Overseas Assurance Corporation (Malaysia) Berhad (102249-P)

(A member of Great Eastern Holdings Limited)

Level 18, Menara Great Eastern,
303, Jalan Ampang, 50450 Kuala Lumpur.
Telephone: 03-4259 7888 Facsimile: 03-4813 0055 Website: www.oac.com.my

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Motor Insurance Cover Note

JPJ Code / Kod JPJ: 86
Road Transport Act 1987 (Malaysia)
Motor Vehicles (Third Party Risks) Rules 1959 (Malaysia)
Motor Vehicles (Third Party Risks and Compensation) Act (Cap 189) Republic of Singapore
Motor Vehicles (Third Party Risks Compensation) Rules 1960 (Republic of Singapore)
Motor Vehicles (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam
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Whereas the Proposer named in the Schedule below having proposed for insurance and paid the Sum as stated below in respect of the Motor Vehicle described in the Schedule
below the risk is hereby HELD COVERED in the terms of the Corporation's usual form of policy applicable there to for the period as stated below unless the cover be
terminated by the Corporation by notice in writing in which case the insurance will there upon cease and the Corporation will return a proportionate part of the premium
already collected for such insurance after due allowance for the period the Corporation has been on risk.
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SCHEDULE
Cover Note No. : J0769994
Date Issued : 24-07-2013
Policy No. : NIL

Name of Proposer : ANGAMAH A/P SELVARAJOO

Postal Address : 41 JALAN SERI DUYONG 2/3
TAMAN SERI DUYONG SEK. 2
75460 MELAKA TENGAH
MELAKA

Occupation : FACTORY
Identity Card No. : (New) 640107-05-5534 (Old) :-
Business Reg No. : NA Passport No. :-
Period of Insurance : From 17/08/2013 till midnight : 16/08/2014
Registration No. : MCC6766 Engine No : S4PHRJ7213
Make/Model : PROTON PERSONA 1.6 (M) Chasis No. : PL1CM6SNRCG349988
Type of body : Year of Manufacture : 2011
C.C/Tonnage : 1597 CC Log Book No. : B1384952
Sum Insured(RM) : 39000.00
Seating Capacity :5 Loading(%) : 15.00
Type of Cover : COMPREHENSIVE COVER Premium(RM) : 790.42
Hire Purchase Owner : RHB ISLAMIC BANK BERHAD Excess(RM) : 0.00
NCD Entitlement(%) : 55.00
Extension of Cover(if any) : WINDSCREEN GLASS WITH TINT - RM700.00 Named Driver(s) : 1. THE INSURED
ADD NAMED DRIVER 2. RAMANATHAN A/L VALU
3. KARTHIK A/L
RAMANATHAN
4. MARAN A/L
RAMANATHAN
JPJ eInsurance Status : ACCEPTED BY JPJ

I/We hereby certify that this covering note is issued in accordance with the provisions of Section IV of the Road Transport Act 1987 (Malaysia) Motor Vehicles (Third Party
Risks)Rules 1959 (Malaysia) Motor Vehicles (Third Party Risks and Compensation) Act (Cap 189) Republic of Singapore Motor Vehicles (Third Party Risks Compensation)
Rules 1960 (Republic of Singapore) Motor Vehicles (Third Party Risks) Act (Cap 90) Negara Brunei Darussalam

Overseas Assurance Corporation (Malaysia) Berhad

(Approved Insurers)

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Agent Code : VHML0457 Authorised Signature

Dear Policy owners, kindly contact our nearest OACM branch or your servicing agent if you have not received your motor policy within one month after receiving this motor
e-cover note confirmation slip from your agent. Thank you.