Section C (Inconvenience Benefits)
a. Delay or amendment of the booked trip by the service provider, when due to government regulation or statute; and
b. Delay of baggage upon returning to Malaysia;
Section D (Loss or Damage to Baggage, Personal Effects, Personal Money and/or Travel Documents)
a. Loss of data;
b. Fragile items;
c. Electronic items, laptop or jewellery that is checked-in;
d. Sports items and equipment;
e. Confiscation or detention by customs or any other authority;
f. Devaluation of currency or shortage due to errors or omissions during any transactions involving money;
g. Failure to take due and reasonable care and precautions to safeguard and secure such property; and
h. Wear & tear, scratching or denting or any damage that does not impair the function of the baggage.
Section E (Personal Liability)
a. Liability contractually, as an employer, or to a family member;
b. Liability related to pursuit of a trade, business or profession;
c. Property loss or damage, where owned or in possession of an employee, yourself or family member;
d. Ownership or occupation of land and buildings, other than a temporary occupied residence;
e. Ownership, possession or use of a land, air or water vehicle or animals; and
f. Criminal proceedings legal costs, damages awarded by courts, or non-pecuniary losses.
Section H (COVID-19 Benefit)
a. Not fully vaccinated for adult insured person;
b. Travelling in, to or through a country classified and/or identified as Level 4: COVID-19 Very High listed on https://www.cdc.gov/coronavirus/2019-
ncov/travelers/map-and-travel-notices.html for which any announcement, advice, warning, restriction and/or declaration has been issued;
c. You travel against a medical practitioner’s or doctor's advice, (including, but not limited to, travelling with COVID-19 symptoms);
d. Circumstances known to you before you take up the certificate or booked the trip which could reasonably have been expected to lead to a claim
on the certificate;
e. Your failure to obtain any mandatory vaccines, inoculations or prescribed medications prior to the trip; and
f. Any expenses incurred related to compulsory quarantine or stay-at-home requirements imposed by a foreign government.
Note: This list is non-exhaustive. Please refer to the takaful certificate for the full list of exclusions.
8. Can I cancel my certificate?
You may cancel your certificate at any time by giving written notice to us. Such termination shall become effective on the date the notice is received,
or on the date specified in such notice, whichever is the later. Refund of contribution, however, is subject to the terms and conditions stipulated in the
takaful certificate.
9. What do I need to do if there are changes to my contact details?
It is important that you inform us of any changes in your contact details to ensure that all correspondence reaches you in a timely manner.
10. Where can I get further information?
Should you require additional information about personal accident coverage, please refer to the insuranceinfo booklet available at all our branches,
or visit www.insuranceinfo.com.my.
If you have any enquiries, please contact us at:
Etiqa General Takaful Berhad (201701025031)
(Licensed under Islamic Financial Services Act 2013 and regulated by Bank Negara Malaysia)
Level 13, Tower B, Dataran Maybank
No. 1, Jalan Maarof
59000 Kuala Lumpur, Malaysia
Telephone Number: +603 2297 3888
Facsimile Number: +603 2297 3800
Etiqa Oneline: 1300 13 8888
E-mail: [email protected]
Homepage: www.etiqa.com.my
11. Other types of similar takaful cover available
Please refer to our agents or us for other similar types of cover available.

IMPORTANT NOTE:
YOU ARE ADVISED TO NOTE THE SCALE OF BENEFITS FOR DEATH AND DISABLEMENT IN YOUR TAKAFUL CERTIFICATE. YOU MUST
NOMINATE A NOMINEE AND ENSURE THAT YOUR NOMINEE IS AWARE OF THE PERSONAL ACCIDENT CERTIFICATE THAT YOU HAVE
PARTICIPATED. YOU SHOULD READ AND UNDERSTAND THE TAKAFUL CERTIFICATE AND DISCUSS WITH OUR AGENT OR CONTACT US
DIRECTLY FOR MORE INFORMATION.
The information provided in this disclosure sheet is valid as at 18/12/2021.

5 PMG/EGTB/TRIPCARE360/PDS/ENG/AGENCY/2111V1.5
Helpful Facts on Personal Accident Takaful

Introduction
This is an introductory guide to help you understand how personal accident takaful works. It
gives you some basic information so that you can ask your takaful operator the right questions,
understand the answers and make the right choice before you participate in a takaful plan.

What is personal accident (PA) takaful?

A PA takaful is an annual plan that provides compensation in the event of death, disablement or
injuries arising from an accident. PA takaful is also available for short durations to cover you
should any accident occur during your travel period. Cover for PA takaful is provided in respect
of accidents occurring anywhere in the world, 24 hours a day, subject to the terms and
conditions mentioned in the certificate.

Takaful concept in PA takaful

When you participate in a PA takaful, you contribute a sum of money to a general takaful fund in
the form of participative contribution (tabarru'). Contractually, all participants mutually agree to
help each other, should any of the participants meet with an accident resulting in death,
disablement or injuries.

If you do not make any claim during the period of takaful, at maturity you are entitled to a share
of the surplus in the general takaful fund. The surplus will be shared between you and the
takaful operator under the concept of surplus-sharing at a pre-agreed ratio.

Example: A takaful operator has a total surplus (S) of RM4 million and total general contribution
(GC) of RM10 million. Your contribution (C) for the year is RM500 and the surplus will be shared
between you and the takaful operator at a pre-agreed sharing ratio (PSR) of 50:50. The share of
surplus that you will receive is calculated as follows:

Surplus-sharing ratio = PSR x S

GC

= 50% x RM4 million

RM10 million

= 20%

Surplus attributable to you = Surplus sharing ratio x C

= 20% x RM500

= RM100

1-15
Scope of cover

The basic cover of a PA takaful includes death and disablement arising from accidents. In
addition to the basic cover, takaful operators may also provide coverage on medical expenses,
hospitalisation benefits, corrective surgery and funeral expenses. The scope of cover varies
between takaful operators. You are advised to participate in a plan that meets your
requirements.

You can either participate in a PA takaful for yourself or group plan for your family. Employers
can participate in PA takaful for their employees and in such cases, payment of compensation
to the employees is at the discretion of the employer. Certain PA takaful plans specify the range
of age limits that can be covered.

Exclusions

PA takaful will usually not cover accidents caused by the following events:

war risks
suicide and insanity
self -inflicted injury

influenced by liquor, drugs or narcotics

AIDS/HIV or any other venereal diseases

provoked murder or assault

childbirth, pregnancy or miscarriage
involvement in unlawful activities
hazardous sports
operating or riding a two-wheel motor vehicle

In addition, it is quite common for PA takaful to also exclude persons employed under the
following professions:

police/ military and law enforcement officers

divers
pilots or crew members
aircraft testers
racing drivers

seamen and sea fishermen

professional sports person

Please note that the above may vary between takaful operators.

1-16
Important points to note when participating in PA takaful

Scale of benefits
The scale of benefits refers to the amount of compensation payable by the takaful operator in
the event of death, disablement or injury. You are advised to note the scale of benefits in the
plan as these varies between takaful operators

Multiple coverage
If you have more than one PA takaful or insurance, in the event of your death or disablement,
you or your beneficiary will be entitled to compensation under each plan. However, for certain
losses such as medical expenses where compensation are on reimbursement basis, you will
only be compensated once, based on the actual loss suffered.

Beneficiary
You are advised to nominate a beneficiary and ensure that your beneficiary is aware of the PA
takaful that you have participated.

How do I make a claim?

Death claim
In the event of death, a police report must be made and the takaful operator must be notified as
soon as possible. The claimant will be given a claim form which should be submitted together
with supporting documents required by the takaful operator such as death certificate and burial
permit. If there is no beneficiary nominated, the dependents of the deceased or the executor of
the deceased's estate should provide proof of dependency or letter of administration.

Injury claim
You must notify the takaful operator of the injury in writing within the time frame stipulated in the
PA takaful certificate. You should submit the claim form with supporting documents such as
medical reports and receipts of payment for the hospital expenses to your takaful operator. You
will be compensated for benefits under the plan if the treatment is obtained or diagnosis is made
within the specified time frame from the date of accident.

Do's and don'ts

When applying for takaful plan

Do Don't

Disclose all material facts on the risks to be Leave any question in the Proposal Form
covered. unanswered.
Read the 'Important Notice' on the Proposal Use ticks & dashes to answer the questions
Form. requiring full answers.
Answer all questions fully and accurately. Withhold or misrepresent any material fact.
Complete and sign the Proposal Form Otherwise, the certificate issued will be void,
yourself. meaning that the claim can be repudiated.

To ensure your takaful plan remains valid

Do Don't

Comply with all the terms, conditions and Forget to pay the contribution within the
endorsements of the certificate. terms allowed by the takaful operator.

1-17
Personal Data Protection Act Slip for Individual Customers

Name : SAIDIN BIN AWANG

NRIC No : 690304-11-5079

Certificate No : TPT-C6014833-B1

Type Of Certificate : GENERAL TAKAFUL

Date : 02-09-2022

I/We, agree, consent and allow Etiqa General Takaful Berhad (hereinafter called "Etiqa General Takaful") to process
my/our personal data (including sensitive personal data) ("Personal Data") with the intention of entering into a contract of
Takaful, in compliance with the provisions of the Personal Data Protection Act 2010

I/We, understand and agree that any Personal Data collected or held by Etiqa General Takaful (whether contained in
this application or otherwise obtained) may be held, used, processed and disclosed by Etiqa General Takaful to
individuals and/or organizations related to and associated with Etiqa General Takaful or any selected third party (within
or outside Malaysia, including medical institutions, reinsurers, claim adjusters/investigators, solicitors, industry
associations, regulators, statutory bodies and government authorities) for the purpose of processing this application and
providing subsequent service related to it and to communicate with me/us for such purposes.

I/We understand that I/We have a right to obtain access to and to request correction of any Personal Data held by Etiqa
General Takaful concerning me/us.

Such request can be made by completing the Access Request Form available at all Etiqa website, Etiqa Takaful
branches or contact Etiqa General Takaful via email [email protected]. In accordance with the provisions of the
Personal Data Protection Act 2010, I/We may contact the Customer Service Centre at Etiqa Oneline 1 300 13 8888 for
the details of my/our Personal Data. Such information shall only be granted upon verification.

I/We agree, consent and allow Etiqa General Takaful to share my/our Personal Data with Maybank Group, Etiqa General
Takaful's agents or strategic partners and other third parties ("other entities") as Etiqa General Takaful deems fit.

I/We agree to receive marketing communication from Etiqa General Takaful or from these other entities about products
and services that may be of interest to me/us.
Yes No

Note: If you no longer wish to receive marketing communications, please notify Etiqa General Takaful to withdraw your
consent and Etiqa General Takaful will stop processing and sharing your Personal Data with these other entities for the
purpose of sending you marketing communications. For avoidance of doubt, the withdrawal does not include processing
of your mandatory Personal Data.

THIS IS A COMPUTER GENERATED DOCUMENT AND IT DOES NOT REQUIRE A SIGNATURE.