10/02/2018

H7-Z03-P46-115193
YEO CHIN LING j2.e l
PL11100000
B-9-2 BLOCK B KONDO CITA DAMANSARA
NO 2 JLN PJU 3/27
SUNWAY DAMANSARA
47810 PETALING JAYA
SELANGOR, MALAYSIA

TL201311998963/TLAS/KG/A0064641/A0019903
YEAR 2017 LIFE INSURANCE PREMIUM STATEMENT
PENYATA PREMIUM INSURANS HAYAT TAHUN 2017
Life Policy No. / No. Polisi TL201311998963 Status / Status IN-FORCE
Commencement Date / Tarikh Permulaan 03/06/2013 Maturity Date/Tarikh Matang 02/06/2038
Payment Mode / Frekuensi Pembayaran YEARLY
Policy Owner / Pemunya polisi YEO CHIN LING
Assignor / Penyerah Hak Not Applicable
Life Assured / Hayat Diinsuranskan YEO CHIN LING
PREMIUM PAID / JUMLAH PREMIUM DIBAYAR (01/01/2017-31/12/2017)
Life / Insurans hayat RM 17,922.09

Medical / Perubatan RM 0.00
Education / Pendidikan RM 0.00
Annuity / Anuiti RM 0.00

Total Premium Paid (excluding GST, if any) / Jumlah Premium Dibayar (tidak termasuk cukai barangan dan
RM 17,922.09
perkhidmatan, jika ada)

*Total Automatic Premium Loan / *Jumlah Pinjaman Premium Automatik RM 0.00

GST (if any)/GST (jika ada) RM 0.00

Note : This statement is issued for the PURPOSE OF SUBMISSION TO THE INLAND REVENUE BOARD. Eligibility for deductions which may be claimed is subject to the approval of Inland Revenue Board.
Nota : Penyata ini dikeluarkan untuk TUJUAN PELEPASAN CUKAI. Kelayakan tuntutan pelepasan cukai pendapatan adalah tertakluk kepada keputusan Jabatan Hasil Dalam Negeri.

* Deduction is not allowable for premiums which are not in fact paid although treated by the insurance company as having paid because of a non-forfeiture clause in the policy ie. Automatic Premium
Loan (APL). Please refer to www.hasil.com.my for further information.
* Potongan tidak dibenarkan bagi premium yang belum dibayar walaupun dianggap oleh syarikat insurans sebagai telah dibayar dengan adanya klausa non-forfeiture dalam polisi seperti Pinjaman

Premium Automatik dan sebagainya. Sila melanggani www.hasil.com.my untuk maklumat lanjutan.

H7-Z03-P46-115193 : 1/5

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Hong Leong Assurance Berhad (94613-X)

Level 3, Tower B, PJ City Development, No.15A, Jalan 219, Seksyen 51A, 46100 Petaling Jaya, Selangor, P.O.Box 120, 46710 Petaling Jaya
Telephone +03-7650 1818 Fascimile +03-7650 1991
Customer Service Hotline 03-7650 1288 Customer Service Hotfax 03-7650 1299 GST ID 001544552448 Website www.hla.com.my
ANNUAL STATEMENT FOR POLICY / PENYATA TAHUNAN UNTUK POLISI (TL201311998963) @ 31/12/2017
Plan Sum Assured / Benefits (RM) /Basic Annuity Premium (RM)
Pelan Jumlah Diinsuranskan / Faedah (RM) / Anuiti Asas Premium (RM)
Basic / Asas
HLA CASH PROMISE 3,650.12 17,922.09
Riders / Rider
WAIVER OF PREMIUM BENEFIT (FOR HLA CASH 17,922.09 PER YEARLY 0.00
PROMISE)
DEATH BENEFIT (FOR HLA CASH PROMISE) 3,650.12 0.00

Total Relevant Amount / Jumlah Amaun Relevan 17,922.09

Bonus Type Previous Accumulation (RM) Current (RM)** Total / Jumlah (RM)
Jenis Bonus Jumlah Terdahulu (RM) Semasa (RM)** @ 31/12/2017
Compound Reversionary Bonus / Annuity Bonus
Not Applicable Not Applicable Not Applicable
Bonus Berbalik Majmuk / Anuiti

Amount Declared Preceding Last 5 Years

2016 2015 2014 2013 2012
Amaun Dideklarasi 5 Tahun Sebelumnya
Compound Reversionary Bonus / Annuity Bonus
Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
Bonus Berbalik Majmuk / Anuiti
Cash Dividend (excluding interest)
365.01 365.01 365.01 0.00 0.00
Dividen Tunai (tidak termasuk faedah)
Cash Payment / Guaranteed Monthly or Yearly Income
/ Guaranteed Monthly or Yearly Cash Coupons
(excluding interest)
3,650.12 3,650.12 3,650.12 0.00 0.00
Deposit Bayaran Tunai / Pendapatan Bulanan atau
Tahunan Terjamin / Kupon Tunai Bulanan atau Tahunan
Terjamin (tidak termasuk faedah)

Policy Benefits / Polisi Faedah

Current Year (excluding interest)** Total / Jumlah (RM)
Cash Dividend / Dividen Tunai 365.01
Cash Payment / Guaranteed Monthly or Yearly Income / Guaranteed Monthly or Yearly Cash Coupons /
3,650.12
Bayaran Tunai / Pendapatan Bulanan atau Tahunan Terjamin / Kupon Tunai Bulanan atau Tahunan Terjamin

Accumulated (inclusive of interest) Total / Jumlah (RM) @ 31/12/2017

Deposited Cash Dividend
A. 1,626.15
Deposit Dividen Tunai
Deposited Cash Payment / Guaranteed Monthly or Yearly Income / Guaranteed Monthly or Yearly Cash Coupons
Deposit Bayaran Tunai / Pendapatan Bulanan atau Tahunan Terjamin / Kupon Tunai Bulanan atau Tahunan B. 16,261.50
Terjamin
Guaranteed Cash Surrender Value***
C. 4,470.71
Nilai Serahan Yang Dijamin***
Terminal Dividend / Bonus (Value based on condition there are no changes to Policy 2 months before
31/12/2017)**
D. 55,678.52
Dividen Terminal / Bonus (Nilai berdasarkan andaian tidak terdapat sebarang perubahan kepada Polisi 2 bulan
sebelum 31/12/2017)**
Total Automatic Premium Loan
E. 0.00
Jumlah Pinjaman Premium Automatik
Total Policy Loan
F. 0.00
Jumlah Pinjaman Polisi
Projected Total Cash Surrender Value G = (A+B+C+D) -E - F
H7-Z03-P46-115193 : 2/5

G. 78,036.88
Anggaran Jumlah Nilai Serahan
Assignment and Nomination Details/Butir-butir Penyerahan Hak dan Penamaan

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Hong Leong Assurance Berhad (94613-X)
Level 3, Tower B, PJ City Development, No.15A, Jalan 219, Seksyen 51A, 46100 Petaling Jaya, Selangor, P.O.Box 120, 46710 Petaling Jaya
Telephone +03-7650 1818 Fascimile +03-7650 1991
Customer Service Hotline 03-7650 1288 Customer Service Hotfax 03-7650 1299 GST ID 001544552448 Website www.hla.com.my
 YEO CHIN LING (Trustee/Pemegang Amanah)
B-9-2 BLOCK B KONDO CITA DAMANSARA, NO 2 JLN PJU 3/27, SUNWAY DAMANSARA, 47810, PETALING JAYA, SELANGOR, MALAYSIA
YEO KIN KEE @ YU KAI KEE (Nominee/Penama)
PT 233 TAMAN KOPERATIF, TANJONG CHAT, 15300, KOTA BHARU, KELANTAN, MALAYSIA

Note/Nota :
1. The current interest rate for Policy Loan and Automatic Premium Loan is 8% per annum. The company will review this rate periodically based on prevailing interest rate and this rate can be
revised at the Company’s discretion.
Kadar faedah semasa untuk Pinjaman Polisi dan Pinjaman Premium Automatik ialah 8% setahun. Syarikat akan menyemak kadar ini secara berkala berdasarkan kadar faedah lazim dan kadar
ini boleh disemak semula pada budi bicara Syarikat.
2. The current interest rate for Deposited Cash Dividend and Deposited Cash Payment / Guaranteed Yearly Income / Guaranteed Yearly Cash Coupons is adjusted to 5.10% per annum with effect
from 01/10/2017, based on the prevailing interest rate, investment experience and operating results of the company. This interest rate is not guaranteed and the company reserves the right to
review and change the rate periodically.
Kadar faedah semasa untuk Deposit Dividen Tunai dan Deposit Bayaran Tunai / Pendapatan Tahunan Dijamin/Kupon Tunai Tahunan Terjamin telah diselaraskan kepada 5.10% setahun berkuat
kuasa dari 01/10/2017, berdasarkan kadar faedah semasa, pengalaman pelaburan dan keputusan operasi syarikat. Kadar faedah ini tidak terjamin dan syarikat berhak untuk menyemak semula
dan menukar kadar tersebut secara berkala.
3. Terminal Dividend would be payable only upon Surrender from first year anniversary onwards or Maturity of the Policy (if applicable)
Dividend Terminal hanya akan dibayar atas syarat Penyerahan Nilai dari ulang tahun pertama atau Kematangan Polisi (jika berkenaan)
4. Critical Year (CY) option is an option to utilize the accumulated Cash Dividends to offset premium due. In the event that the accumulated dividends are exhausted, take up an Automatic
Premium Loan (APL) to offset premium due (if applicable)
Opsyen Tahun Kritikal (CY) merupakan satu pilihan untuk menggunakan Dividen Tunai terkumpul untuk mengimbangi premium yang perlu dibayar Sekiranya dividen terkumpul habis, Pinjaman
Premium Automatik (APL) akan digunakan untuk mengimbangi premium yang perlu dibayar (jika berkenaan)
5. The overall healthcare costs in Malaysia increase every year. In order to provide you with adequate coverage amidst the rising costs, we carefully review the claim experience of each product
annually to ensure that the current premium/insurance charge remains sustainable. Premium/ insurance charge adjustments will only be made when the actual claim experience has exceeded
what we have projected (if applicable)

** Current Reversionary Bonus / Annuity Bonus / Cash Dividend / Yearly or Monthly Cash Payment Declared

** Semasa Bonus Berbalik Majmuk / Bonus Anuiti / Dividen Tunai / Bayaran Tunai tahunan atau bulanan
** Bonus and or Terminal Dividend / Bonus to be declared in future (if any) is not guaranteed and will depend on the investment and operating results of the company
** Bonus dan atau Dividen / Bonus Terminal yang akan dideklarasikan (jika ada) untuk pada masa akan datang adalah tidak terjamin dan bergantung kepada pelaburan dan keputusan operasi

*** Subject to deduction of any indebtedness in the policy i.e APL including interest, Policy Loan including interest and etc.

*** Potongan akan diambil kira dari segala tunggakan seperti Pinjaman Premium Automatik termasuk faedah, Pinjaman Polisi termasuk faedah and sebagainya.
*** Guaranteed Cash Surrender Value is inclusive of the Cash Surrender Values of Basic Plan, Rider(s) (if any) and Reversionary Bonus (if any) and Annuity Bonus (if any) as at the date of extraction.
*** Jaminan Nilai Serahan Yang Dijamin adalah termasuk Nilai Serahan Pelan Asas Polisi, Rider (jika ada) dan Bonus Berbalik Majmuk (jika ada) Bonus Anuiti (jika ada) pada tarikh diekstrak.

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Hong Leong Assurance Berhad (94613-X)

Level 3, Tower B, PJ City Development, No.15A, Jalan 219, Seksyen 51A, 46100 Petaling Jaya, Selangor, P.O.Box 120, 46710 Petaling Jaya
Telephone +03-7650 1818 Fascimile +03-7650 1991
Customer Service Hotline 03-7650 1288 Customer Service Hotfax 03-7650 1299 GST ID 001544552448 Website www.hla.com.my
Bonus / Cash Dividend / Terminal Dividend / Terminal Bonus
If your policy shares in the profits of the Participating Fund managed by the company, by way of Compound Reversionary Bonuses (CRB), Cash
Dividends (CD), Terminal Dividend (TD) or Terminal Bonus (TB), please note that actual CRB, CD, TD or TB may vary from year to year depending on the
investment returns and operating results of the Fund. Thus CRB, CD, TD or TB declared may be higher or lower from that shown in the sales illustration
given previously to you. Once annual CRB or CD is declared, they are guaranteed and are not affected by subsequent year's declarations. If you have
elected a Critical Year option, please note that as it depends on the amount of CRB or CD declared, and the interest rates applied,it is thus not
guaranteed. A reduction of the CRB or CD declared may require you to make premium payments after the Critical Year.

Period of Grace
A thirty (30) days' grace period from the due date shall be allowed for the payment of renewal premiums. A payment for premium made after grace
period is subject to interest on late payment at a rate, which the Company may prescribe from time to time. The policy shall remain in force during the
grace period. In the event of the premium not being paid within the period of grace, the Policy shall be automatically converted to an Automatic
Non-Forfeiture Privilege or Extended Term Insurance after the expiry of the grace period.

Automatic Extended Term Assurance Privilege

To use the cash value available less any indebtedness due to us (if any) to continue this Policy as a non-participating extended term insurance for such
period as the cash value less any indebtedness due to us (if any) could purchase at the Life Assured's age at the time this Policy is continued. If the
cash value is more than sufficient to purchase Extended Term Insurance to the expiry date, the excess shall be refunded to the Policy Owner.

Bonus / Dividen / Dividen Terminal / Bonus Terminal

Jika polisi anda ialah polisi hayat sertaan, secara bonus berbalik majmuk (CRB), Dividen Tunai (CD), Dividen Terminal(TD) atau Bonus Terminal(TB), sila
ambil perhatian bahawa CRB, CD, TD, atau TB yang diagihkan setiap tahun akan berbeza dari tahun ke tahun mengikut pulangan pelaburan dan
pengurusan dana. Oleh yang demikian, CRB, CD, TD, atau TB yang diisytiharkan berkemungkinan berbeza dengan illustrasi yang ditunjukkan kepada
anda sebelum ini. Apabila CRB atau CD telah diperuntukan, ianya adalah dijamin dan tidak akan terjejas oleh pengisytiharan yang berikutnya. Jika anda
memilih opsyen tahun kritikal, ianya adalah bergantung kepada jumlah dari CRB atau CD yang diisytiharkan dan kadar faedah yang dikenakan. Oleh
yang demikian, ia adalah tidak dijamin. Pengurangan ke atas CRB atau CD yang bakal diisytiharkan mungkin memerlukan pembayaran premium
seterusnya selepas tahun kritikal.

Tempoh Tenggang
Suatu tempoh tenggang selama tiga puluh (30) hari akan dibenarkan untuk pembayaran pembaharuan premium. Dalam keadaan premium tidak
dibayar dalam tempoh tenggang, polisi akan berakhir dan semua premium yang tidak dibayar akan dilucut oleh Syarikat kecuali dimana premium
boleh dibayar dengan permohonan Keistimewaan Tiada Lucut Automatik ataupun Keistimewaan Insurans Sementara Automatik.

Keistimewaan Insurans Sementara Automatik

Selepas polisi anda memperoleh nilai serahan tunai, anda boleh menggunakan nilai tunai anda yang ada selepas ditolak apa-apa keterhutangan yang
patut dibayar kepada kami (jika ada) untuk meneruskan Polisi ini sebagai insurans bertempoh lanjutan tanpa penyertaan untuk selama tempoh yang
boleh dibeli dengan nilai tunai selepas ditolak apa keterhutangan yang patut dibayar kepada kami (jika ada) pada umur Hayat Diinsuranskan pada
Polisi ini diteruskan. Jika nilai tunai adalah lebih daripada cukup untuk membeli insurans Bertempoh Lanjutan hingga tarikh tamat tempoh, maka
lebihnya akan dibayar balik kepada pemunya Polisi.

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Hong Leong Assurance Berhad (94613-X)

Level 3, Tower B, PJ City Development, No.15A, Jalan 219, Seksyen 51A, 46100 Petaling Jaya, Selangor, P.O.Box 120, 46710 Petaling Jaya
Telephone +03-7650 1818 Fascimile +03-7650 1991
Customer Service Hotline 03-7650 1288 Customer Service Hotfax 03-7650 1299 GST ID 001544552448 Website www.hla.com.my
ANNOUNCEMENT

What is JomPAY?
JomPAY is a service that allows banks' customer to easily pay insurance bills using their credit cards or from their banking accounts.

Why JomPAY?
Fast, convenient and secure.

How to Make Payment with JomPAY?

1. Spot
Look for JomPAY logo and Biller Code on your insurance premium statement.

2. Go Online
Log on to your preferred Internet or Mobile Banking and look for JomPAY

3. Pay
Enter the policy no from the insurance premium statement and proceed to submit

PERSONAL DATA

Hong Leong Assurance Berhad (“HLA”) safeguards your personal data in accordance with applicable laws in Malaysia. HLA uses personal
data in accordance with the HLA Notice On Personal Data as may be amended from time to time (“Notice on Personal Data”). The Notice
on Personal Data explains the data collection purposes, the persons to whom HLA may transfer data, your data access and correction rights
and how you may contact HLA’s Data Protection Officer. Copies of the Notice on Personal Data are available upon request or from the HLA
website (www.hla.com.my) and you are advised to read the Notice on Personal Data. All personal data provided to HLA by yourself and/or
acquired by HLA from the public domain, as well as personal data that arises as a result of the provision of services to yourself will be
subject to such Notice on Personal Data. If you have any queries, please contact HLA Data Protection Officer at 03-76501817 (fax number),
03-76501660 (telephone number) or by way of email to [email protected].

DATA PERIBADI

Hong Leong Assurance Berhad ("HLA") melindungi data peribadi anda selaras dengan undang-undang di Malaysia. HLA menggunakan data
peribadi mengikut Notis Data Peribadi HLA sebagaimana yang dipinda dari semasa ke semasa ("Notis Data Peribadi"). Notis Data Peribadi
menerangkan tujuan pengumpulan data, orang yang kepadanya HLA boleh memindahkan data, data akses anda dan hak-hak pembetulan
anda dan bagaimana anda boleh menghubungi Pegawai Perlindungan Data HLA . Salinan Notis Data Peribadi boleh didapati atas
permintaan atau daripada laman web HLA (www.hla.com.my) dan anda dinasihatkan supaya membaca Notis Data Peribadi. Semua data
peribadi yang anda berikan kepada HLA dan/atau yang diperoleh oleh HLA daripada domain awam, dan juga data peribadi yang timbul
akibat daripada penyediaan perkhidmatan kepada anda akan tertakluk kepada Notis Data Peribadi. Jika anda mempunyai sebarang
pertanyaan, sila hubungi Pegawai Perlindungan Data HLA di 03-76501817 (nombor faks), 03- 76501660 (nombor telefon) atau melalui e-mel
kepada [email protected].

Minimum Guaranteed Unit Price at Fund Maturity for HLA EverGreen Funds (If Applicable)

We are pleased to append below the minimum unit price at fund maturity for EverGreen Funds updated as of 29/12/2017.

Fund Type Maturity Date Min Unit Price at Funds Maturity (before tax)
HLA EVERGREEN 2023 26/12/2023 1.2358
HLA EVERGREEN 2025 26/12/2025 1.2670
H7-Z03-P46-115193 : 5/5

HLA EVERGREEN 2028 26/12/2028 1.3136

HLA EVERGREEN 2030 26/12/2030 1.3446
HLA EVERGREEN 2035 26/12/2035 1.4221

The minimum Guaranteed Unit Price at Fund maturity before tax will attract a portion of tax which has yet to be provided for. The further
tax adjustment is the difference of tax payable on the capital gains of the Funds determined at the funds maturity and tax which has been
provided for the Funds through weekly unit pricing.

The unit prices published weekly are on after tax basis.