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Data Form – STU Takaful Guru


Promotion Premium RM30/= Per Month for Each Participant
Member’s Details RM30
Name: Mailing Address:

NRIC:

Old IC: Postcode:

Mobile*: Bank Name:


(Mandatory)
Email: Bank Account Number:

Bank Branch:

Spouse’s Details RM30 Child – 1’s Details RM30


Name: Name:

NRIC: NRIC:
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Date of Birth: Date of Birth:

Child – 2’s Details RM30 Child – 3’s Details RM30


Name: Name:

NRIC: NRIC:

Date of Birth: Date of Birth:

I declare that the above information is true and authorise Sarawak Teachers’ Union to deduct my monthly premium for Takaful
Guru scheme for RM30 each Participant through Biro Perkhidmatan Angkasa (BPA).


Member’s Signature: ______________________
 REMINDER: Do not forget to attach your pay slip here!
Date: ______________________
Should you wish to contribute more than RM30 per month, please tick!  Fold Here

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