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BORANG PERMOHONAN INSURAN KEMALANGAN
PERSONAL ACCIDENT PROPOSAL FORM


A. BUTIRAN PENCADANG / THE PROPOSER

(Untuk tujuan pulangan wang Sumbangan pembahagian lebihan dan / atau tuntutan. Contoh MBB001)
(For the purpose of refund of Contibution surplus distribution, and / or claim. E.g: MBB001)

B. TEMPOH TAKAFUL / PERIOD OF TAKAFUL

C. SOALAN-SOALAN AM / GENERAL QUESTION

Adakah anda mempunyai Perlindungan Takaful Keluarga atau Kemalangan Diri?
Do you already have Family Takaful and Persona Accident Takaful?

Jika jawapan kepada soalan berikut ini adalah YA, sila berikan butiran penuh termasuk nama dan tarikh.
If the answer to any of the following question is YES, please give full details including name "Sharikat" and date.

 
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