Scribd
Upload
385 views2 pages

Endorsement Form KCX 8000

The document is an endorsement form for a motor insurance policy. It provides details of the policy holder and vehicle. It lists options to cancel the policy, withdraw or transfer no-claim discount, extend the policy, or request other changes.

Uploaded by

SITI NADRAH BINTI YUSSOF Moe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
385 views2 pages

Endorsement Form KCX 8000

The document is an endorsement form for a motor insurance policy. It provides details of the policy holder and vehicle. It lists options to cancel the policy, withdraw or transfer no-claim discount, extend the policy, or request other changes.

Uploaded by

SITI NADRAH BINTI YUSSOF Moe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

ENDORSEMENT FORM

POLICY DETAILS

Policy No 5750123TMA043486 Period of Insurance 5.1.2024 to 25.3.2024


Name MUHAMMAD HAKIMI YUSSOF Vehicle No KCX 8000

Email [email protected] Mobile Number 0177023933

Please tick any of the item below whichever is applicable

Cancel my/ our motor insurance policy with effect from


Reason:

To enclose- E-auto receipt or JPJ road tax cancellation slip or grant copy with new ownership.

Withdraw NCD from my/ our policy with effect from

Transfer the NCD from Vehicle no. (previous insurance) to Vehicle No.
(with Tune Insurance)

Please transfer my I our motor policy with effect from To


NRIC No.

Please extend my I our motor policy for a further months


with effect from To
To enclose - copy of road tax slip or JPJ record

Others

Tune Protect Malaysia


Tune Insurance Malaysia Berhad
Company No.: 197601004719 (30686-K)
Page 1 of 2
Level 9, Wisma Tune, No 19, Lorong Dungun, Damansara Heights, 50490, Kuala Lumpur Version 09/2021
Tel +603 2087 9000 Fax +603 2094 1366 Website tuneprotect.com
Authorization Form to Register for Payment by Direct Credit to Bank Account

l/We hereby authorize Tune Protect Malaysia Insurance Malaysia Berhad (Tune Protect Malaysia) to credit all my/our
payments to my/our bank account indicated below:

1. l/We hereby declare that the information given below is true and accurate to the best of my/our knowledge
and records.
2. I/We understand that Tune Protect Malaysia will rely, and act based on the given information contained
herein.
3. I/We shall indemnify Tune Protect Malaysia and its banker(s) against any loss and/or damage howsoever
arising from any matters in relation to Fund Transfer requested by me/us herein including but not limited to
error/incorrectness/inaccuracies of the information provided, delayed payment(s) and any other
circumstances beyond the control of Tune Protect Malaysia and/or its banker(s).
4. I/We understand and acknowledge that Tune Protect Malaysia has the right to collect the/my/our
information. By signing the authorization form, I/We consent to Tune Protect Malaysia using and disclosing
my/our personal information for the purpose stated here. I/We also agree to provide information necessary to
verify any statement given on this authorization form and to update information promptly to Tune Protect
Malaysia.
5. I/We understand and acknowledge that my/we providing the bank details does not tantamount to Tune
Protect Malaysia having admitted liability towards my/our claim under the relevant insurance policies but is
only to facilitate the safe receipt of any monies that is due to me/us.

Account Details

Account Name (Beneficiary Name) SITI NADRAH YUSSOF

Business Registration No./NRIC 901217145402


Bank Name MAYBANK Bank Account Number 101133308531

Signature Name SITI NADRAH YUSSOF

Date 26.09.2023

Tune Protect Malaysia


Tune Insurance Malaysia Berhad
Company No.: 197601004719 (30686-K)
Page 2 of 2
Level 9, Wisma Tune, No 19, Lorong Dungun, Damansara Heights, 50490, Kuala Lumpur Version 09/2021
Tel +603 2087 9000 Fax +603 2094 1366 Website tuneprotect.com

You might also like