Detail1: A0104236_UL201919772740____N_NA_1_I Doc: ULS

Detail2: RAJDAVE SINGH A/L HARDEV SINGH_NO32 JLN 11_RAJDAVE SINGH A/L HARDEV SINGH_70200_

PL11100000
PL11100000
A0104236_UL201919772740
RAJDAVE SINGH A/L HARDEV SINGH
NO.32, JALAN 11,
TAMAN DESA TEMIANG
70200 SEREMBAN
NEGERI SEMBILAN, MALAYSIA

UL201919772740/ULAS/KL/A0104236/A0009763
YEAR 2023 LIFE INSURANCE PREMIUM STATEMENT
PENYATA PREMIUM INSURANS HAYAT TAHUN 2023
Life Policy No. / No. Polisi UL201919772740 Status / Status IN-FORCE
Commencement Date / Tarikh Permulaan 07/01/2020 Maturity Date / Tarikh Matang 06/01/2061
Payment Mode / Frekuensi Pembayaran MONTHLY
Policy Owner / Pemunya polisi RAJDAVE SINGH A/L HARDEV SINGH
Assignor / Penyerah Hak NOT APPLICABLE
Life Assured / Hayat Diinsuranskan RAJDAVE SINGH A/L HARDEV SINGH
PREMIUM PAID / JUMLAH PREMIUM DIBAYAR ( 01/01/2023 - 31/12/2023 )
Life / Insurans hayat RM 1,275.06
Medical / Perubatan RM 884.94
Education / Pendidikan RM 0.00
Annuity / Anuiti RM 0.00
Total Premium Paid / RM 2,160.00
Jumlah Premium Dibayar

Modal Premium / Modal Premium RM 2,160.00

Top-up / Excess Premium / Premium Tambahan RM 0.00
Service Tax (if any) / Cukai Perkhidmatan (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 PENYERAHAN KEPADA LEMBAGA HASIL DALAM NEGERI. Kelayakan untuk potongan cukai yang boleh dituntut adalah tertakluk kepada
kelulusan Lembaga Hasil Dalam Negeri.
* PROTECTION BY PERBADANAN INSURANS DEPOSIT MALAYSIA (PIDM) ON BENEFITS PAYABLE FROM THE UNIT PORTION OF THIS POLICY IS SUBJECT TO LIMITATIONS.
Please refer to PIDM✙s TIPS Brochure or contact Hong Leong Assurance Berhad or PIDM (visit www.pidm.gov.my).
* PERLINDUNGAN PERBADANAN INSURANS DEPOSIT MALAYSIA (PIDM) UNTUK MANFAAT YANG DIBAYAR DARIPADA BAHAGIAN UNIT POLISI INI ADALAH TERTAKLUK KEPADA
SYARAT-SYARAT TERTENTU. Sila rujuk Brosur Sistem Perlindungan Manfaat Takaful dan Insurans PIDM atau hubungi Hong Leong Assurance Berhad atau PIDM (layari
www.pidm.gov.my).

HLA Asset Elite

You Care For Your Family. We Care For YOU
With HLA Asset Elite, it is now possible to secure ample protection in your prime
years, and all the way into your golden age for retirement and to leave a meaningful
legacy for your loved ones. This plan offers:

• Life Coverage up to age 100

• Cancer Coverage up to 30% of basic sum assured (BSA) upon Cancer Diagnosis
during prime age
• Supplementary Income of 50% of BSA if you suffer elderly disablement such
as not being able to take care of your daily life during golden age
• Loyalty Bonus up to 15% of BSA when you stay longer with us
• Retrenchment Benefit to ease your financial commitments

Our friendly agents are ever ready to assist. Call them for a chat today,
or contact us at 03-7650 1288 | www.hla.com.my

This is a computer generated letter, no signature is required.

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ANNUAL STATEMENT FOR POLICY / PENYATA TAHUNAN UNTUK POLISI ( UL201919772740 ) @ 31/12/2023
For Insurance Charges made / Untuk Caj Insurans dibuat @ 01/01/2023 - 31/12/2023
Plan Sum Assured (RM) Insurance Charges (RM)
Pelan Jumlah Diinsuranskan (RM) Caj Insurans (RM)

Coverage for / Perlindungan Untuk RAJDAVE SINGH A/L HARDEV SINGH

HLA COMPLETECOVER 100,000.00 116.34

DISABILITY LUMP SUM RIDER 100,000.00 14.84

CI CARE RIDER (LEVEL SA) 100,000.00 66.16

CRITICAL ILLNESS WAIVER OF 180.00 18.98

PREMIUM RIDER (CIWP)

TPD WAIVER OF PREMIUM RIDER 180.00 3.84

(TPDWP)

MILLION EXTRA III (FOR MS 200 PRE 0 200.00 22.80

- POST 0)

HLA MEDISHIELD III 200 (PRE 0 - POST 200.00 777.00

0)

Guaranteed Cash Surrender Value (RM) / Nilai Serahan Yang Dijamin (RM) 0.00

Current Guaranteed Yearly Income / No Claim Incentive (RM) (if applicable) / 105.42
Pendapatan Tahunan Terjamin Tahun Ini / Insentif Tiada Tuntutan (RM) (jika berkenaan)

Advance Payment/Premium Deposit / Bayaran Pendahuluan/Deposit Premium 0.00

Assignment, Nomination and Contingent Owner Details/Butir-butir Penyerahan Hak, Penamaan dan Pemunya Kotinjen
NIL

With effect from 1st September 2018, the premium charged* on the provision of all types of insurance policy to all business organization inclusive of life policy assigned to a business
organization is subject to 6% service tax. However, provision of insurance policy to educational institution and religious organization registered under any written law are excluded from service
tax.
Please take note that HLA reserves the right to collect from policyholders an amount equivalent to the Service Tax payable on the applicable premium for the policy period. In the event that the
policy period commences before but expires after 1st September 2018, HLA may collect from the policyholders an amount equivalent to the Service Tax payable on the applicable premium
calculated from 1st September 2018 on a pro-rated basis.

If the organization is exempted from 6% service tax, please provide us with a Service Tax Exemption Letter issued by the relevant authorities (e.g. Royal Malaysia Customs Department or
Ministry of Finance). The exemption from service tax will only take effect at next premium due date after HLA receives the Service Tax Exemption Letter.

Please take note that with effect from 1st March 2024, the service tax on premium charged* on the provision of all types of insurance policy to all business organization inclusive
of life policy assigned to a business organization would be revised from 6% to 8%.

*Top up premium (single/ regular top up) and reinvestment of claims/benefit paid (if applicable) forms part of the premium mentioned above

This is a computer generated letter, no signature is required.

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 UL201919772740

HONG LEONG BANK * Mandatory Field *

Recipient Account Number 00100108802 * Mandatory Field *

* Mandatory Field *
Recipient Reference UL201919772740

Other Payment Details [ NRIC of Policy Owner ] * Optional Field *

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ANNOUNCEMENTS

PERSONAL DAT A
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-
76501660 or by way of email to [email protected].

DAT A 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 talian 03-76501660 atau melalui
emel kepada [email protected].

Minimum Guaranteed Unit Price at Fund Maturity for HLA EverGreen Funds

We are pleased to append below the Minimum Guaranteed Unit Price at Fund Maturity for EverGreen Funds updated as of
26/12/2023.

Minimum Guaranteed Unit Price at Fund Maturity

Fund Name Fund Maturity Date
(before tax)
HLA EVERGREEN 2023 26/12/2023 Matured
HLA EVERGREEN 2025 26/12/2025 1.2670
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.

Minimum Guaranteed Unit Price at Fund Maturity for HLA Horizon Fund(s) (if applicable)

Fund Name Fund Maturity Unit Price Fund Size (RM) @ Guaranteed Unit Price Upon
Date (RM) @ 26/12/2023 Fund Maturity (RM) @
26/12/2023 26/12/2023
HLA Horizon28 Fund 08/10/2028 1.0193 9,102,270.50 1.121
HLA Horizon38 Fund 08/10/2038 1.1057 512,480,828.75 1.500
HLA Horizon48 Fund 08/10/2048 1.1037 236,549,554.56 2.000

Publication of Unit Price

The unit prices of investment linked funds are available on www.hla.com.my.

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