REQUEST FOR CHANGE FORM - MAA
REQUEST FOR CHANGE FORM - MAA
REQUEST FOR CHANGE FORM - MAA
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No. iCERT<br />
iCERT No.<br />
(Branch<br />
Use Only)<br />
JENIS PENUKARAN<br />
TYPE OF <strong>CHANGE</strong>S<br />
DOKUMEN DIPERLUKAN<br />
REQUIRED DOCUMENT<br />
SILA NYATAKAN<br />
PLEASE SPECIFY<br />
5. Penukaran Mod Caruman kepada<br />
Change of Contribution Mode to<br />
1. Bayaran diperlukan sekurangkurangnya<br />
satu bulan untuk<br />
caruman baru<br />
Required at least one month payment<br />
for new contribution amount<br />
Tahunan /Annually<br />
Setengah Tahun /Semi Annually<br />
Suku Tahun /Quarterly<br />
Bulanan /Monthly<br />
Pekerjaan /Occupation<br />
6. Penyemakan semula perubahan dalam<br />
pekerjaan kepada<br />
Review of change in occupation to<br />
…………………………………………………………<br />
Keterangan Pekerjaan /Exact Duties<br />
…………………………………………………………<br />
Pendapatan Tahunan /Annual Income<br />
…………………………………………………………<br />
7. Pindaan Jantina Orang Yang Dilindungi /<br />
Peserta<br />
Amendment of Person’s Covered /<br />
Participant’s Sex<br />
1. Salinan Kad Pengenalan/Sijil Lahir/<br />
Pasport<br />
Photocopy of Identity Card / Birth<br />
Certificate / Passport<br />
8. Ubah Caruman Lazim<br />
Change Regular Contribution<br />
1. Bayaran diperlukan sekurangkurangnya<br />
satu bulan untuk<br />
caruman baru<br />
Required at least one month payment<br />
for new contribution amount<br />
Pembayaran/<br />
Contribution<br />
Asas/Basic<br />
Jumlah/<br />
Amount (RM)<br />
…………………………<br />
9. Penambahan Takaful Saver / Penukaran<br />
jumlah Takaful Saver<br />
Addition of Takaful Saver / Change of<br />
Takaful Saver Amount<br />
1. Bayaran diperlukan sekurangkurangnya<br />
satu bulan untuk<br />
caruman baru<br />
Required at least one month payment<br />
for new contribution amount<br />
Pembayaran/<br />
Contribution<br />
MTSVR<br />
Jumlah/<br />
Amount (RM)<br />
………………………….<br />
10. Pembatalan Takaful Saver/ Deletion of<br />
Takaful Saver<br />
11. Pengurangan Jumlah Asas Takaful kepada<br />
Decrease Basic Sum Covered to<br />
1. Bayaran diperlukan sekurangkurangnya<br />
satu bulan untuk<br />
caruman baru<br />
Required at least one month payment<br />
for new contribution amount<br />
Delete MTSVR<br />
Yes<br />
Sila tandakan ( / ) untuk pembatalan<br />
Takaful Saver<br />
Please tick ( / ) for deletion of Takaful<br />
Saver<br />
Jumlah Asas Takaful / Sum Covered<br />
……………………………………………………….<br />
12. Pembatalan Manfaat<br />
Deletion of Benefit (s)<br />
Kod Manfaat<br />
Rider Code<br />
……………………<br />
……………………<br />
……………………<br />
Jumlah Asas Takaful<br />
Sum Covered<br />
…………………………<br />
…………………………<br />
…………………………<br />
13. Penambahan Jumlah Asas Takaful kepada<br />
Increase Basic Sum Covered to<br />
14. Penukaran Pelan kepada<br />
Change of Plan to<br />
1. Borang Perisytiharan Kesihatan<br />
Health Declaration Form<br />
1. Borang Perisytiharan Kesihatan<br />
(Untuk peningkatan pelan sahaja)<br />
Health Declaration Form<br />
(For Upgrade plan only<br />
Jumlah Asas Takaful / Sum Covered<br />
……………………………………………………….<br />
Jumlah Asas Takaful / Sum Covered<br />
………………………………………………………..<br />
---------------------------------------------------------<br />
Tandatangan Saksi /Signature of Witness *<br />
Nama Saksi /Name Witness<br />
No. KP Saksi / IC No. of Witness<br />
---------------------------------------------------------<br />
Tandatangan Peserta/Signature of Participant<br />
(Jika lain daripada individu, cop Syarikat diperlukan).<br />
(If other than individual, Company’s stamp is required).<br />
---------------------------------------------------------<br />
Tandatangan Pemegang Serah Hak /Signature of<br />
Assignee<br />
(Jika lain daripada individu, cop Syarikat diperlukan).<br />
(If other than individual, Company’s stamp is<br />
required).<br />
*Nota/Note:<br />
Saksi mesti telah mencapai usia 18 tahun.The witness must have attained the age of 18 years.<br />
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