Overseas Assurance Corporation (Malaysia) Berhad (102249-P) (A member of Gr eat Eastern Holdings Limited) Level 18, Menara Grea t Eastern, 303, Jalan Ampang, 50450 Kua la Lumpur. Telephone: 03-4259 7888 Facsimile: 03-4813 0055 Website: www.oac.com.my ____________________________________________________________________________________________________________________________________________ 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 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. SCHEDULE Cover Note No. Date Issued Policy No. : J1453619 : 13-02-2014 : V1521428 Name of Proposer Postal Address : JEYARANI A/P VALLIAPPAN : BATU 21 KAMPUNG RIM, 77000 JASIN Occupation Identity Card No. Business Reg No. Period of Insurance Registration No. Make/Model Type of body C.C/Tonnage Sum Insured(RM) Seating Capacity Type of Cover Hire Purchase Owner : : : : : : : : : : : : FACTORY WORKER (New) 620531-04 -5150 NA From 13/02/2014 JFX6293 PROTON - PROTON ISWARA 1.5 AEROBACK SALOON 1495 CC 10000.00 5 Comprehensive HONG LEONG BANK BERHAD (Old) Passport No. till midnight Engine No Chasis No. Year of Manufacture Log Book No. Loading(%) Premium(RM) Excess(RM) NCD Entitlement(%) : - : - : 1 2/02/2015 : 4G15PHJ0829 : PL1C22LKR1B5 52104 : 2000 : 332659 : 10.00 : 263.69 : 200.00 : 55.00 Extension of Cover(if any) :ADD NAMED DRIVER Named Driver(s) : 1. JEYARANI A/P VALLIAPPAN 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) 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.
