Date : 23/12/2021
PP13B-POLISYM-TAKAFUL PA PLUS - MONTHLY
MR AZNI BIN DAUD
LOT 181 JALAN 11/141 ,KG MALAYSIA
TAMBAHAN ,KL ,57100 ,WP KUALA LUMPUR
MYS
57100 WILAYAH PERSEKUTUAN
WELCOME TO THE ETIQA FAMILY
Certificate No. : TDA-J2126307-W1
Product Name : Takaful PA Plus - Monthly
Effective Date : 23/06/2021
We are pleased to extend our warmest welcome to you for being a part of our family.
We enclose herewith the following document for your action:-
Certificate Schedule
This important document summarizes the details of your certificate and we suggest that you keep this
document for reference. Kindly be informed that the details stated in the certificate schedule is based on the
information you have declared to us at the time of application. We advise that you check the document
carefully and if there is any discrepancy, please inform us immediately. Our consultant will be glad to serve
you.
For any enquiries on the above or any of our products, feel free to call Etiqa Oneline at 1 300 13 8888 or
e-mail us at info@etiqa.com.my. In case of any claim, you may call our Claim Assist at
1 300 88 1007 for fast and efficient claim service. Again, we welcome you to the Etiqa family.
Thank you.
Yours sincerely,
Etiqa General Takaful Berhad
9225-374175
Tarikh : 23/12/2021
MR AZNI BIN DAUD
LOT 181 JALAN 11/141 ,KG MALAYSIA
TAMBAHAN ,KL ,57100 ,WP KUALA LUMPUR
MYS
57100 WILAYAH PERSEKUTUAN
SELAMAT MENYERTAI KELUARGA ETIQA
No Sijil : TDA-J2126307-W1
Nama Produk : Takaful PA Plus - Bulanan
Tarikh Berkuatkuasa : 23/06/2021
Dengan sukacitanya kami mengalu-alukan penyertaan ke dalam keluarga Etiqa.
Kami sertakan dokumen berikut untuk tindakan anda yang selanjutnya:-
Jadual Sijil
Dokumen penting ini adalah rumusan bagi maklumat-maklumat sijil anda dan hendaklah disimpan sebagai
rujukan. Harap maklum bahawa maklumat-maklumat yang terdapat dalam jadual sijil ini adalah berdasarkan
maklumat-maklumat yang telah anda isytiharkan kepada kami sewaktu permohonan. Anda dinasihatkan
untuk memeriksa dokumen ini dengan teliti dan sekiranya terdapat sebarang percanggahan, sila maklumkan
kepada kami dengan segera. Para penasihat kami bersedia untuk membantu anda.
Untuk sebarang pertanyaan mengenai perihal yang di atas atau berkenaan produk-produk kami yang lain,
sila hubungi Etiqa Oneline di talian 1 300 13 8888 atau emelkan kepada kami di alamat info@etiqa.com.my.
Untuk sebarang urusan tuntuan, anda boleh menghubungi Claim Assist kami di talian 1 300 88 1007 bagi
perkhidmatan tuntutan yang cepat dan efisyen. Kami sekali lagi mengucapkan selamat datang ke Etiqa.
Terima kasih.
Yang Benar,
Etiqa General Takaful Berhad
STAMP DUTY PAID
DUTI
SETEM
JADUAL/SCHEDULE DIJELASKAN
Takaful PA Plus(Monthly)
_____________________________________________________________________________
Orang Yang Dilindungi/Covered Person(s) Nombor Sijil/
AZNI BIN DAUD Certificate No.
TDA-J2126307-W1
Skim Yang Dipilih Tarikh Berkuatkuasa/
Scheme Selected Effective Date
23/06/2021
SKIM INDIVIDU / INDIVIDUAL SCHEME
Sumbangan Bulanan/
Peserta/Participant Monthly Contribution
MR AZNI BIN DAUD RM 21.73
_____________________________________________________________________________
BAYARAN PAMPASAN/ PAMPASAN/BENEFIT
BENEFIT PAYMENT (Setiap orang/Each Person)
--------------- (RM )
01 Pampasan Lumpuh / -----------
Total Paralysis Benefit 200000
02 Pampasan Lain Untuk Hilang Upaya Kekal 150000
sehingga/
Other Permanent Disablement up to
03 Pampasan Kemalangan Maut/ 100000
Accidental Death Benefit
04 Pampasan Pengkebumian/ 2000
Compassionate Cash Benefit
05 Pampasan Tunai Penghantaran 3000
Pulang Jenazah /
Repatriation Cash Benefit
06 Pampasan Tunai Pesakit Luar / 100
Outpatient Cash Benefit
07 Pampasan Kecederaan atas Kejadian 150
Ragut /
Snatch Thief Injury Benefit
08 Pembayaran Balik Pampasan Pesakit 1000
Dalam sehingga /
In-Hospital Medical Expenses
Reimbursement up to
-1- .....2/
Visit www.etiqa.com.my or our nearest branch to obtain the full policy wordings.
Help preserve the country's natural resources
9225-374176
JADUAL/SCHEDULE
TDA-J2126307-W1
Takaful PA Plus(Monthly)
_____________________________________________________________________________
BAYARAN PAMPASAN/ PAMPASAN/BENEFIT
BENEFIT PAYMENT (Setiap orang/Each Person)
(RM )
--------------- -----------
09 Pampasan Tunai Hospital sehari 100
(sehingga 100 hari) /
Hospital Cash Benefit per day (up to
100 days)
10 Yuran Ambulans sehingga / 200
Ambulance Fees up to
CHANGES IN TAXATION, REGULATIONS AND LEGISLATION
We may vary the terms of the Certificate As We consider appropriate
and equitable, if there are changes in taxation, regulations or
legislation that affect this Certificate.We will notify You in writing
three (3) months prior when terms in this Certificate need to be
changed.
If such tax applies, it shall be Your obligation to pay such
chargeable tax (where applicable).
In the event You do not pay such all value added tax, goods and
services tax or any other tax of a similar nature, We may, but is
not obliged to pay such tax on Your behalf, and You shall reimburse or
indemnify Us for all of such tax upon demand by Us.
PERSONAL DATA PROTECTION ACT
Personal Data shall have the same meaning as described to it as under
Section 4 of the Personal Data Protection Act 2010.
Personal Data refers to the personal data furnished by the Person
Covered, the Participant , or an authorized third party related to the
Certificate of Takaful.
Personal Data does not include information on an individual which is
in the public domain.
Your and Our Data Protection Obligations and Rights
We shall be able to process Personal Data according to the Section 4
of the Personal Data Protection Act 2010. We shall be able to disclose
Personal Data provided by You, as the context may require, to:
1. Etiqa General Insurance Berhad, Etiqa General Takaful Berhad ,
Etiqa Life International (L) Ltd or Etiqa Offshore Insurance (L)
Ltd;
2. Other entities within the Maybank Group;
3. Our authorized agents and service providers with whom We have
contractual agreements for some of Our functions, services and
-2- .....3/
Visit www.etiqa.com.my or our nearest branch to obtain the full policy wordings.
Help preserve the country's natural resources
9225-374177
JADUAL/SCHEDULE
TDA-J2126307-W1
Takaful PA Plus(Monthly)
_____________________________________________________________________________
activities.
4. Other Insurance or Takaful companies and distribution partners
(such as banks , islamic banks , insurance brokers , Takaful
brokers, reinsurance companies, Retakaful companies);
5. Industry trade association such as Life Insurance Association of
Malaysian (LIAM) , Persatuan Insurans Am Malaysia (PIAM) and
Malaysian Takaful Association (MTA);
6. Our merchants and strategic partners;
7. Any parties authorised by You (from time to time); or
8. Enforcement regulatory and governmental agencies as permitted or
required by law , authorized by any order of court or to meet
obligations to regulatory authorities.
You will keep Us updated in respect of all such Personal Data as soon
as is practicable.
We shall not be liable for any direct or indirect loss or damage due
to any inaccuracy or incompleteness in the Personal Data provided to
Us.
We may from time to time request that You provide other Personal data
required for the purposes of this Certificate.
Prior to providing Us with the Personal Data of a Person Covered , or
another individual, you must inform that individual of Our privacy
notice.
For the detailed privacy noticed on how We collect, use, process,
protect and disclose Personal Data, please visit Our branches, contact
Etiqa Oneline at 1300 13 8888 , or refer to Our website at www.etiqa.
com.my
IMPORTANT NOTICE - applicable to ALL CONSUMER Products
(Takaful wholly for purposes unrelated to your trade, business or
profession)
-----------------------------------------------------------------
Where You have applied for this Takaful wholly for purposes unrelated
to Your trade, business or profession, You had a duty to take
reasonable care not to make a misrepresentation in answering the
questions in the Application Form (or when You applied for this
Takaful) i.e. You should have answered the questions fully and
accurately. Failure to have taken reasonable care in answering the
questions may result in avoidance of Your contract of Takaful, refusal
or reduction of Your Claim(s), change of terms or termination of Your
Contract of Takaful in accordance with the remedies in Schedule 9
of the Islamic Financial Services Act 2013. You were also required
to disclose any other matter that You knew to be relevant to our
decision in accepting the risks and determining the rates and terms
to be applied.
You also have a duty to tell Us immediately if at any time after
Your contract of Takaful has been entered into, varied or renewed
with Us any of the information given in the Application Form (or
-3- .....4/
Visit www.etiqa.com.my or our nearest branch to obtain the full policy wordings.
Help preserve the country's natural resources
9225-374178
JADUAL/SCHEDULE
TDA-J2126307-W1
Takaful PA Plus(Monthly)
_____________________________________________________________________________
when You applied for this Takaful) is inaccurate or has changed.
IMPORTANT NOTICE - applicable to ALL NON CONSUMER Products
(Takaful wholly for purposes related to your trade, business or
profession)
--------------------------------------------------------------
This Certificate is issued in consideration of the payment of
contribution as specified in the Certificate Schedule and pursuant to
the answer given in Your Proposal Form (or when you applied for this
Takaful) and any other disclosures made by you between the time of
submission of Your Proposal Form (or when you applied for this
Takaful) and the time this contract is entered into. The answers and
any other disclosures given by you shall form part of this contract
of between you and us. In the event of any pre-contractual
misrepresentation made in relation to your answers or in any
disclosures made by you, it may result in avoidance of your contract
of takaful, refusal or reduction of your claim(s), change of terms
or termination of your contract of takaful.
This Certificate reflects the terms and conditions of the contract
of takaful as agreed between you and us.
COMMUNICABLE DISEASE EXCLUSION
------------------------------
1. Notwithstanding any provision to the contrary within this takaful
agreement ,this takaful agreement excludes all actual or alleged
loss, liability, damage, compensation, injury, sickness,disease,death,
medical payment, defense cost, cost, expense or any other amount
incurred by or accruing to the Participant, directly or indirectly
and regardless of any other cause contributing concurrently or in any
sequence, originating from, caused by, arising out of, contributed to
by, resulting from, or otherwise in connection with a Communicable
Disease or the fear ot threat (whether actual or perceived) of a
Communicable Disease.
2. As used herein, a Communicale Disease means any disease which can
be transmitted by means of any substance or agent from any organism to
another organism where :
2.1 the substance or agent includes, but is not limited to, a virus,
bacterium, parasite or other organism or any variation thereof,
whether deemed living or not, and
2.2 the method of transmission, whether direct or indirect, includes
but is not limited to, airborne transmission, bodily fluid
transmission, transmission from or to any surface or object, solid,
liquid or gas or between organisms, and
2.3 the disease, substance or agent can cause or threaten bodily
injury, illness, emotional distress or damage to human health, human
-4- .....5/
Visit www.etiqa.com.my or our nearest branch to obtain the full policy wordings.
Help preserve the country's natural resources
9225-374179
JADUAL/SCHEDULE
TDA-J2126307-W1
Takaful PA Plus(Monthly)
_____________________________________________________________________________
welfare or property damage.
Subject otherwise to the terms, exceptions and conditions of the
Certificate.
_16__/1__2_/_2_0_2_1 _N_00__2_6_7_43__G5__2_7_X_J
Tarikh Dikeluarkan/Date Issued Kod Agensi/Agency Code
Oleh/By ITC819
For and on behalf of,
ETIQA GENERAL TAKAFUL BERHAD
-5-
Visit www.etiqa.com.my or our nearest branch to obtain the full policy wordings.
Help preserve the country's natural resources
9225-374180
This Page Is Intentionally Left Blank
9225-374181
Client's Copy/Salinan Pelanggan : EGTG2021UWPM00426453
Invoice No/ No.Invois : 23/06/2021
Date/ Tarikh
INVOICE/
INVOIS
ETIQA GENERAL TAKAFUL BERHAD : W10-1808-31012539)
LEVEL 19, TOWER C
DATARAN MAYBANK
NO 1, JALAN MAAROF
59000 KUALA LUMPUR
(Service Tax No ................
To/ Kepada : Account No/No Akaun : N0026743
MR AZNI BIN DAUD
LOT 181 JALAN 11/141 ,KG MALAYSIA
TAMBAHAN ,KL ,57100 ,WP KUALA LUMPUR
MYS
57100 WILAYAH PERSEKUTUAN
Particulars Amount(RM )
Type Of Certificate/Jenis Sijil:Takaful PA
Certificate Number/No Sijil :TDA-J2126307-W1
Period Of Cover/ :From/Dari 23/06/2021 To/hingga 22/06/2022
Tempoh Perlindungan
Yearly Contribution/Sumbangan Tahunan : 246.00
-----------------
Total(Excluding Service Tax)/
Jumlah(Tidak Termasuk Cukai Perkhidmatan) : 246.00
Service Tax Payable/
Cukai Perkhidmatan Perlu Dibayar @ 6.00% : 14.76
-----------------
Total Amount Payable/ Jumlah Perlu Dibayar
: 260.76
=================
Monthly Contribution/Sumbangan Bulanan : 21.73
Service Tax (ST) is effective 01/09/2018.
Cukai Perkhidmatan (ST) berkuatkuasa 01/09/2018.
This is a computer generated document. Therefore, no signature is required.
Ini adalah dokumen yang dijana komputer. Oleh itu, tiada tandatangan diperlukan.
9225-374182
This Page Is Intentionally Left Blank
9225-374183
PRODUCT DISCLOSURE SHEET Etiqa General Takaful Berhad ("We/Us/Our")
Read this Product Disclosure Sheet before you decide to participate in the Takaful PA Plus
Takaful PA Plus. Be sure to also read the general terms and conditions. Date : 01/11/2020
1. What is this product about?
This product is a takaful personal accident plan which provides cover for death, permanent disability and medical benefits due to an
accident.
2. What are the Shariah concepts applicable?
Wakalah
This product applies the wakalah (agency) concept, whereby the participants appoint us to act on their behalf to invest and manage
the General Takaful Fund (Fund). The participants also agree to authorize us to delegate our rights, duties and obligations to any third
party as we deem fit for the purpose of achieving the objective to invest and manage the Fund, provided that, in the event of any such
delegation, we will remain liable and responsible for all such rights, duties and obligations towards the participant. As an agent, we are
entitled to receive a wakalah fee as a service charge. The wakalah fee is as follows:
Item (% of contribution)
Commission paid to the bank 15%
Management expenses 30%
Total Wakalah Fee 45%
Tabarru.'
This plan also applies the tabarru' (contribution) concept, whereby the participants agree to donate or contribute their contributions to
the Fund for the purpose of mutual aid and assistance to the participants based on the pre-agreed events, in case of need. At the end
of each financial year, any distributable surplus in the Fund, less repayment of historic deficits, makes allowance for contingency
provisions, and is subject to the surplus policy approved by our Shariah Committee is shared 50% among the participants whose
certificates have not terminated and who have not made any claims within the financial year, and 50% to us for operating and
managing the Fund, based on the contract of ju'alah. Ju'alah is a wage contract that specifies the share of the distribution of surplus on
this basis. If the surplus is less than RM10.00, it will be credited to charitable fund which will be utilized as 'Amal Jariah' on behalf of
the participant. The charitable fund will be distributed to eligible recipients as approved by our Shariah Committee for charitable
purposes.
3. What are the covers / benefits provided?
The following is a summary of Takaful PA Plus benefits:
No. Benefits Sum Covered
(RM)
1 Total paralysis, complete insanity or permanently bedridden up to 200,000
2 Other permanent disability benefits up to 150,000
3 Death benefit 100,000
Benefit for accidental death if accident occurred whilst taking public transport
OR occurring outside Malaysia, Singapore & Brunei. 50,000
Benefit for accidental death if occurred within Malaysia. 2,000
Compassionate cash 3,000
Repatriation benefit
100
4 Out-patient medical benefits 150
Out-patient cash benefit
Snatch theft injury benefit up to 1,000
100 per day
5 In-hospital medical benefits
Medical expenses reimbursement (per accident)
Hospital cash benefit up to 100 days
6 Ambulance fee (per accident) up to 200
Children Benefits (each child) - 25% of all the above benefits.
This is a yearly renewable certificate and the contribution can be paid on a monthly or yearly basis.
Note : Please refer to the takaful certificate contract for more information.
4. How much contribution do I have to pay?
Contribution
Scheme
Monthly Yearly
Myself 20.50 216.50
Myself & Spouse 33.00 348.50
Myself & Family 41.00 433.00
Contribution can be automatically debited from your preferred account (current/savings/credit card) according to your choice of
payment mode, either monthly or yearly.
All contributions (if applicable) will be subjected to relevant charges or taxes including Goods and Services Tax as deemed necessary
by the Malaysia tax authorities. It is important to keep any receipt that you receive as proof of payment of contributions
1 PMG/EGTB/PAPLUS/PDS/ENG/DM/2011V1.9
TDA-J2126307-W1
9225-374184
5. What are the fees and charges that I have to pay? Amount (RM)
6% of the contribution
Type
Sales and Services Tax 10.00
Stamp Duty
6. What are some of the key terms and conditions that I should be aware of?
Importance of disclosure
a. Pursuant to Paragraph 5 of Schedule 9 of the Islamic Financial Services Act 2013, if you are applying for this takaful wholly for
purpose unrelated to your trade, business or profession, you have a duty to take reasonable care not to make a misrepresentation in
answering the questions in the Application Form (or when you apply for this takaful). You must answer the questions fully and
accurately.
b. Failure to take reasonable care in answering the questions may result in avoidance of your contract of takaful, refusal or reduction of
your claim(s), change of terms or termination of your contract of takaful.
c. The above duty of disclosure shall continue until the time your contract of takaful is entered into, varied or renewed with us.
d. In addition in answering the questions in the Application Form (or when you apply for this takaful), you are required to disclose any
other matter that you know to be relevant to our decision in accepting the risks and determining the rates and terms to be applied.
e. You also have a duty to tell us immediately if at any time after your contract of takaful has been entered into, varied or renewed with
us any of the information given in the Application Form (or when you applied for this takaful) is inaccurate or has changed.
Cash before Cover - the contribution due must be paid to us before the effective date of the certificate.
Claims - if an accident occurs which give rise to a claim, you must notify us within 30 days from the date of accident.
Other Takaful - No person shall be covered under more than one Takaful PA Plus certificate.
Note: This list is non-exhaustive. Please refer to the takaful certificate contract for the full list of terms and conditions.
7. What are the major exclusions under this certificate?
a. Engaged in any illegal act, committing suicide, self-inflicted injury or is insane;
b. Under the influence of alcohol or drugs;
c. Engaging in hazardous sports or activities;
d. Engaging in flying or other aerial activities not as a passenger;
e. Engaging in dangerous occupations;
f. Taking part in naval, military, air force, police force, fire service, etc;
g. Pregnancy or childbirth;
h. AIDS or the presence of any HIV;
i Sickness, disease, parasite, bacterial or viral infection;
j. Pre-existing condition;
k. W ar and terrorism risks; or
l. Contamination of radiation or nuclear.
Note: This list is non-exhaustive. Please refer to the takaful certificate contract for the full list of exclusions.
8. Can I cancel my takaful certificate?
You may cancel your certificate at any time by giving written notice and returning your original Certificate of Takaful to us. Upon
cancellation, you are entitled to a partial refund of the contribution provided you have not made a claim during the period of takaful.
9. What do I need to do if there are changes to my contact details?
It is important that you inform us of any changes in your contact details to ensure that all correspondences reach you in a timely manner.
10. Where can I get further information?
Should you require additional information about Personal Accident takaful, please refer to the insuranceinfo booklet available at all our
branches or visit www.insuranceinfo.com.my
If you have any enquiries, please contact us at:
Etiqa General Takaful Berhad (201701025031)
(Licensed under Islamic Financial Services Act 2013 and regulated by Bank Negara Malaysia)
Level 13, Tower B, Dataran Maybank
No. 1, Jalan Maarof
Telephone Number: +603 2297 3888
Facsimile Number: +603 2297 3800
E-mail: info@etiqa.com.my
Homepage: www.etiqa.com.my
Maybank Group Customer Care: 1 300 88 6688
11. Other types of Personal Accident Takaful cover available
Please refer to our branches for other similar types of cover available.
IMPORTANT NOTE:
YOU ARE ADVISED TO NOTE THE SCALE OF BENEFITS FOR DEATH AND DISABLEMENT IN YOUR TAKAFUL CERTIFICATE. YOU
MUST NOMINATE A NOMINEE AND ENSURE THAT YOUR NOMINEE IS AWARE OF THE PERSONAL ACCIDENT TAKAFUL
CERTIFICATE THAT YOU HAVE PARTICIPATED. YOU SHOULD READ AND UNDERSTAND THE TAKAFUL CERTIFICATE AND
CONTACT US DIRECTLY FOR MORE INFORMATION.
The information provided in this disclosure sheet is valid as at 01/03/2020. .
2 PMG/EGTB/PAPLUS/PDS/ENG/DM/2001V1.8
TDA-J2126307-W1
9225-374185
HELAIAN PENDEDAHAN PRODUK Etiqa General Takaful Berhad (".Kami")
Baca Helaian Pendedahan Produk ini sebelum anda memutuskan untuk menyertai Takaful PA Plus
Takaful PA Plus. Pastikan juga anda membaca terma-terma dan syarat-syarat am. Date : 01/11/2020
1. Apakah produk ini?
Produk ini merupakan pelan kemalangan diri yang memberi perlindungan terhadap kematian, hilang upaya kekal dan manfaat
perubatan disebabkan oleh kemalangan.
2. Apakah konsep-konsep Syariah yang digunapakai?
Wakalah
Produk ini menggunapakai konsep wakalah (perwakilan), di mana para peserta melantik kami untuk bertindak bagi pihak mereka
untuk melabur dan menguruskan Dana Takaful Am (Dana). Para peserta juga bersetuju untuk memberikan kuasa kepada kami untuk
mewakilkan hak, tanggungjawab dan kewajipan kepada mana-mana pihak ketiga sebagaimana yang dianggap sesuai oleh kami bagi
mencapai objektif untuk melabur dan menguruskan Dana tersebut dengan syarat, bagi perwakilan ini, kami akan tetap
bertanggungjawab terhadap semua hak, tanggungjawab dan kewajipan terhadap para peserta. Sebagai ejen, kami berhak menerima
fi wakalah sebagai caj perkhidmatan. Fi wakalah adalah seperti berikut:
Butir-butir (% daripada sumbangan)
Komisen dibayar kepada bank 15%
Perbelanjaan pengurusan 30%
Jumlah Fi Wakalah 45%
Tabarru.'
Pelan ini juga menggunapakai konsep Tabarru' (derma), di mana para peserta bersetuju untuk menderma atau menyumbang
sumbangan mereka kepada Dana bagi tujuan saling membantu dan menolong mana-mana peserta lain yang memerlukan bantuan
berdasarkan peristiwa yang telah dipersetujui terlebih dahulu. Pada akhir setiap tahun kewangan, sebarang lebihan dalam Dana, tolak
pembayaran balik defisit bersejarah dan peruntukan luar jangka, dan tertakluk kepada polisi lebihan yang diluluskan oleh
Jawatankuasa Syariah kami, 50% akan dikongsi antara peserta yang sijilnya belum ditamatkan dan yang belum membuat tuntutan
dalam tahun kewangan, dan 50% kepada kami kerana mengendali dan menguruskan Dana, berdasarkan kontrak Ju'alah. Ju'alah
ialah kontrak upah yang menentukan pengagihan perkongsian lebihan. Jika lebihan itu kurang daripada RM10.00, lebihan itu akan
dimasukkan ke dalam tabung kebajikan yang akan digunakan sebagai 'Amal Jariah' bagi pihak peserta. Tabung kebajikan akan
diagihkan kepada penerima yang layak sebagaimana yang diluluskan oleh Jawatankuasa Syariah kami untuk tujuan kebajikan.
3. Apakah perlindungan/manfaat yang diberi? Jumlah Perlindungan
Berikut adalah manfaat-manfaat Takaful PA Plus: (RM)
No. Manfaat-manfaat Sehingga 200,000
Sehingga 150,000
1 Lumpuh sepenuhnya, hilang akal sama sekali atau kecederaan yang menyebabkan terlantar
kekal 100,000
2 Ketidakupayaan kekal yang lain 50,000
2,000
3 Kematian 3,000
Kemalangan maut ketika menaiki kenderaan awam atau sewaktu berada di luar negara
Malaysia, Singapura dan Brunei. 100
Kemalangan maut sewaktu berada di dalam Malaysia, Singapura dan Brunei. 150
Tunai belas kasihan
Penghantaran pulang jenazah Sehingga 1,000
100 sehari
4 Rawatan pesakit luar
Tunai pesakit luar
Kecederaan ragut
5 Perubatan hospital
Pembayaran balik perbelanjaan perubatan (setiap kemalangan)
Tunai hospital (sehingga 100 hari)
6 Yuran ambulans (setiap kemalangan) Sehingga 200
Manfaat untuk anak-anak (setiap orang anak) - 25% daripada semua manfaat di atas.
Ini adalah sijil takaful yang diperbaharui secara tahunan dan sumbangan boleh dibayar secara bulanan atau tahunan.
Nota : Sila rujuk kepada sijil takaful untuk maklumat lanjut.
4. Berapakah jumlah sumbangan yang perlu saya bayar?
Sumbangan (RM)
Skim
Bulanan Tahunan
Diri sendiri 20.50 216.50
Diri sendiri & Pasangan 33.00 348.50
Diri sendiri & Keluarga 41.00 433.00
PMG/EGTB/PAPLUS/PDS/BM/DM/2011V1.9
9225-374186
5. Apakah bayaran dan caj yang perlu saya bayar?
Jenis Amaun (RM)
Cukai Barang dan Perkhidmatan (GST) 0%
Duti Setem
10.00
6. Apakah terma- terma dan syarat-syarat penting yang perlu saya ketahui?
Kepentingan Pendedahan
a. Menurut Perenggan 5 daripada Jadual 9 Akta Perkhidmatan Kewangan Islam 2013, jika anda memohon takaful ini sepenuhnya untuk
tujuan yang tidak berkaitan perdagangan, perniagaan atau profesion anda, anda mempunyai kewajipan untuk mengambil langkah
yang munasabah untuk tidak salah nyata dalam menjawab soalan-soalan di dalam Borang Permohonan (atau semasa memohon
takaful ini). Anda dikehendaki menjawab soalan-soalan dalam Borang Permohonan ini dengan lengkap dan tepat.
b. Kegagalan untuk mengambil langkah yang munasabah dalam menjawab soalan-soalan, mungkin mengakibatkan pembatalan kontrak
takaful anda, keengganan atau pengurangan gantirugi, perubahan terma atau penamatan kontrak takaful anda.
c. Kewajipan pendedahan diatas hendaklah diteruskan sehingga kontrak takaful anda dimeterai, diubah atau diperbaharui dengan kami.
d. Sebagai tambahan kepada soalan-soalan di dalam Borang Permohonan (atau semasa memohon takaful ini), anda dikehendaki untuk
mendedahkan apa-apa perkara lain yang anda tahu akan mempengaruhi keputusan kami dalam menerima risiko dan menentukan
kadar dan terma yang dikenakan
e. Anda juga mempunyai kewajipan untuk memberitahu kami dengan serta-merta jika pada bila-bila masa selepas kontrak takaful anda
ditandatangani, diubah atau diperbaharui dengan kami (atau semasa permohonan takaful ini), apa-apa maklumat yang dinyatakan
dalam Borang Permohonan tidak tepat atau sudah berubah.
Bayaran Sebelum Perlindungan (CBC) - sumbangan hendaklah dibayar kepada kami atau pengantara kami yang diiktiraf sebelum
tarikh perlindungan sijil dikuatkuasakan
Tuntutan - jika berlaku kemalangan yang membawa kepada tuntutan, anda hendaklah memberitahu kami dalam masa 30 hari dari tarikh
kemalangan itu berlaku.
Takaful Lain - seseorang itu tidak boleh dilindungi lebih daripada satu sijil Takaful PA Plus.
Nota: Senarai ini tidak menyeluruh. Sila rujuk sijil takaful untuk senarai lengkap terma-terma dan syarat-syarat.
7. Apakah pengecualian-pengecualian utama di bawah sijil ini?
a. Mengambil bahagian dalam sebarang perbuatan yang menyalahi undang-undang, bunuh diri, mencederakan diri sendiri dengan
sengaja atau gila;
b. Dibawah pengaruh alkohol atau dadah;
c. Mengambil bahagian dalam sukan dan aktiviti berbahaya;
d. Mengambil bahagian dalam penerbangan atau lain-lain kegiatan udara selain daripada sebagai seorang penumpang;
e. Mengambil bahagian dalam pekerjaan berbahaya;
f. Menyertai pasukan tentera laut, darat, udara, polis, jabatan bomba atau yang lain-lain;
g. Kehamilan atau kelahiran anak;
h. AIDS atau kehadiran sebarang HIV;
i Keuzuran, penyakit, parasit, bakteria atau jangkitan kuman;
j. Penyakit sedia ada;
k. Peperangan atau risiko tindakan pengganas; atau
l. Kontaminasi radioaktif atau nuklear
Nota: Senarai ini tidak menyeluruh. Sila rujuk sijil takaful untuk senarai penuh pengecualian-pengecualian.
8. Bolehkah saya membatalkan sijil saya?
Anda boleh membatalkan sijil dengan memberi notis bertulis kepada kami. Atas pembatalan tersebut, anda boleh mendapat kembali
sebahagian daripada sumbangan dengan syarat tiada tuntutan telah dibuat sepanjang tempoh takaful.
9. Apa yang perlu saya lakukan jika maklumat perhubungan berubah?
Adalah penting untuk anda memaklumkan kepada kami tentang sebarang perubahan maklumat perhubungan anda bagi memastikan
semua surat-menyurat sampai kepada anda tepat pada masanya.
10. Di manakah saya boleh mendapatkan maklumat lanjut?
Sekiranya anda memerlukan maklumat tambahan tentang takaful kemalangan diri, sila rujuk buku panduan maklumat infoinsurans yang
boleh didapati di semua cawangan kami atau layari laman web www.insuranceinfo.com.my.
Sekiranya anda mempunyai sebarang pertanyaan, sila hubungi kami di:
Etiqa General Takaful Berhad (201701025031)
(Dilesenkan di bawah Akta Perkhidmatan Kewangan Islam 2013 dan dikawalselia oleh Bank Negara Malaysia)
Aras 13, Menara B, Dataran Maybank
No. 1, Jalan Maarof
59000 Kuala Lumpur, Malaysia
Nombor Telefon: +603 2297 3888
Nombor Faksimile: +603 2297 3800
E-mel: info@etiqa.com.my
Laman Web: www.etiqa.com.my
Pusat Perkhidmatan Kumpulan Maybank: 1300 88 6688
11. Lain-lain jenis perlindungan takaful kemalangan diri yang boleh didapati
Sila rujuk kepada cawangan kami untuk jenis perlindungan serupa yang ditawarkan.
NOTA PENTING:
ANDA DINASIHATKAN MERUJUK SKALA MANFAAT UNTUK KEMATIAN DAN HILANG UPAYA DI DALAM SIJIL ANDA. ANDA
MESTI MELANTIK PENAMA DAN MEMASTIKAN PENAMA ANDA MENGETAHUI TENTANG SIJIL TAKAFUL KEMALANGAN DIRI
YANG ANDA SERTAI. ANDA MESTI BACA, FAHAMI KANDUNGAN SIJIL TAKAFUL DAN HUBUNGI KAMI UNTUK MAKLUMAT
LANJUT.
Maklumat yang disediakan di dalam helaian pendedahan ini adalah sah pada 01/03/2020. .
PMG/EGTB/PAPLUS/PDS/BM/DM/2001V1.8
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Helpful Facts on Personal Accident Takaful
Introduction
This is an introductory guide to help you understand how personal accident takaful works. It
gives you some basic information so that you can ask your takaful operator the right questions,
understand the answers and make the right choice before you participate in a takaful plan.
What is personal accident (PA) takaful?
A PA takaful is an annual plan that provides compensation in the event of death, disablement or
injuries arising from an accident. PA takaful is also available for short durations to cover you
should any accident occur during your travel period. Cover for PA takaful is provided in respect
of accidents occurring anywhere in the world, 24 hours a day, subject to the terms and
conditions mentioned in the certificate.
Takaful concept in PA takaful
When you participate in a PA takaful, you contribute a sum of money to a general takaful fund in
the form of participative contribution (tabarru'). Contractually, all participants mutually agree to
help each other, should any of the participants meet with an accident resulting in death,
disablement or injuries.
If you do not make any claim during the period of takaful, at maturity you are entitled to a share
of the surplus in the general takaful fund. The surplus will be shared between you and the
takaful operator under the concept of surplus-sharing at a pre-agreed ratio.
Example: A takaful operator has a total surplus (S) of RM4 million and total general contribution
(GC) of RM10 million. Your contribution (C) for the year is RM500 and the surplus will be shared
between you and the takaful operator at a pre-agreed sharing ratio (PSR) of 50:50. The share of
surplus that you will receive is calculated as follows:
Surplus-sharing ratio = PSR xS
= 50% GC
= 20%
x RM4 million
RM10 million
Surplus attributable to you = Surplus sharing ratio x C
= 20% x RM500
= RM100
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Scope of cover
The basic cover of a PA takaful includes death and disablement arising from accidents. In
addition to the basic cover, takaful operators may also provide coverage on medical expenses,
hospitalisation benefits, corrective surgery and funeral expenses. The scope of cover varies
between takaful operators. You are advised to participate in a plan that meets your
requirements.
You can either participate in a PA takaful for yourself or group plan for your family. Employers
can participate in PA takaful for their employees and in such cases, payment of compensation
to the employees is at the discretion of the employer. Certain PA takaful plans specify the range
of age limits that can be covered.
Exclusions
PA takaful will usually not cover accidents caused by the following events:
war risks
suicide and insanity
self -inflicted injury
influenced by liquor, drugs or narcotics
AIDS/HIV or any other venereal diseases
provoked murder or assault
childbirth, pregnancy or miscarriage
involvement in unlawful activities
hazardous sports
operating or riding a two-wheel motor vehicle
In addition, it is quite common for PA takaful to also exclude persons employed under the
following professions:
police/ military and law enforcement officers
divers
pilots or crew members
aircraft testers
racing drivers
seamen and sea fishermen
professional sports person
Please note that the above may vary between takaful operators.
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Important points to note when participating in PA takaful
Scale of benefits
The scale of benefits refers to the amount of compensation payable by the takaful operator in
the event of death, disablement or injury. You are advised to note the scale of benefits in the
plan as these varies between takaful operators
Multiple coverage
If you have more than one PA takaful or insurance, in the event of your death or disablement,
you or your beneficiary will be entitled to compensation under each plan. However, for certain
losses such as medical expenses where compensation are on reimbursement basis, you will
only be compensated once, based on the actual loss suffered.
Beneficiary
You are advised to nominate a beneficiary and ensure that your beneficiary is aware of the PA
takaful that you have participated.
How do I make a claim?
Death claim
In the event of death, a police report must be made and the takaful operator must be notified as
soon as possible. The claimant will be given a claim form which should be submitted together
with supporting documents required by the takaful operator such as death certificate and burial
permit. If there is no beneficiary nominated, the dependents of the deceased or the executor of
the deceased's estate should provide proof of dependency or letter of administration.
Injury claim
You must notify the takaful operator of the injury in writing within the time frame stipulated in the
PA takaful certificate. You should submit the claim form with supporting documents such as
medical reports and receipts of payment for the hospital expenses to your takaful operator. You
will be compensated for benefits under the plan if the treatment is obtained or diagnosis is made
within the specified time frame from the date of accident.
Do's and don'ts Don't
When applying for takaful plan Leave any question in the Proposal Form
unanswered.
Do Use ticks & dashes to answer the questions
requiring full answers.
Disclose all material facts on the risks to be
covered. Withhold or misrepresent any material fact.
Read the 'Important Notice' on the Proposal Otherwise, the certificate issued will be void,
Form. meaning that the claim can be repudiated.
Answer all questions fully and accurately.
Complete and sign the Proposal Form
yourself.
To ensure your takaful plan remains valid Don't
Do Forget to pay the contribution within the
terms allowed by the takaful operator.
Comply with all the terms, conditions and
endorsements of the certificate.
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BORANG PENAMAAN / NOMINATION FORM
Peserta / Participant : MR AZNI BIN DAUD
No. Sijil / Certificate No : TDA-J2126307-W1
Sila tanda pada salah satu kotak yang berkenaan / Please tick either one of the appropriate box.
Penamaan Baru / New Nomination Membatalkan Penama Sedia ada tanpa Pindaan Butiran Penama Sedia
Penamaan Baru / Delete Existing Nominee Ada / Amendment of Existing
without a New Nomination Nominee Details
Nota-Nota Penting / Important Notes:
1. Borang Penamaan ini perlu dilengkapkan oleh Peserta takaful yang telah mencapai usia 16 tahun di mana orang(-orang) yang
dinamakan di bawah akan menerima manfaat takaful termasuk jumlah terkumpul daripada Dana Pelaburan Peserta sebagai
Wasi atau sebagai Benefisiari (Hibah Bersyarat) atau menyerahkan hak menerima manfaat takaful kepada seseorang (sama
ada orang sebenar atau entiti yang ditubuhkan secara perundangan di bawah Penyerahan Hak Mutlak selepas sijil
dikeluarkan.
This Nomination form is to be completed by the takaful Participant who has attained the age of 16 years, whereby the Person(s) named
below shall receive the takaful benefits including accumulated amount in the Participant Investment Fund as an Executor or Beneficiary
(Conditional Hibah) or assign the takaful benefits to a person (whether a natural person or a juridical entity) under an Absolute
Assignment after the certificate is issued.
2. Penamaan Wasi(-Wasi) atau Benefisiari(-Benefisiari) hanya dibenarkan jika Peserta ialah Orang Dilindungi.
Nomination of Executor(s) or Beneficiary(s) is allowed only if the Participant is the Person Covered.
WASI :
3. Wasi adalah penerima manfaat takaful mengikut peratusan (%) yang dinyatakan dan bertanggungjawab untuk mengagihkan
manfaat takaful tersebut, tertakluk kepada syarat dibawah :
i) Bagi Peserta beragama Islam, Wasi hendaklah membahagikan manfaat takaful seperti yang dinyatakan di bawah Akta
Perkhidmatan Kewangan Islam 2013 menurut Hukum Syarak dan/atau mana-mana undang-undang yang berkaitan; atau
ii) Bagi Peserta Bukan Beragama Islam, Wasi hendaklah membahagikan manfaat takaful mengikut Akta Pembahagian 1958,
Surat Kuasa Mentadbir atau Perintah Probet.
The Executor(s) is the recipient of the takaful benefits according to the percentage (%) indicated and is responsible to distribute the
takaful benefits, subject to condition below:
i) For Muslim Participant, the Executor(s) has to distribute the takaful benefit(s) as specified under the Islamic Financial
Services Act 2013 according to Islamic Law and/or any other applicable laws; or
ii) For Non Muslim Participant, the Executor(s) has to distribute the takaful benefit(s) according to the Distribution Act 1958,
Letter of Administration or Grant of Probate.
4. Pada masa tuntutan, jika mana-mana Wasi telah meninggal dunia, peratusan (%) Wasi yang meninggal dunia akan diagihkan
sama rata antara Wasi yang masih hidup, di mana Wasi yang masih hidup akan bertindak sebagai Wasi untuk mengagihkan
manfaat tersebut.
At the time of claim, if any of the Executor(s) has passed away, the percentage (%) of the deceased Executor(s) will be
distributed equally among the surviving Executor(s), who will then act as Executor(s) to distribute the proceeds.
Benefisiari :
5. Benefisiari(-Benefisiari) berhak menerima manfaat takaful berdasarkan Hibah (Pemberian) Bersyarat. Hibah Bersyarat
mempunyai kesan memindahkan pemilikan manfaat takaful yang kena dibayar kepada Benefisiari(-Benefisiari) setelah Peserta
meninggal dunia dan tidak menjadi sebahagian daripada harta pusaka atau tertakluk kepada hutang Peserta.
Walaubagaimanapun, Hibah Bersyarat adalah pemberian yang boleh dibatalkan oleh Peserta semasa hayat Peserta tersebut.
The Beneficiary(s) is entitled to receive the takaful benefits on the basis of Conditional Hibah (Gift). Conditional Hibah has the
effect of transferring ownership of the takaful benefits payable to the Beneficiary(s) upon the death of the Participant and shall
not form part of the estate of the Participant or be subject to his/her debts. Conditional Hibah is however a revocable gift
which the Participant may revoke during his/her lifetime.
6. Jika Benefisiari di bawah Hibah Bersyarat ini meninggal dunia terlebih dahulu daripada Peserta, bahagian bagi Benefisiari
tersebut akan dibayar kepada estet Peserta setelah Peserta meninggal dunia melainkan Peserta membuat penamaan baru
menggantikan Benefisiari yang telah meninggal dunia tersebut.
If the Beneficiary under Conditional Hibah predeceases the Participant, the share of the deceased Beneficiary, upon the death of the
Participant shall be paid to the estate of the Participant unless the Participant has made a subsequent nomination in place of the
deceased Beneficiary.
BIBZZABBAGUW42
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Penyerahan Hak Mutlak :
7. Berkenaan serahhakan, pemegang serah hak boleh menyerahkan kembali manfaat takaful kepada sesiapapun mengikut
kehendak atau budibicaranya; walau bagaimanapun anda tidak boleh secara sendirian menarik balik atau merombak
serahhakan tersebut dengan melanggar hak-hak pemegang serah hak atau tanpa keizinannya.
In case of assignment, the assignee can reassigned the takaful benefits to anyone according to his/her own will or discretion; however,
you cannot unilaterally revoke or revise the assignment in breach of the assignee's rights or without his/her consent.
8. Penghantaran dan pengendorsan penamaan terkini oleh Syarikat akan menggantikan penamaan sebelumnya.
The latest submission and endorsement of nomination by the Company will supersede any previous nomination made.
Pengakuan & Pemberian Kuasa / Declaration & Authorization:
Saya, Peserta seperti nama di atas dengan ini bersetuju sekiranya saya meninggal dunia kesemua manfaat takaful yang kena
dibayar tertakluk kepada terma-terma dan syarat-syarat Sijil akan dibayar kepada Benefisiari(-Benefisiari) berdasarkan Hibah
Bersyarat atau Wasi(-Wasi) yang dinamakan di bawah ini. Bayaran kepada Benefisiari(-Benefisiari) atau Wasi(-Wasi) yang
dinamakan di bawah ini akan membebaskan Etiqa General Takaful Berhad dari segala tanggungjawab dan liabiliti di bawah sijil
tersebut.
I, the above named Participant do hereby agree that in the event of my death all takaful benefits payable under the terms and conditions
of the Certificate be paid to the Beneficiary(s) on the basis of Conditional Hibah or Executor(s) named below. Payment to the
Beneficiary(s) named herein shall discharge Etiqa General Takaful Berhad from all obligations and liabilities under the Certificate.
Sila tanda pada salah satu Jenis Penamaan yang berkenaan. Jenis Penamaan yang dipilih akan digunapakai kepada semua
penama-penama yang dilantik. Jika Penyerahan Hak Mutlak dipilih sila isi borang C /
Please tick either one of the Nomination type below. The selected Nomination Type will be applied to all the appointed nominee(s).
If Absolute Assignment is chosen please fill up another form which is form C
Benefisiari Di Bawah Hibah Bersyarat / Wasi / Penyerahan Hak Mutlak /
Beneficiary Under Conditional Hibah Executor Absolute Assignment
Butiran Penama / Nominee Details Penama II / Nominee II Penama III / Nominee III
Penama I / Nominee I
Nama* / Name*
Jantina* / Gender*
Jenis Pengenalan Diri* /
ID Description*
Nombor ID* / ID Number*
(KP lama/ Sijil Kelahiran/
KP Tentera/ KP Polis/
Pasport) /
(Old IC/ Birth Certificate/
army ID/ Police ID/
Passport)*
No K.P. Baru (jika ada)*/
New IC Number (if any)*
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Butiran Penama / Nominee Details Penama II / Nominee II Penama III / Nominee III
Penama I / Nominee I
Tarikh Lahir* /
Date of Birth*
Umur / Age
Kerakyatan* /
Nationality*
Pekerjaan* /
Occupation*
(Nyatakan tugas
sebenar) /
State the exact duties
Nama Majikan* /
Name of Employer*
Jenis Perniagaan, jika
bekerja sendiri* /
Nature of Business if
self employed*
Hubungan dengan
Peserta* / Relationship
with Participant*
Nombor Akaun Semasa /
Simpanan / Current or
saving account number
Nama Bank / Bank's name
Bahagian (%) / Share(%)
Alamat Surat Menyurat* /
Mailing Address*
Alamat Kediaman* Rumah/House: Rumah/House: Rumah/House:
(jika berbeza dengan Pejabat/Office : Pejabat/Office : Pejabat/Office :
Alamat Surat Menyurat) / Bimbit/Handphone : Bimbit/Handphone : Bimbit/Handphone :
Residential Address (if
different form mailing
address)*
Nombor Telefon* /
Contact Number*
Personal Accident General TakafulETBNF1312V00 Muka Surat 3 dari 4
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Butiran Penama / Nominee Details Penama II / Nominee II Penama III / Nominee III
Penama I / Nominee I
Sebab Perlantikan /
Purpose of Nomination*
Nota / Notes:
- * Ruang wajib diisikan / Mandatory fields to be filled.
- Serahan salinan Kad Pengenalan Wasi atau benefisiari / Pasport adalah digalakkan /
Submission of a copy of the executor or beneficiary's IC/Passport is encouraged
Tarikh / Date Tandatangan Peserta / Signature of Participant
Tandatangan Saksi** / Signature of Witness Nama / Name:
Nama / Name: No KP / IC:
No KP / IC:
Alamat / Alamat /
Address: Address:
No Tel / Tel No: No Tel / Tel No:
Nota / Note:
- **Saksi hendaklah telah mencapai usia 18 tahun, berfikiran waras dan bukan seorang wasi atau benefisiari yang dinamakan./
Witness must be at least 18 years of age, of sound mind and cannot be named as an executor or beneficiary.
- Dokumen ini disediakan mengikut Akta Perkhidmatan Kewangan Islam 2013./
This document is prepared in accordance with Islamic Financial Services Act 2013.
Akta Perlindungan Data Peribadi 2010 telah dikuatkuasakan pada 15 November 2013. Sila baca Notis Privasi kami yang boleh
didapati dengan melayari http://www.etiqa.com.my atau di mana-mana cawangan kami untuk keterangan lanjut bagaimana
kami memproses/melindungi data peribadi anda.
The Personal Data Protection Act 2010 has been enforced on 15 November 2013. Please read our Privacy Notice which can be
found at http://www.etiqa.com.my or at any our branches for details on how we process/protect your personal data.
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Hasil Setem
Stamp Duty
RM 10
BORANG C : BORANG PENYERAHAN HAK MUTLAK
FORM C : ABSOLUTE ASSIGNMENT FORM
Saya, ....................................................................................................... (No. K/P: ............................................) dari
.............................................................................................................................................. (selepas dari ini dirujuki
sebagai "Penyerah Hak") sebagai pemunya sijil, dalam hal pemberian ganjaran dengan wang berjumlah RM10-00
yang dibayar pada hari ini oleh ........................................................................................................................ yang
beralamat di ..................................................................................................................................................................
(selepas dari ini dirujuki sebagai "Pemegang Serah Hak") dengan ini, menyerahkan dan memindahkan kepada
Pemegang Serah Hak secara mutlak, semua hak, hak milik dan kepentingan saya yang terkandung dalam No. Sijil
......................................................... yang dikeluarkan oleh Etiqa General Takaful Berhad, memberi perlindungan
kemalangan diri kepada ..................................................................... bertarikh pada .................................
termasuklah segala nilai, bonus dan opsyen daripadanya, dan saya mengakui bahawa pembayaran kepada
Pemegang Serah Hak segala wang sijil dan / atau segala manfaatnya akan melepaskan Etiqa General Takaful
Berhad sepenuhnya daripada segala liabiliti dan segala tanggungjawab di bawah sijil tersebut.
I ................................................................................................................. (I/C NO ............................................... ) Of
..................................................................................................................................................... (hereinafter referred
to as "the Assignor") as Participant, in consideration of the sum of RM10-00 this day paid by
....................................................................... of ...........................................................................................................
.............................................................................(hereinafter called "the Assignee") do hereby assign and transfer
to the Assignee absolutely all my rights, title and interest in and under the Certificate No
.................................................................................... issued by Etiqa General Takaful Berhad, providing personal
accident cover to ............................................................... dated ......................................... inclusive of all values,
bonuses and options thereof, and I declare that payment to the Assignee of certificate moneys and/or benefits shall
fully discharge Etiqa General Takaful Berhad from its liabilities and obligations under the certificate.
Saya juga mengakui bahawa ini adalah penyerahan hak saya yang pertama dan saya belum pernah membuat
apa-apa penyerahan hak akan sijil ini sebelum dari tarikh ini.
I also declare that this is the first assignment made and I have not made any assignment prior to the date hereof in
respect of this certificate.
Butiran Pemegang Serah Hak / Assignee Details
Nama* / Name*
Jantina */ Gender*
Jenis Pengenalan Diri* /
ID Description *
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Nombor ID*
(KP lama/ KP Tentera/
KP Polis/ Pasport) /
ID Number*
(Old I.C. / Army ID /
Police ID / Passport)
No K.P. Baru (jika ada)*/
New I.C. Number (if any)*
Tarikh Lahir*/
Date of Birth*
Umur / Age
Kerakyatan*/ Nationality
Pekerjaan*
(Nyatakan tugas sebenar) /
Occupation*
(State the exact duty)
Nama Majikan* /
Name of Employer
Jenis Perniagaan, jika
bekerja sendiri* /
Nature of business, if
self employed
No. Syarikat* /
Company No
Alamat Surat Menyurat* / Rumah / House:
Mailing Address Pejabat / Office:
Bimbit / Mobile:
Alamat Kediaman*
(jika berbeza dengan
Alamat Surat Menyurat) /
Residential Address*
(if different from Mailing
Address)
Nombor Telefon* /
Contact Number
Sebab Penyerahan Hak* /
Reason for Assignment
Nota:
- * Ruang wajib diisikan.
- Serahan salinan Kad Pengenalan / Pasport benefisiari adalah digalakkan.
- Jika Pemegang Serah Hak merupakan suatu Perbadanan dan bukan orang sebenar, butiran wajib diisikan adalah
Nama, No. Syarikat, Alamat Surat Menyurat, Nombor Telefon dan Sebab Penyerahan Hak.
Note:
- * Mandatory fields to be filled.
- Submission of a copy of the assignee's IC / Passport is COMPULSORY.
- If the assignee is a Corporation and not a natural person, the mandatory details to be completed are Name, Company No.,
Mailing Address, Contact Number and Reason for Assignment.
PSG/EGTB/FORMCAA/1802V1.0 Muka Surat 2 of 4
9225-374196
BAGI MENYAKSIKAN DARIPADANYA, Saya dan Pemegang Serah Hak menurunkan tandatangan di dalam dokumen ini, yang
bertarikh pada ................................ haribulan .............................. tahun ............................
IN WITNESS WHEREOF, I and the Assignee have hereunto set our hands this ..................... day of ...................... year ...............
................................................................ ................................................................
Tandatangan Saksi / Tandatangan Penyerah Hak /
Signature of Witness Signature of Assignor
Nama Penuh / ................................................. Nama Penuh / .................................................
Full name Full name .................................................
.................................................
No. K.P / ................................................. No. K.P / .................................................
NRIC No. NRIC No.
Alamat / ................................................. Alamat /
Address ................................................. Address
................................................................ ................................................................
Tandatangan Saksi / Tandatangan Pemegang Serah Hak /
Signature of Witness Signature of Assignee
Nama Penuh / ................................................. Nama Penuh / .................................................
Full name Full name
No. K.P / ................................................. No. K.P./ Syarikat / .................................................
NRIC No. NRIC No /Company No
Alamat / ................................................. Hubungan dengan .................................................
Address
Penyerah Hak/
................................................. Relationship to Assignor
**Dengan ini saya mempersetujui penyerahan hak di atas
** Hereby, I agree with the above Absolute Assignment
................................................................ ................................................................
Tandatangan Saksi / Tandatangan Ibu bapa / Penjaga /
Signature of Witness Signature Parent / Guardian
Nama Penuh / ................................................. Nama Penuh / .................................................
Full name Full name .................................................
.................................................
No. K.P / ................................................. No. K.P / .................................................
NRIC No. NRIC No.
Alamat / ................................................. Alamat /
Address Address
.................................................
PSG/EGTB/FORMCAA/1802V1.0 Muka Surat 3 of 4
9225-374197
Penyerahan Hak ini telah didaftarkan pada hari ini di Ibu Pejabat Etiqa General Takaful Berhad./
This Assignment has this day been filed at Head Office of Etiqa General Takaful Berhad
Tarikh / Date : ......................................................... ................................................................
Penandatangan yang dibenarkan /
Authorized Signatory
Nota:
- ** Seseorang Penyerah Hak yang masih belum dewasa dan telah mencapai umur 10 tahun tetapi belum mencapai umur
16 tahun boleh menyerah hak akan satu-satu sijil kemalangan dengan persetujuan ibubapanya/penjaganya.
- Dokumen ini perlu dimanterai setemnya seperti yang ditetapkan oleh Undang-Undang Setem Duti di negara tempat sijil
dikeluarkan.
- Borang ini dikeluarkan oleh Etiqa General Takaful Berhad atas budi bicara, namun Syarikat tidak bertanggungjawab atas
kesahihan atau kebenaran Penyerahan Hak tersebut, atau kesannya ke atas hak pihak-pihak yang terlibat.
Note:
- ** An Assignor who is minor and who has attained the age of 10 years but not attained 16 years of age may assign a
personal accident certificate with the consent of his/her parent/guardian.
- This document requires to be stamped in accordance with the Stamp Duty Laws of the country in which it is executed.
- This form is furnished by Etiqa General Takaful Berhad as a matter of courtesy, but the Company accepts no responsibility
for the validity of this assignment, nor for its effect on the rights of the parties to it.
Akta Perlindungan Data Peribadi 2010 telah dikuatkuasakan pada 15 November 2013. Sila baca Notis Privasi kami yang boleh
didapati dengan melayari http://www.etiqa.com.my atau di mana-mana cawangan kami untuk keterangan lanjut bagaimana
kami memproses/melindungi data peribadi anda.
The Personal Data Protection Act 2010 has been enforced on 15 November 2013. Please read our Privacy Notice which can be
found at http://www.etiqa.com.my or at any our branches for details on how we process/protect your personal data.
PSG/EGTB/FORMCAA/1802V1.0 Muka Surat 4 of 4
9225-374198
Sila lampirkan Jadual Sijil
Please affix the Certificate Schedule
TAKAFUL PA PLUS
TAKAFUL PRIVILEGE PA
Dokumen Penting .Sila Simpan di tempat yang selamat
Ini Sijil anda. Sila baca dengan teliti dan simpan bersama-sama dengan dokumen .dokumen yang
berkaitan dengan Sijil ini di tempat yang selamat supaya mudah dirujuk apabila perlu
Important Documents .Please keep in a safe place
This is your Certificate. Please read it carefully and keep it in a safe place with all other documents
concerning to this Certificate for easy refrence in the future.
9225-374199
PENDAHULUAN
Takaful adalah suatu skim saling bantu membantu berlandaskan semangat persaudaraan dan perpaduan di mana Peserta
seperti Anda sepakat untuk membantu satu sama lain secara kewangan sekiranya berlaku keperluan tertentu seperti yang telah
ditetapkan. Dengan niat sedemikian, Peserta membayar Sumbangan Takaful berasaskan Tabarru. (pemberian) kepada Dana
Takaful Am (Dana) yang dikendalikan oleh Etiqa General Takaful Berhad (Pengendali Takaful).
Sebagai Pengendali Takaful, Kami bertanggungjawab untuk memilih Peserta, menentu dan memungut Sumbangan Takaful.
Kami juga bertanggungjawab untuk melaburkan Dana & membayar Manfaat Takaful kepada Peserta yang berhak. Semua
perolehan dari pelaburan akan dikreditkan ke dalam Dana tersebut. Perhubungan antara Anda dan Kami adalah berlandaskan
kontrak Wakalah.
Peserta bersetuju untuk mengambil bahagian dalam skim Takaful Am ini berdasarkan prinsip Takaful dan membayar
sumbangan atas dasar Tabarru' bagi tujuan membantu setiap peserta lain yang telah mengalami musibah dan dengan
sumbangan ini, Peserta berhak terhadap perlindungan Takaful seperti yang dinyatakan dalam terma-terma & syarat-syarat
kontrak Takaful ini.
Lebihan dari Dana akan ditentukan setiap tahun. Pengagihan, sekiranya ada, diperuntukkan bagi peruntukan luar jangka, dan
tertakluk kepada dasar lebihan yang diluluskan oleh Jawatankuasa Syariah Kami. Lebihan yang boleh diagih, sekiranya ada,
lima puluh peratus (50%) daripadanya dibayar kepada Kami sebagai Fi prestasi kerana bertanggungjawab dalam mengendalikan
dan menguruskan Dana, manakala baki 50% akan diperuntukkan kepada para Peserta yang Sijil belum ditamatkan dan tidak
membuat sebarang tuntutan dalam tahun kewangan tersebut. Sekiranya berlaku apa-apa defisit daripada Dana, tidak akan ada
pengagihan lebihan bagi tahun kewangan tersebut. Dalam keadaan sedemikian, defisit akan dibiayai oleh jumlah yang
diperuntukkan bagi tujuan luar jangka. Sekiranya Dana ini masih defisit, Qard dari Dana Pemegang Saham akan diaturkan.
Qard akan dibawa ke tahun kewangan yang berikutnya dan sebarang lebihan yang diperolehi selepas itu akan digunakan untuk
membayar semula Qard. Sekiranya lebihan kurang daripada Ringgit Malaysia Sepuluh (RM10), Kami akan mengkreditkan jumlah
wang itu ke dalam tabung kebajikan yang akan digunakan sebagai Amal Jariah bagi pihak Peserta. Dana amal akan diagihkan
kepada badan-badan kebajikan yang berdaftar.
Permohonan Anda untuk menyertai Skim Takaful ini sebagai Peserta telah Kami terima berdasarkan Permohonan yang Anda
telah tandatangani berserta segala maklumat yang diberikan kepada Kami. Jika Anda tidak mengisi Borang Permohonan,
penerimaan Kami adalah berdasarkan pernyataan fakta dan apa-apa maklumat yang Anda berikan kepada Kami. Sebagai
Peserta, Anda akan menerima perlindungan Takaful sekiranya berlaku kematian, hilang upaya menyeluruh dan kekal yang
mungkin berlaku dalam Tempoh Takaful tertakluk kepada peraturan dan syarat kontrak Takaful ini.
Kontrak Takaful Anda terdiri daripada Borang Permohonan, Sijil ini dan Jadual. Anda harus menelitinya untuk menentukan ianya
menepati perlindungan yang Anda perlukan.
Terima kasih kerana memilih Skim Takaful ini yang dikendalikan oleh Etiqa General Takaful Berhad.
Ketua Pegawai Eksekutif
INTRODUCTION
Takaful is a mutual assistance scheme based on the spirit of brotherhood and solidarity where Participants like You agree to
assist each other financially in case of certain defined need. With this intention in mind, Participants pay their Contributions on the
basis of Tabarru.(donation) to the General Takaful Fund (Fund) managed by Etiqa General Takaful Berhad (Takaful Operator).
As the Takaful Operator, We are responsible for selecting Participants and to determine and collect the Contributions. We are
also responsible for investing the Fund and paying Benefits to entitled Participants. All proceeds from investments will be credited
into the Fund. The relationship between You and Us is governed by the Wakalah contract.
The Participant agrees to participate in this general Takaful scheme based on the principle of Takaful and to pay the Contribution
on the basis of Tabarru.for the purpose of helping each other participants who have suffered tragedy and with this Contribution,
The Participant is entitled to the Takaful cover as expressed in the terms and conditions of this Takaful contract.
The surplus from the Fund will be determined annually. The distribution, if any, makes allowance for contingency provisions, and
is subject to the surplus Certificate approved by Our Shariah Committee. The distributable surplus, if any, is fifty percent (50%)
paid to Us as a performance fee for operating and managing the Fund, and the remaining fifty percent (50%) is shared between
Participants whose Certificates have not terminated and who have not made any claim within the financial year. In the event of
any deficit from the Fund, there will be no surplus distribution for that financial year. Under such circumstance, the deficit will be
first funded by the amount allocated for contingency purposes. If the Fund is still in deficit, a Qard from the Shareholder's Fund
will be arranged. The Qard will be carried forward to the following financial year and any surplus emerging thereafter will
be used to pay off the Qard. If the surplus is less than Ringgit Malaysia Ten (RM10), We shall credit such sum into a charitable
fund, which will be utilized as Amal Jariah on behalf of the Participants. The charitable fund will be distributed to registered
charitable organizations.
Your application to join this Takaful Scheme as a Participant has been accepted based on the application You signed and any
other information provided to Us. If You did not fill in the Application Form, Our acceptance is based on the statement of fact and
on any other information You gave Us. As a Participant, You will receive Takaful cover for death or Total Permanent Disability
that may happen to You during the Period of Takaful according to the terms and conditions of this Takaful contract.
This Takaful contract is made up of the Application Form, this Certificate and Schedule. You should read them together carefully
to make sure that You get the cover You need.
Thank you for choosing this Takaful Scheme managed by Etiqa General Takaful Berhad.
Chief Executive Officer
1 PMG/EGTB/CW/PPAPPADUAL/1808v1.6
9225-374200
SIJIL TAKAFUL PA PLUS DAN TAKAFUL PRIVILEGE PA BAYARAN MANFAAT
1. Sijil ini, Jadual dan Endorsemen, sekiranya ada, adalah Jumlah nilai Manfaat adalah seperti yang dinyatakan di bawah:
bukti kepada perjanjian di antara Anda (Orang Yang 1. Manfaat Ketidakupayaan Kekal
Dilindungi) dengan pihak Kami. Permohonan yang dibuat
kepada Kami, dan maklumat penting seperti didedahkan Manfaat Takaful Takaful
kepada Kami berkaitan dengan Takaful ini hendaklah PA Plus Privilege PA
menjadi sebahagian daripada kontrak ini.
(RM) (RM)
2. Jika Anda gagal mendedahkan kepada Kami secara
penuh dan tepat, semua fakta yang Anda tahu atau a) Lumpuh sepenuhnya, 150,000 300,000
sepatutnya tahu, atau jika Anda salah nyata mana-mana
fakta penting kepada Kami sebelum Sijil dimulakan, Kami hilang akal sama sekali atau
boleh mengetepikan Sijil ini.
kecederaan yang
3. Jika anda dikehendaki oleh Kami, sebelum Sijil ini
diperbaharui atau diubah, untuk menjawab apa-apa soalan menyebabkan terlantar kekal
atau jika Anda diminta untuk mengesahkan atau meminda
apa-apa perkara yang telah dinyatakan oleh Anda kepada b) Pendapatan Ketidakupayaan 40,000 80,000
Kami berhubung dengan Sijil ini, adalah menjadi
tanggungjawab Anda untuk mengambil langkah yang c) Manfaat Pemulihan 10,000 20,000
sewajarnya dan tidak membuat salahnyataan apabila
menjawab soalan-soalan atau mengesahkan atau Manfaat Berbayar Maksima 200,000 400,000
meminda apa-apa perkara yang telah dinyatakan. Lumpuh Sepenuhnya
4. Anda dikehendaki secara berterusan mendedahkan Manfaat 1b & 1c di atas hanya
sehingga mana Sijil ini dibuat, diubah atau diperbaharui. akan dibayar bersama Manfaat
1a sekali gus, contohnya jika
PERLINDUNGAN berlaku Lumpuh. Sepenuhnya,
hilang akal sama sekali atau
Dalam tempoh Takaful ini, pihak kami membayar Manfaat kecederaan yang menyebabkan
yang telah ditetapkan jika Anda mengalami Kecederaan terlantar kekal.
Anggota Badan yang mengakibatkan Ketidakupayaan Kekal,
Kematian atau Penghospitalan dalam tempoh 52 minggu dari 2. Manfaat Ketidakupayaan Kekal yang Lain
masa kemalangan berlaku dengan syarat Anda telah
menjelaskan Sumbangan dan pihak kami bersetuju Manfaat Takaful Takaful
menerimanya. PA Plus Privilege PA
Kecederaan Badan bermaksud kecederaan badan yang (RM) (RM)
dialami oleh Anda semasa Tempoh Takaful yang disebabkan
semata-mata dan secara langsung daripada Kemalangan. Ini a) Hilang daya penglihatan kekal 150,000 300,000
tidak termasuk apa-apa keuzuran, penyakit, parasit, bakteria, sepenuhnya kedua-dua mata
jangkitan parasit atau virus walaupun dijangkiti daripada atau hilang upaya kekal
Kemalangan, atau apa-apa keadaan yang berlaku secara sepenuhnya pada kedua-dua
semula jadi atau proses hilang upaya atau disebabkan oleh belah tangan atau kaki atapun
sebarang punca yang berlaku secara berperingkat. kedua-duanya sekali.
PEMBAYARAN SUMBANGAN b) Hilang Daya Pertuturan Kekal 150,000 300,000
Sepenuhnya 150,000 300,000
Adalah asas dan syarat keistimewaan mutlak bagi kontrak 75,000 150,000
Takaful ini bahawa sumbangan penuh perlu dibayar dan c) Hilang Daya Pendengaran
diterima oleh pihak Kami sebelum perlindungan Takaful di Kekal Sepenuhnya bagi
bawah Sijil ini, Endorsemen atau Pembaharuan, akan kedua-dua belah telinga.
bermula. Jika syarat ini tidak dipatuhi, Sijil ini akan secara
automatik terbatal dan tidak sah. Tertakluk selainnya kepada d) Hilang Daya Penglihatan
terma-terma dan syarat-syarat Sijil ini. Kekal Sepenuhnya sebelah
mata atau hilang upaya kekal
a) Bayaran Sumbangan Bulanan sepenuhnya pada sebelah
Bayaran sumbangan bulanan bermaksud salah satu dari tangan atau kaki.
siri bayaran bulanan yang berterusan, di mana bayaran
pertama hendaklah dibuat pada atau sebelum Tarikh e) Hilang Daya Pendengaran 30,000 60,000
Takaful Berkuatkuasa sebagaimana tercatat di dalam Kekal Sepenuhnya bagi sebelah 22,500 45,000
Jadual & bayaran untuk bulanbulan yang berikutnya akan telinga.
dibuat pada setiap bulan sesudah itu. Bayaran
Sumbangan akan didebit terus ke akaun Anda apabila tiba f) Hilang upaya kekal
masanya. Sijil ini secara automatik akan dilanjutkan sepenuhnya penggunaan bahu,
secara bulanan tertakluk kepada bayaran Sumbangan. siku, pinggul, lutut, pergelangan
Tiada dokumen selanjutnya akan dikeluarkan tangan atau pergelangan kaki.
sebagaimana Jadual menunjukkan tiada tarikh tamat.
g) Hilang Keupayaan Kekal 22,500 45,000
a) Bayaran Sumbangan Bulanan Sepenuhnya atau kehilangan 15,000 30,000
Bayaran Sumbangan tahunan bermaksud salah satu dari anggota akibat dikudungkan 7,500 15,000
siri bayaran tahunan yang berterusan, di mana bayaran bagi: 3,000 6,000
pertama hendaklah dibuat pada atau sebelum Tarikh
Takaful Berkuatkuasa sebagaimana tercatat di dalam i) Satu ibu jari tangan
Jadual & bayaran berikutnya akan dibuat pada setiap ii) Satu jari telunjuk
tahun sesudah itu. Bayaran Sumbangan akan didebit iii) Salah satu jari tangan yang
terus ke akaun Anda apabila tiba masanya. Sijil ini lain atau satu ibu jari kaki
diperbaharui secara tahunan. Kami berhak untuk iv) salah satu jari kaki yang lain.
memperbaharui, membatalkan atau meminda ke atas
pembaharuan tahunan Sijil ini. Tiada dokumen selanjutnya Sekiranya Ketidakupayaan Kekal yang dialami tidak seperti yang
akan dikeluarkan sebagaimana Jadual menunjukkan tiada dinyatakan, jumlah Manfaat akan ditentukan mengikut kadar
tarikh tamat. Kehilangan Keupayaan Kekal yang dialami dengan jadual di atas.
2 PMG/EGTB/CW/PPAPPADUAL/1808v1.6
9225-374201
3. Manfaat Kematian
Takaful Takaful Pembayaran balik kos sebenar
PA Plus Privilege PA
Manfaat untuk rawatan di hospital atau
(RM) (RM)
a) Kemalangan Maut 300,000 klinik yang berdaftar akibat
100,000 150,000
i) Individu -. ketika menaiki kemalangan. (sehingga had
kenderaan awam atau 50,000 6,000
kemalangan sewaktu berada di maksima seperti yang
luar Negara Malaysia, Brunei & 6,000
Singapura. dinyatakan termasuk kos
ii) Individu -. ketika menaiki laporan perubatan).
kenderaan awam atau
kemalangan sewaktu berada di b) Manfaat Tunai Hospital 100 sehari 200 sehari
dalam Malaysia, Brunei &
Singapura. Jika berlaku Manfaat bagi setiap hari untuk
kematian yang disebabkan kemasukan ke hospital dengan
oleh kemalangan, pihak kami bayaran maksima sehingga 100
hanya akan membayar salah hari disebabkan oleh
satu daripada Manfaat di atas kemalangan.
iaitu Manfaat 3a(i) atau 3a(ii),
mana yang berkaitan. 6. Fi Ambulans (bagi setiap kemalangan)
Manfaat Takaful Takaful
PA Plus Privilege PA
Pembayaran balik fi sebenar
(RM) (RM)
b) Tunai Belas Kasihan 2,000 (sehingga had maksima seperti
Sehingga Sehingga
Bayaran sekaligus kepada yang dinyatakan) untuk 200 500
keluarga jika berlaku kematian
akibat kemalangan. perkhidmatan ambulans,
tertakluk kepada penyerahan
resit asal.
c) Manfaat Penghantaran 3,000 Manfaat Untuk Anak-Anak Yang Layak
Pulang Jenazah Kesemua Manfaat bagi setiap anak adalah 25% daripada jumlah
yang dinyatakan.
Bayaran sekali gus untuk
membawa balik jenazah Umur
Peserta dari tempat berlaku
kematian di luar Negara Tiada Peserta akan dilindungi di bawah Sijil ini telah mencapai
disebabkan oleh kemalangan, umur 70 tahun. Perlindungan Takaful yang diberi oleh Sijil ini
ke Negara asal akan ditamatkan apabila Orang Yang Dilindungi sudah mencapai
(Malaysia,Brunei/ Singapura). umur tujuh puluh (70) tahun.
4. Manfaat Rawatan Pesakit Luar (bagi setiap kemalangan)
Manfaat Takaful Takaful PERUNTUKAN
PA Plus Privilege PA
a) Kos Rawatan 1. Jika Manfaat yang dituntut untuk;
i) Manfaat Tunai Pesakit Luar (RM) (RM)
Bayaran sekaligus tanpa 100 100 a) Hilang Keupayaan Kekal Sepenuhnya bagi salah satu
mengambil kira jumlah yang anggota kaki atau tangan maka tiada Manfaat lain yang
tercatit di resit, untuk rawatan Tidak 400 boleh dituntut untuk bahagian-bahagian lain anggota kaki
kecemasan di klinik/hospital Dilindungi atau tangan tersebut; atau
yang berdaftar. 300
150 b) Hilang Keupayaan bagi anggota kaki atau tangan atau
ii) Manfaat Pembayaran Balik kehilangan penggunaan bahagian salah satu anggota
Kos Rawatan Pesakit Luar tersebut, maka jumlah Manfaat yang akan dibayar tidak
akan melebihi Manfaat yang akan dibayar untuk Hilang
Sekiranya kos rawatan Keupayaan Kekal bagi keseluruhan anggota kaki & tangan
kecemasan di hospital/klinik berkenaan.
yang berdaftar itu melebihi
jumlah Manfaat yang dibayar 2. Jika Manfaat yang dituntut lebih daripada satu jenis Hilang
di atas a(i), kami akan Keupayaan Kekal akibat sesuatu kemalangan, maka pihak
membayar balik jumlah Kami tidak akan membayar melebihi daripada Manfaat bagi
tambahan sehingga had lumpuh sepenuhnya atau kecederaan yang menyebabkan
maksima seperti yang terlantar kekal.
dinyatakan.
3. Sebelum pihak Kami membayar Manfaat Hilang Keupayaan
b) Manfaat Kecederaan Ragut Kekal bagi Butiran 1a di dalam Jadual Bayaran Manfaat yakni
Bayaran sekaligus ke atas lumpuh sepenuhnya atau kecederaan yang menyebabkan
kecederaan tubuh badan terlantar kekal, ia mestilah dialami selama 52 minggu dan
yang disebabkan oleh pihak kami berpuas hati bahawa Hilang Keupayaan itu
kejadian ragut (berserta berkekalan dan tidak ada harapan untuk dipulihkan.
laporan polis). Walau bagaimanapun, jika pihak Kami berpuas hati bahawa
lumpuh sepenuhnya atau kecederaan yang menyebabkan
5. Manfaat perubatan Hospital (bagi setiap kemalangan) kekal terlantar sakit pihak Kami akan menggunakan budi
bicara untuk membayar Manfaat tersebut sebelum tamat
Manfaat Takaful Takaful tempoh 52 minggu.
PA Plus Privilege PA
a) Manfaat Pembayaran Balik 4. Pihak Kami tidak akan membayar kedua-dua Manfaat Hilang
Kos Rawatan (RM) (RM) Keupayaan Kekal dan Kematian ke atas Peserta akibat
daripada kemalangan yang sama.
Sehingga Sehingga
1,000 4,500 5. Kadangkala kesan penuh akibat kemalangan tidak begitu
ketara pada waktu kemalangan walaupun Hilang Keupayaan
Kekal boleh berlaku semasa kemalangan dan oleh kerana itu
pihak Kami perlu menunggu bagi satu jangka masa yang
bersesuaian untuk memastikan kesan penuh kecederaan
yang sebenarnya.
3 PMG/EGTB/CW/PPAPPADUAL/1808v1.6
9225-374202
PERUNTUKAN AM Kami akan membayar Manfaat kematian di bawah kontrak
Takaful ini dengan syarat bahawa orang yang akan dibayar ini
Syarat-Syarat Tuntutan perlu menandatangani aku janji untuk memulangkan wang yang
telah dibayar kepada Kami jika Orang Yang Dilindungi ini
a) Pemberitahuan Kemalangan kemudiannya didapati masih hidup.
Semua tuntutan mestilah dibuat sendiri/menerusi wakil Anda/ Tanggungjawab dan Hak Terhadap Data Perlindungan
waris yang sah di sisi undang-undang secara bertulis kepada
Kami dalam masa tiga puluh (30) hari tentang apa-apa Kami berhak untuk memproses Data Peribadi menurut Seksyen 4
Kematian atau Kecederaan yang mungkin mengakibatkan Akta Perlindungan Data Peribadi 2010. Kami juga berhak untuk
tuntutan di bawah Sijil ini. mendedahkan Data Peribadi yang telah diberikan oleh Anda
sebagaimana yang dituntut berdasarkan konteks, kepada:
b) Dokumen
a) Etiqa General Insurance Berhad, Etiqa General Takaful
Semua laporan perubatan, Sijil, maklumat dan bukti-bukti Berhad, Etiqa Life International (L) Ltd atau Etiqa Offshore
yang diperlukan oleh Kami untuk menyokong tuntutan Insurance (L) Ltd.;
mestilah dikemukakan atas tanggungan Anda atau
mana-mana pihak yang menuntut sekiranya berlaku kematian b) Entiti-entiti lain dalam Kumpulan Maybank;
Orang Yang Dilindungi. Jika Kami memerlukan Orang Yang
Dilindungi untuk menjalani pemeriksaan lanjutan, kos tersebut c) Ejen-ejen dan penyedia perkhidmatan Kami yang diberi kuasa
akan ditanggung oleh Kami. Sekiranya berlaku kematian yang dengannya Kami telah mengikat perjanjian kontrak untuk
Orang Yang Dilindungi, Kami memerlukan sijil kematian beberapa fungsi, perkhidmatan dan aktiviti Kami;
sebagai bukti dan mungkin memerlukan pemeriksaan bedah
siasat dibuat atas tanggungan Anda. d) Syarikat insurans atau pengendali takaful lain dan wakil
pengedar (contohnya, bank, bank-bank Islam, broker
Tuntutan adalah dianggap sebagai tidak lengkap dan Manfaat insurans, broker takaful, syarikat insurans semula dan
yang layak tidak akan dibayar melainkan jika laporan pengendali takaful semula);
perubatan, sijil, maklumat dan bukti-bukti untuk tuntutan
tersebut telah dikemukakan dan dipersetujui oleh Kami. Untuk e) Pertubuhan Perdagangan industri seperti Persatuan Insurans
sebarang tuntutan berkenaan dengan bayaran balik Hayat Malaysia (LIAM), Persatuan Insurans Am Malaysia
perubatan, hanya kos sebenar yang ditanggung akan (PIAM) dan Persatuan Takaful Malaysia (MTA);
dipertimbangkan untuk pembayaran balik yang mana tertakluk
kepada pengemukaan resit asal. f) Pedagang dan rakan kongsi strategik Kami;
c) Penyelesaian Tuntutan g) Mana-mana pihak yang diberi kuasa oleh Anda (dari semasa
ke semasa); atau
i) Kami akan membayar apa-apa Manfaat di bawah Sijil ini
kepada Anda, atau waris Anda sekiranya berlaku kematian h) Penguatkuasaan peraturan dan agensi-agensi kerajaan yang
terhadap Anda mengikut Akta Perkhidmatan Kewangan dibenarkan atau dikehendaki oleh undang-undang, yang diberi
Islam 2013. kuasa oleh mana-mana perintah mahkamah atau untuk
memenuhi kewajiban kepada pihak berkuasa.
ii) Bayaran tuntutan di bawah Sijil ini adalah bergantung
kepada pematuhan terma dan syarat oleh Anda, dan Anda perlu memastikan semua Data Peribadi dikemaskini
setakat mana ia dikenakan, oleh Orang Yang Dilindungi kepada Kami pada kadar segera.
atau mana-mana pihak menuntut.
Kami tidak akan bertanggungjawab terhadap sebarang
Pekerjaan Pentadbiran/Perlindungan Diluar Waktu Bekerja kehilangan atau kerosakan secara langsung atau tidak langsung
terhadap Data Peribadi yang tidak tepat atau tidak lengkap yang
Sekiranya Anda terlibat dalam mana-mana pekerjaan yang diberikan kepada Kami.
dikecualikan yang dinyatakan dalam perkara (g) di bahagian
Pengecualian, Anda masih akan dilindungi di bawah Sijil ini, Kami dari semasa ke semasa berhak untuk meminta Anda untuk
dengan syarat bahawa : memberikan Data Peribadi lain yang dikehendaki bagi tujuan Sijil
ini.
a) Anda digaji untuk melakukan kerja-kerja pengkeranian atau
pengurusan (desk-work) sahaja; Sebelum memberikan Kami Data Peribadi Orang Yang
Dilindungi, atau mana-mana individu, Anda hendaklah
b) Anda tidak bertugas dan atau telah pun berada di daratan memaklumkan individu tersebut mengenai notis privasi Kami.
pada masa Kemalangan berlaku dan Kecederaan Badan tidak
timbul pada masa bertugas atau apa-apa aktiviti yang Untuk butiran terperinci notis privasi mengenai bagaimana Kami
berkaitan dengan pekerjaan Anda. mengumpul, menggunakan, memproses, melindungi dan
mendedahkan Data Peribadi Anda, sila kunjungi cawangan Kami,
Fasal Had Sekatan hubungi Etiqa Oneline di talian 1300 13 8888, atau rujuk ke
laman web Kami di www.etiqa.com.my
Sijil ini tidak akan memberikan perlindungan dan Kami tidak akan
bertanggungjawab untuk membayar apa-apa tuntutan atau Hak untuk menamatkan kerana Pencegahan Pengubahan
memberikan apa-apa Manfaat di bawah ini di mana peruntukan Wang Haram dan Pembiayaan Keganasan
perlindungan, pembayaran tuntutan, atau peruntukan Manfaat
tersebut akan mendedahkan Kami kepada mana-mana larangan Jika Kami mengetahui atau mengesyaki bahawa Sijil ini
atau sekatan di bawah Resolusi Pertubuhan Bangsa-Bangsa dimanfaatkan untuk kegiatan pengubahan wang haram atau
Bersatu, atau sekatan, undang-undang atau peraturan untuk membiayai Keganasan, Kami berhak untuk menamatkan
perdagangan atau ekonomi Kesatuan Eropah, United Kingdom Sijil ini dengan serta-merta. Kami akan menguruskan semua
atau Amerika Syarikat. Sumbangan yang dibayar dan semua Manfaat atau jumlah yang
dibayar berkenaan dengan Sijil ini melalui apa-apa cara yang
Notis Amanah atau Penyerah Hak Kami anggap sesuai, termasuk tetapi tidak terhad kepada
menyerahkannya kepada pihak berkuasa berkaitan.
Kami tidak akan terikat untuk menerima atau dipengaruhi oleh
mana-mana notis amanah, gadaian, lien, tugasan atau urusan Perubahan dalam Percukaian, Peraturan dan Perundangan
lain atau seumpamanya yang berkaitan dengan Sijil ini.
Kami berhak mengubah terma-terma Sijil ini sebagaimana Kami
Fasal Kehilangan fikirkan sesuai dan adil, sekiranya terdapat perubahan dalam
percukaian, perundangan, atau peraturan yang mempengaruhi
Jika Orang Yang Dilindungi ini hilang, semasa perlindungan Sijil ini. Kami akan memaklumkan kepada Anda dalam masa tiga
Takaful ini masih berkuatkuasa dan: (3) bulan sebelum Kami mengubah terma-terma di dalam Sijil ini.
a) Jasadnya tidak dijumpai dalam tempoh satu (1) tahun selepas Sekiranya apa-apa cukai sedemikian dikenakan, ia akan menjadi
kehilangannya, dan kewajipan Anda untuk membayar cukai tersebut (jika berkenaan).
b) Bukti yang mencukupi untuk memuaskan Kami dan membawa
kepada kesimpulan bahawa beliau mengalami kecederaan
badan akibat kemalangan dan kecederaan tersebut
menyebabkan kematiannya,
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Sekiranya Anda tidak membayar cukai nilai tambahan Definisi Skim yang dipilih adalah seperti berikut:
sedemikian, cukai barang dan perkhidmatan atau sebarang cukai
lain yang serupa, Kami boleh, tetapi tidak diwajibkan untuk a) Skim Individu bermaksud hanya Peserta yang akan dilindungi.
membayar cukai sedemikian bagi pihak Anda, dan Anda akan
membayar balik atau menanggung rugi Kami untuk semua cukai b) Skim Individu dan Pasangan bermaksud Peserta dan
tersebut apabila diminta oleh Kami. Pasangan (isteri atau suami) Anda akan dilindungi.
Hak untuk menamakan c) Skim Keluarga bermaksud Peserta, Pasangan (isteri atau
suami) Anda dan Anak-anak Anda yang layak akan dilindungi.
Sekiranya Peserta adalah Orang Yang Dilindungi, Peserta Sijil ini
boleh; Pasangan yang Dilindungi bermaksud Pasangan Peserta melalui
a) Menamakan seorang individu untuk menerima Manfaat perkahwinan yang sah dan dinyatakan di dalam Jadual Sijil. Bagi
tujuan Sijil Takaful ini, perkahwinan secara .common law. tidak
Takaful yang akan dibayar sekiranya Orang Yang Dilindungi dianggap sebagai perkahwinan yang sah kecuali di bawah .the
meninggal dunia, sama ada sebagai Wasi atau Benefisiari di Law of Reform (Marriage & Divorce) Act 1976.
bawah Hibah Bersyarat; atau
Kelayakan Peserta bermaksud Orang Yang Dilindungi yang
Penamaan boleh dibuat: berumur melebihi lapan belas (18) tahun dan tidak melebihi enam
a) Semasa permohonan dibuat; atau puluh (60) tahun.
b) Dengan memaklumkan kepada Kami secara bertulis. Anak Yang Layak bermaksud anak-anak yang belum berkahwin
yang di bawah tanggungan anda, anak tiri dan anak angkat yang
Peserta boleh menentukan bahagian pengagihan untuk dibayar diambil secara sah melalui undang-undang, yang berumur lebih
kepada setiap Penama. Jika tiada arahan pengagihan diterima, daripada satu (1) bulan dan di bawah lapan belas (18) tahun atau
Kami akan membayar Penama-penama secara sama rata. dua puluh lima (25) tahun, jika masih belajar di Institusi Pengajian
Tinggi, dan yang tidak bekerja, semasa mengalami kecederaan.
Jika terdapat lebih daripada seorang Penama dan mana-mana
Penama yang telah dinamakan sebagai Benefisiari di bawah Kecederaan Badan bermaksud kecederaan badan yang dialami
Hibah Bersyarat meninggal dunia terlebih dahulu sebelum oleh Anda semasa Tempoh Takaful yang disebabkan
Peserta,Kami akan membayar bahagian Penama yang semata-mata dan secara langsung daripada Kemalangan. Ini
meninggal dunia tersebut, apabila Peserta meninggal dunia tidak termasuk apa-apa keuzuran, penyakit, parasit, bakteria,
kepada harta pusaka Peserta kecuali Peserta telah menamakan jangkitan parasit atau virus walaupun dijangkiti daripada
Penama yang lain selepas kematian Penama tersebut. Kemalangan, atau apa-apa keadaan yang berlaku secara semula
jadi atau proses hilang upaya atau disebabkan oleh sebarang
Penamaan Benefisiari di bawah Hibah Bersyarat hendaklah, punca yang berlaku secara berperingkat.
tanpa mengambil kira mana-mana undang-undang bertulis,
mempunyai kesan terhadap pemindahan hak terhadap Manfaat Kehilangan Daya Penglihatan bermaksud kehilangan mata
Takaful yang akan dibayar apabila berlakunya kematian Peserta secara fizikal atau hilang daya penglihatan sepenuhnya dan kekal
kepada Penama. Pemindahan Manfaat Takaful tersebut tidak yang mana akan dipertimbangkan sebagai telah berlaku kepada:
akan membentuk sebahagian daripada harta pusaka Peserta,
atau tertakluk kepada hutang mereka. a) Kedua-dua belah mata yang disahkan oleh pakar opthtalmik
yang bertauliah dan berdaftar. Walau bagaimanapun, pihak
Tanggungjawab Wasi yang dinamakan Kami berhak untuk mendapatkan pendapat kedua.
Sekiranya Penama dilantik sebagai Wasi, bahagian setiap Wasi b) Sebelah mata jika darjah pandangan yang tinggal selepas
akan ditetapkan di dalam Borang Penamaan Wasi. dipulihkan hanya 1/60 atau kurang berdasarkan Skala Snellen
(bererti anda boleh melihat pada jarak 1 kaki objek yang
Bagi Peserta beragama Islam, Wasi perlu mengagihkan Manfaat berjarak 60 kaki). Walau bagaimanapun, pihak Kami berhak
Takaful tersebut seperti yang dinyatakan di bawah Akta untuk mendapatkan pendapat kedua.
Perkhidmatan Kewangan Islam 2013, undang-undang Islam dan
mana-mana undang-undang yang berkaitan dengan pengagihan Kehilangan anggota Kaki dan Tangan bermaksud
harta pusaka Peserta yang meninggal dunia.
a) Bagi tangan
Bagi Peserta yang bukan beragama Islam, Wasi perlu
mengagihkan Manfaat Takaful mengikut wasiat Peserta yang i) Keseluruhan tangan/keempat-empat jari dikudungkan pada
meninggal dunia dan mana-mana undang-undang yang berkaitan paras pangkal jari yang bersambung dengan tapak tangan
dengan pengagihan harta pusaka Peserta. Jika pada masa atau
tuntutan, seorang Wasi telah meninggal dunia sebelum Peserta,
peratusan bagi Wasi yang meninggal dunia akan diagihkan sama ii) Hilang keupayaan kekal bagi tangan keseluruhannya atau
rata antara Wasi yang masih hidup, yang akan bertindak sebagai keempat-empat jari.
Wasi untuk mengagihkan manfaat tersebut.
b) Bagi kaki
Hak untuk membatalkan penamaan
i) Sebelah kaki (pada paras atau atas daripada buku lali)
Penamaan akan dibatalkan: dikudungkan atau
a) Apabila semua Penama-penama meninggal dunia semasa ii) Hilang keupayaan kekal bagi sebelah kaki.
Peserta masih hidup;
Pengamal Perubatan bermaksud pengamal perubatan bertauliah
b) Melalui notis bertulis daripada Peserta kepada Kami; atau yang sah, selain daripada anda atau mana-mana ahli keluarga
terdekat.
c) Melalui penamaan berikutnya yang dilakukan oleh Peserta
kepada Kami. Penghospitalan bermaksud kemasukan atau siri-siri kemasukan
dari punca yang sama kecuali jika kemasukan dari punca yang
Penamaan tidak akan terbatal melalui wasiat atau melalui sama berlaku dalam tempoh dua belas (12) bulan atau lebih,
sebarang tindakan, peristiwa atau cara-cara lain. kemasukan tersebut akan ditakrifkan sebagai penghospitalan
yang berasingan.
DEFINISI
Sehari Kemasukan ke Hospital bermaksud sehari di mana pihak
Anda/Kamu bermaksud Orang Yang Dilindungi yang dinamakan Hospital mengenakan caj bayaran di atas pengunaan kemudahan
di dalam Jadual. bilik kepada Anda sebagai pesakit untuk tempoh minimum dua
puluh empat (24) jam dengan syor daripada Pengamal Perubatan.
Kita/Kami bermaksud Etiqa General Takaful Berhad
(1239197-A). Hospital bermaksud mana-mana institusi yang memenuhi
kesemua ciri-ciri yang berikut:
Peserta
Peserta adalah dikenal pasti menerusi Skim yang Dipilih seperti a) Mengendalikan kemudahan-kemudahan yang kekal dan
yang dinyatakan di dalam Jadual: sepenuh masa untuk penjagaan pesakit yang bermalam dan
menetap; dan
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b) Mempunyai kemudahan-kemudahan diagnos dan terapi untuk a) Mengambil bahagian dalam sebarang perbuatan yang
diagnos pembedahan, perubatan & rawatan serta penjagaan menyalahi undang-undang;
bagi orang-orang yang tercedera & sakit oleh kakitangan
Pengamal Perubatan ataupun dengan penyeliaan kakitangan b) Di bawah pengaruh arak ;
tersebut.
c) Mengambil bahagian di dalam (atau mengamalkan atau
c) Menyediakan perkihidmatan kejururawatan siang malam (24 mengambil bahagian di dalam latihan yang khusus dengan)
jam) sedara selanjar di bawah penyeliaan jururawat-jururawat menyelam, mendaki gunung, bukit atau tebing tinggi, lompat
yang bertauliah. .bungee.,penggerudian, penerjunan payung, kegiatan-kegiatan
di bawah air yang melibatkan penggunaan alat pernafasan,
d) Bukan institusi pemulihan pesakit otak atau tempat berehat sukan musim dingin (tidak termasuk permainan lempar batu
atau rumah orang-orang tua atau tempat pemulihan penagih kepada air beku dan meluncur), bermain bola ragbi,
dadah atau arak. perlumbaan (kecuali lumba jalan kaki);
Kenderaan Awam bermakna sebarang bas, teksi, kapal, d) Apa saja jenis sukan, sama ada disebut atau tidak, yang
keretapi, feri, bot, hoverkraf atau sebarang pesawat terbang yang dimainkan sebagai professional atau semi professional;
disewa atau terbang mengikut jadual, yang dilesenkan untuk
memberi perkhidmatan kepada penumpang. e) Mengambil bahagian dalam penerbangan atau lain-lain
kegiatan udara selain daripada sebagai sorang penumpang
Endorsemen bermaksud bukti bertulis tentang pindaan yang telah dalam sebuah kapal terbang yang mempunyai lesen penuh
dipersetujui bagi Sijil ini. membawa penumpang, tetapi tidak :
i) Sebagai seorang anak kapal;
Tempoh Takaful
ii) Dengan tujuan berniaga atau dalm operasi teknikal di
a) Sumbangan Bulanan dalam atau di atas kapal terbang;
Bermaksud pembaharuan bulanan bermula dari tarikh
berkuatkuasanya di dalam jadual Sijil. Sijil ini akan f) Mengambil bahagian di dalam selaman, penggerudian,
diperbaharui secara automatik pada setiap bulan apabila pembalakan, kerja-kerja bawah tanah, pembuatan atau
tamat tempohnya, tertakluk pada bayaran Sumbangan. Pihak pengendalian atau penjagaan atau meletupkan bahan letupan
Kami tidak akan menghantar sebarang dokumen setelah Sijil pengeluaran gas atau semasa bertugas sebagai anak kapal
anda diperbaharui kerana Jadual Sijil ini tidak menyebut tarikh atau nelayan atau pekerja pelantar minyak; atau
tamat tempoh Takaful.
g) Mengambil bahagian di dalam tugas berhubung dengan
b) Sumbangan Tahunan pasukan tentera laut, tentera darat, tentera udara, polis,
i) Satu tahun bermula dari tarikh berkuatkuasa; atau jabatan bomba atau sebarang operasi yang berkaitan dengan
ii) Satu tahun bermula dari tarikh pembaharuan. ketenteraan atau sebarang pekerjaa yang bersenjata.
Sijil ini akan diperbaharui secara automatik pada tarikh ulang Tuntutan
tahun, tertakluk pada bayaran Sumbangan. Kami berhak untuk
memperbaharui, membatalkan atau mengendors ke atas Jika sekiranya berlaku kemalangan yang layak dibuat tuntutan &
pembaharuan tahunan Sijil ini. Pihak Kami tidak akan pihak Kami telah membayar Manfaat Hilang Keupayaan Kekal
menghantar sebarang dokumen setelah Sijil Anda diperbaharui bagi butiran 1a, 2a, 2b atau 2c di dalam Jadual Manfaat, maka
kerana Jadual Sijil ini tidak menyebut tarikh tamat tempoh Sijil ini luput bagi Pesertanya.
Takaful.
Takaful/Insurans Lain
Jadual bermaksud helaian maklumat yang mengandungi
butir-butir peribadi Peserta, Manfaat, Sumbangan dan Tempoh Seseorang itu tidak boleh dilindungi lebih daripada satu Sijil
Takaful yang dilampirkan bersama Sijil ini. Takaful PA Plus, Privilege PA atau Sijil Takaful atau Polisi
Insurans yang bersamaan dengannya yang dikeluarkan oleh
Permohonan bermaksud Permohonan yang telah Anda Kumpulan Etiqa. Sekiranya Peserta mempunyai perlindungan
tandatangani dan maklumat lain yang Anda atau sesiapa yang lebih daripada satu Sijil atau Polisi, Kami akan menganggap
bertindak bagi pihak Anda telah berikan pada Kami. bahawa orang itu dilindungi di bawah Sijil atau Polisi pertama
yang dikeluarkan (jika Manfaat di bawah setiap satu Sijil atau
Penama ialah seseorang yang telah Anda namakan diborang Polisi tersebut adalah serupa sama sekali) atau Sijil atau Polisi
penamaan yang akan menerima Manfaat. yang menawarkan Manfaat paling tinggi dan Kami akan
mengembalikan sebarang sumbangan atau premium yang telah
Wakalah bermaksud tindakan satu pihak yang melantik pihak lain dibayar oleh Peserta atau wakil Peserta untuk perlindungan satu
untuk bertindak bagi pihaknya. Dalam konteks Takaful, Etiqa lagi.
General Takaful Berhad dilantik untuk menguruskan Dana bagi
pihak Peserta. Had-had Individu
Tabarru.adalah istilah bahasa Arab yang bermaksud pemberian, Pihak Kami tidak akan membayar apa-apa Manfaat jika sekiranya
hadiah atau sumbangan. Dalam Sijil ini, ia dimaksudkan sebagai Peserta:
pemberian untuk menyertai Takaful.
a) Mati, atau mendapat Kecederaan akibat membunuh diri atau
Perjalanan Luar Negeri bermaksud perjalanan keluar daripada cuba membunuh diri, mencederakan diri sendiri dengan
Negara Malaysia, Singapura, Brunei dan bukannya kepada sengaja atau gila;
Negara asal Peserta.
b) Mengalami Hilang Keupayaan Kekal, Kematian atau
Data Peribadi bermaksud apa-apa maklumat yang berkait secara Penghospitalan akibat daripada atau disebabkan oleh
langsung atau tidak langsung kepada Anda dan meliputi pengambilan dadah kecuali pengambilan itu atas nasihat
mana-mana individu yang data peribadinya telah dikemukakan doktor & bukan pula untuk pemulihan ketagihan dadah;
oleh Anda, yang dikenal pasti atau boleh dikenal pasti daripada
maklumat tersebut atau daripada maklumat tersebut dan c) Mengalami Hilang Keupayaan Kekal, Kematian/Penghospital
maklumat lain dalam milikan Kami, termasuk mana-mana data akibat daripada atau disebabkan oleh hamil/bersalin; atau
peribadi sensitif dan penyataan pendapat tentang Anda dan
individu tersebut. Bagi tujuan penjelasan, data peribadi Anda d) Menghidap HIV (Virus Imunodefisiensi Manusia) dan/atau HIV
mungkin boleh diberikan kepada Kami oleh pihak ketiga yang yang lain yang menyebabkan penyakit-penyakit yang lain
berkuasa. termasuk AIDS (Sindrom Hilang Daya Ketahanan Badan)
dan/atau derivatif mutan atau variasi-variasi yang lain;
PENGECUALIAN
e) Mendapat Kecederaan Anggota secara langsung atau tidak
Had-had Aktiviti langsung atau disebabkan oleh:
Pihak Kami tidak akan membayar apa-apa Manfaat jika sekiranya i) Sinar pengionan atau kontaminasi radioaktif daripada
Peserta mengalami kecederaan semasa: bahan api nuklear daripada pembakaran merangkumi
proses sisa ketahanan pemisahan nuklear.
ii) Bahan-bahan senjata nuklear.
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f) Mengalami Hilang Keupayaan Kekal, Kematian atau PENAMATAN SIJIL
Penghospitalan secara langsung atau tidak langsung akibat
daripada atau disebabkan oleh penyakit, parasit, bakteria, 1. Penamatan Oleh Peserta
jangkitan kuman, walaupun dijangkiti daripada kemalangan; Jika sekiranya Peserta memberi notis secara bertulis kepada
atau pihak Kami untuk menamatkan sijil, atau untuk menamatkan
perlindungan untuk Peserta, maka penamatan itu akan
g) Akibat daripada atau disebabkan oleh keadaan sedia ada. berkuatkuasa daripada tarikh notis Kami terima atau pada
tarikh yang dinyatakan di dalam notis atau mana-mana yang
Risiko Perang terkemudian.
Pihak Kami tidak akan membayar apa-apa Manfaat jika sekiranya 2. Penamatan Secara Automatik
Peserta mendapat Kecederaan akibat perang, penaklukan, Perlindungan Sijil ini akan tamat:
pencerobohan musuh daripada luar, ketegangan (tanpa mengira
perang diisytihar atau tidak) perang saudara, pemberontakan, a) Jika berlaku kematian ke atas Peserta;
rampasan kuasa (revolusi), rampasan kuasa tentera atau
tindakan pengganas. b) Perlindungan Takaful bagi Peserta akan luput pada tarikh
pembaharuan apabila mencapai umur 70 tahun (rujuk
Tindakan Pengganas pada tarikh lahir);
Untuk tujuan ini tindakan pengganas bermaksud tindakan yang c) Apabila Peserta atau suami/isteri anda tidak layak lagi
melibatkan tetapi tidak terhad kepada penggunaan kekerasan sebagai Peserta; atau
atau keganasan dan/atau ugutan pada ketika itu oleh seseorang
atau kumpulan samada bertindak bersendirian atau bagi pihak d) Apabila Peserta tidak lagi bermastautin di Malaysia,
atau yang berkaitan dengan sesebuah organisasi atau kerajaan Singapura dan Brunei.
atas dasar politik, keagamaan, idealogi atau tujuan-tujuan yang
sama termasuk niat untuk mempengaruhi mana-mana kerajaan 3. Penamatan oleh Kami
dan/atau masyarakat atau sebahagian daripada masyarakat,
dalam ketakutan. Tertakluk pada peruntukan yang tercatat dalam Sijil ini maka
Kami akan memberi notis penamatan dengan surat berdaftar
Kelayakan Pemastautin kepada Peserta di alamat yang terakhir yang diketahui.
Penamatan yang seperti itu akan berkuatkuasa empat belas
Sijil ini hanya berkuatkuasa semasa Orang yang Dilindungi (14) hari selepas tarikh notis dikeluarkan oleh pihak Kami.
bermastautin di Malaysia, Singapura atau Brunei.
4. Sumbangan Tidak Dijelaskan (untuk Sumbangan bulanan)
a) Jika Sumbangan permulaan tidak dibayar oleh Peserta,
Sijil ini tidak sah dari tarikh berkuatkuasanya.
b) Jika satu atau lebih Sumbangan telah dijelaskan tetapi
Sumbangan yang berikutnya tidak dibayar, maka Sijil
akan tamat berkuatkuasa dari tarikh Sumbangan yang
tidah dibayar itu.
5. Masa Efektif Penamatan
Sijil ini, atau Takaful bagi Peserta akan luput pada pukul
12:01 pagi waktu Malaysia pada tarikh yang tercatat dalam
Sijil.
6. Kedudukan Sumbangan Tatkala Penamatan
Jika Sumbangan telah dijelaskan untuk sebarang tempoh
lebih dari tarikh penamatan Sijil ini atau lebih dari tarikh
penamatan Takaful bagi Peserta, bahagian Sumbangan yang
berkenaan itu akan dipulangkan kepada Pemegang Sijil.
Tetapi sekiranya Sumbangan untuk sebarang tempoh hingga
ke tarikh penamatan belum dijelaskan maka adalah menjadi
tanggungjawab Peserta untuk menjelaskannya.
7 PMG/EGTB/CW/PPAPPADUAL/1808v1.6
9225-374206
TAKAFUL PA PLUS AND TAKAFUL PRIVILEGE PA CERTIFICATE BENEFITS
1. This Certificate, Schedule and Endorsement, if any, are The amount of your Benefits is determined by the product
evidence of the contract between You (the Covered scheme you have selected which is stated on the Schedule of this
Person) and Us. The application made to Us, and such Certificate.
material information disclosed to Us in connection with this
Takaful shall form part of this contract. 1. Total Paralysis Permanent Disablement
2. If You fail to disclose to Us fully and correctly, all the facts Benefits Takaful Takaful
which You know or know to be relevant, or if You PA Plus Privilege PA
misrepresented any material facts to Us before the
Certificate was entered into, We may avoid this Certificate. (RM) (RM)
3. You are required by Us, before the Certificate is renewed a) Permanent total paralysis 150,000 300,000
or varied, to answer any questions or if You are required or complete insanity or 40,000 80,000
to confirm or amend any matter previously disclosed by injuries resulting in being
You to Us in relation to this Certificate, it is Your duty to permanently bedridden as
take reasonable care not to make a misrepresentation a result of an accident
when answering the questions or confirming or amending
any matter previously disclosed. b) Disability Income
4. Your above duty of disclosure shall continue until the time c) Recovery Benefit 10,000 20,000
the Certificate is entered into, varied or renewed.
Maximum Benefit Payable 200,000 400,000
COVERAGE Total Paralysis
We will pay the appropriate Benefit if, during any Period of Benefit 1b and 1c above will
Takaful for which You have paid and We have agreed to only be payable together with
accept the contribution, the Covered Person sustains Bodily Benefit 1a in one lump sum i.e.
Injury which, within fifty two (52) weeks, is a cause of only in the event of permanent
Permanent Disability, Death or Hospitalisation. total paralysis or complete
insanity/ injuries resulting In
Bodily Injury means bodily injury suffered by You during the being permanently bedridden
Period of Takaful resulting solely and directly from Accident.
This does not include any sickness, disease, parasite, 2. Other Permanent Disability Benefits
bacterial, parasitic or viral infection even if contracted by
Accident, or any naturally occurring condition or degenerative Benefits Takaful Takaful
process or the result of any gradually operating cause. PA Plus Privilege PA
PAYMENT OF CONTRIBUTION (RM) (RM)
It is fundamental and absolute special condition of this a) Permanent Total Loss of 150,000 300,000
contract of Takaful that the full Contribution due must be paid sight of both eyes or use of both
and received by Us before the Takaful cover under the hands or both feet or
Certificate, Endorsement or Renewal as the case may be, combination of these
can commence based on the payment mode You have
selected as specified below. If this condition is not complied b) Permanent Total Loss of 150,000 300,000
with then this Certificate is automatically null and void. speech
Subject otherwise to the terms and conditions of this Certificate.
c) Permanent Total Loss of 150,000 300,000
a) Monthly Payment hearing in both ears
Monthly Payment means one of a series of consecutive
monthly payments, the first of which must be made on or d) Permanent Total Loss of 75,000 150,000
before the Effective Date of Takaful as stated on the sight of one eye or use of one
Schedule and each of the subsequent payments being limb
made at monthly renewal intervals thereafter will be
debited to Your account when due. e) Permanent Total Loss of 30,000 60,000
This Takaful is automatically extended monthly subject to hearing in one ear
the payment of contribution. No further documents will be
issued as the Schedule shows no expiry date. f) Permanent Total Loss of use 22,500 45,000
of a shoulder, elbow, hip, knee,
b) Yearly Contribution Payment ankle or wrist
Yearly Contribution Payment means one of a series of g) Permanent Total Loss of use 22,500 45,000
consecutive yearly payments, the first of which must be or loss by amputation of: 15,000 30,000
made on or before the Effective Date of Takaful as stated 7,500 15,000
on the Schedule and each of the subsequent payments i) One thumb 3,000 6,000
being made at yearly renewal intervals thereafter. ii) One forefinger
Contribution will be debited to Your account when due. iii) Any other finger/ one big toe
iv) Any other toe
This Takaful is issued on a yearly renewable basis. We
have the right to renew, cancel or amend on the For any forms of Permanent Disability not specified above, the
Certificate.s anniversary. No further documents will be amount of Benefit will be assessed by comparing the above list
issued as the Schedule shows no expiry date. with the Permanent Disability sustained.
8 PMG/EGTB/CW/PPAPPADUAL/1808v1.6
9225-374207
3. Death Benefits Takaful Takaful To reimburse the actual cost of
PA Plus Privilege PA medical treatment when
Benefits hospitalised at a registered
(RM) (RM) clinicaI hospital as a result of an
a) Accidental Death Benefits accident (up to a maximum limit
100,000 300,000 shown including cost of medical
i) Individual Accident report).
occurring whilst taking public 50,000 150,000
transport or occurring outside b) Hospital Cash Benefit 100 per day 200 per day
Malaysia, Singapore &
Brunei. If hospitalized as a result of
ii) Individual Accident accidental injury, up to 100
occurring within Malaysia, days.
Singapore & Brunei. In the
event of an accident which 6. Ambulance Fee (per accident)
causes death to the
Participant(s), the Company Benefits Takaful Takaful
will pay only one benefit of PA Plus Privilege PA
the above that is either Reimbursement of the actual
Benefit 3a(i) or 3a(ii), where fee (up to a maximum limit as (RM) (RM)
applicable. specified) incurred for the use of
ambulance services, subject to Up to 200 Up to 500
original receipt being provided.
b) Compassionate Cash 2,000 6,000
Lump sum cash benefit to the
family in the event of
accidental death.
c) Repatriation Benefit 3,000 6,000 Eligible Children Benefits
Lump sum cash benefit to All benefits for children are 25% of the amounts stated.
bring back mortal remains of
deceased Participant(s) to Age
home country (Malaysia,
Singapore or Brunei) in the No Participant shall be included in this Certificate if he or she has
event of accidental death as a attained the age of seventy (70) years. The cover granted by this
result of accident in a foreign Certificate will cease in respect of any Participant at the end of
country. the Period of Takaful during which the Participant attains the age
of seventy (70) years.
4. Outpatient Medical Benefits (per accident)
Benefits Takaful Takaful PROVISIONS
PA Plus Privilege PA
1. If Benefit is claimed for;
(RM) (RM)
a) Permanent Total Loss of a limb then no Benefit can be
a) i) Outpatient Cash Benefit 100 100 claimed for loss of parts of that limb; or
400
Lump sum cash irrespective Not b) Loss of or loss of use of parts of a limb then the total
of amount shown in receipt, Covered amount payable shall not exceed the Benefit payable for
for your emergency treatment Permanent Total Loss of that whole limb.
at a registered clinic/hospital
as a result of an accident. 2. If Benefit is claimed for more than one form of Permanent
Disability sustained in any one accident then We shall not pay
ii) Outpatient Medical more than the Benefit for total paralysis or injuries resulting in
Expenses Reimbursement being permanently bedridden.
If the cost of your emergency 3. Before We pay Permanent Disability Benefit 1a, total paralysis
treatment at a registered or injuries resulting in being permanently bedridden shall have
clinic/hospital exceeds the lasted fifty two (52) weeks and have been proved to Our
amount payable in item 4a(i) satisfaction to be permanent and without expectation of
we will reimburse the recovery.
additional amount up to the
maximum limit shown. However, if it can be proven to Our satisfaction that the total
paralysis or injuries resulting in being permanently bedridden
b) Snatch Theft Injury Benefit 150 300 is permanent then We may at Our discretion pay the Benefit
before the expiry of fifty two (52) weeks.
Lump sum cash for bodily
injury caused by snatch theft 4. We shall not pay under both Permanent Disability and Death
(with police report). Benefits in respect of any one (1) Participant in connection
with the same accident.
5. In-hospital Medical Benefits (per accident)
5. Sometimes the full effects of an accident are not immediately
Benefits Takaful Takaful apparent and although Permanent Disability may occur at the
PA Plus Privilege PA time of the accident We have to wait a reasonable length of
time to ensure that the full effects are known.
(RM) (RM)
a) Medical Expenses Up to Up to
Reimbursement (per accident) 1,000 4,500
9 PMG/EGTB/CW/PPAPPADUAL/1808v1.6
9225-374208
GENERAL PROVISIONS We shall pay the death benefit under this Takaful contract. The
payment is only made provided that the person or persons to
Claims Conditions whom such sum is paid shall sign an undertaking to refund such
sum paid to Us if the Participant is subsequently found to be
a) Notification of Accident living.
All claims must be made by You or through You or Your legal
representatives, to Us within thirty (30) days of any Death or Data Protection Obligations and Rights
Injury which may result in a claim under this Certificate.
We shall be able to process Personal Data according to the
b) Documentation Section 4 of the Personal Data Protection Act 2010. We shall be
able to disclose Personal Data provided by You, as the context
All medical reports, policies, information, certificates, may require to:
information and evidence required by Us to support a claim,
must be provided at Your expense or at the expense of any a) Etiqa General Insurance Berhad, Etiqa General Takaful
claimant in the event of death of the Covered Person. The Berhad, Etiqa Life International (L) Ltd or Etiqa Offshore
Covered Person may have to undergo further medical Insurance (L) Ltd;
examination as required by Us at Our expense. In the event of
a claim due to death of a Covered Person, We shall require b) Other entities within the Maybank Group;
sight of the death certificate and may require a post-mortem
examination at Your expense. c) Our authorised agents and service providers with whom We
have contractual agreements for some of Our functions,
Claims are not deemed complete and eligible Benefits are not service and activities;
payable unless all medical reports, certificates, information
and evidence required by Us have been submitted to Us. In d) Other insurance companies or takaful operators and
the case of a claim for a benefit related to medical distribution partners (such as, banks, Islamic banks, insurance
reimbursement, only the actual costs incurred, which are brokers, takaful brokers, reinsurance companies and retakaful
medically necessary, shall be considered for reimbursement operators);
subject to the presentation of original receipt(s). Any variation
to documentation requirements shall be at our sole discretion. e) Industry trade associations such as Life Insurance Association
of Malaysia (LIAM), Persatuan Insurans Am Malaysia (PIAM)
Claim Settlement & Malaysian Takaful Association (MTA);
i) We will pay any benefit due under this Certificate to You or in f) Our merchants and strategic partners;
the event of Your death, to Your estate in accordance with the
Islamic Financial Services Act 2013. g) Any parties authorised by You (from time to time); or
ii) The payment of claims under this Certificate is dependent h) Regulatory enforcement and governmental agencies as
upon observance of its terms and conditions by You, and so permitted or required by law, authorised by any order of court
far as they apply, by the Covered Person or any other or to meet obligations to regulatory authorities.
claimant.
You will keep Us updated in respect of all such Personal Data as
Sedentary Work/Off-Duty Cover soon as is practicable.
If You are employed under any of the excluded occupations We shall not be liable for any direct or indirect loss or damage
stated in Exceptions (g), You shall still be covered under this due to any inaccuracy or incompleteness in the Personal Data
Certificate provided that; provided to Us.
a) You are employed to do sedentary/desk-bound duties only; We may from time to time request that You provide other
Personal Data required for the purposes of this Certificate.
b) You are off-duty and or safely return to mainland at the time of
the Accident and the Bodily Injury does not arise in the course Prior to providing Us with the Personal Data of a Covered Person,
of Your employment or any activity related to Your or another individual, You must inform that individual of Our
employment. privacy notice.
Sanction Limitation and Exclusion Clause For detailed privacy notice on how We collect, use, process,
protect and disclose Personal Data, please visit Our branches,
This Takaful certificate shall not provide cover and We shall not contact Etiqa Oneline at 1300 13 8888, or refer to Our website at
be liable to pay any claim or provide any Benefit hereunder to the www.etiqa.com.my.
extent that the provision of such cover, payment of such claim, or
provision of such Benefit would expose Us to any Sanction, Right to terminate due to Anti-Money Laundering and
prohibition or restriction under the United Nations resolutions or Counter Financing of Terrorism
trade or economic sanctions, laws or regulations of the European
Union, United Kingdom or United States of America. If We discover, or have justified suspicion, that the Certificate is
exploited for money laundering activities or to finance Terrorism,
Notice of Trust or Assignment We reserve the right to terminate the Certificate immediately. We
shall deal with all Contributions paid and all benefits or sums
We shall not be bound to accept or be affected by any notice of payable in respect of the Certificate in any manner which we
any trust, charge, lien, assignment or other dealing with or deem appropriate, including but not limited to handling it over to
relating to this Certificate. the relevant authorities.
Disappearance Clause Changes in Taxation, Regulations and Legislation
If the Participant disappears, while this Takaful coverage is in We may vary the terms of this Certificate as We consider
force and: appropriate and equitable, if there are changes in taxation,
regulations or legislation that affect this Certificate. We will notify
a) Their body is not found within one (1) year after their You in writing three (3) months prior when terms in this Certificate
disappearance, and need to be changed.
If any such tax applies, it shall be Your obligation to pay such
b) Sufficient evidence is produced to Our satisfaction that leads chargeable tax (where applicable).
inevitably to the conclusion that he sustained accidental bodily In the event You do not pay such all value added tax, goods and
injury and that such injury have resulted in death, services tax or any other tax of a similar nature, We may, but is
not obliged to pay such tax on Your behalf, and You shall
reimburse or indemnify Us for all of such tax upon demand by Us.
10 PMG/EGTB/CW/PPAPPADUAL/1808v1.6
9225-374209
Right to nominate c) Family Scheme means the Participant, his/her Spouse and all
his/her Eligible Children are covered.
Where the Participant is the Covered Person, the Participant of
the Certificate may: Spouse means the legally married Spouse of the Participant
named in the Certificate Schedule. For the purposes of this
a) Nominate an individual to receive Takaful Benefits payable Certificate, a common Law marriage is not considered a legal
upon death of the Covered Person, either as an Executor, or marriage except as provided under the Law reform (Marriage &
as a Beneficiary under a Conditional Hibah; or Divorce) Act 1976.
The nomination or assignment may be made: Eligible Participant means a person who is above 18 years old
and not exceeding sixty (60) years at commencement of cover.
a) At the time of application; or
Eligible Children means all unmarried dependent children,
b) By notifying Us in writing. stepchildren and legally adopted children who are over 1 month
and under 18 years of age or 25 years of age, if still on full time
The Participant may specify the shares of Takaful Benefit be paid education at a higher learning institution and who are not gainfully
to each Nominee. In the absence of such specified shares, We employed at the time of sustaining Bodily Injury.
shall pay the Nominees in equal shares.
Bodily Injury means bodily injury suffered by You during the
Where there is more than one Nominee and any particular Period of Takaful resulting solely and directly from Accident. This
Nominee who is nominated as a Beneficiary under Conditional does not include any sickness, disease, parasite, bacterial,
Hibah predeceases the Participant, We shall pay the share of the parasitic or viral infection even if contracted by Accident, or any
deceased Nominee, upon the death of the Participant to the naturally occurring condition or degenerative process or the result
estate of the deceased Participant, unless the Participant has of any gradually operating cause.
made a subsequent nomination in place of the deceased
Nominee. Loss of Eye means physical loss of an eye or permanent and
total Joss of sight, which shall be considered as having occurred
A Nomination of a Beneficiary under Conditional Hibah shall,
regardless of any written law, have the effect of transferring a) in both eyes if so certified by a registered fully qualified
ownership, of the Takaful Benefits payable on death of the ophthalmic specialist. We, however, reserve the right to seek
Participant to the Nominee. Such Takaful Benefits so transferred a second opinion.
shall not form part of the estate of the Participant, or be subject to
his or her debt. b) in one eye if the degree of sight remaining after correction is
1/60 or less on the Snellen Scale (this means seeing at 1 feet
Obligations of nominated Executors what you should see at 60 feet). We, however, reserve the
right to seek a second opinion.
Where the Nominee is appointed as Executor, the share of the
Executor will be set out in the Nomination of Executor Form. Loss of Limb means
For Muslim Participants, the Executor has to distribute the a) in the case of an upper limb
Takaful Benefits as specified under the Islamic Financial Services i) amputation of an entire hand or all four fingers from where
Act 2013, Islamic Law and any other applicable laws relating to the fingers join the palm of the hand; or
the distribution of the estate of the deceased Participant.
ii) total & permanent loss of use of an entire hand/ all four
For Non-Muslim Participants, the Executor has to distribute the fingers
Takaful Benefits according to the will of the deceased Participant,
and any other applicable laws relating to the distribution of the b) in the case of a lower limb
estate of the deceased Participant. If at the time of claim, an i) amputation of a foot (at or above the ankle); or
Executor has predeceased the Participant, the percentage of the
deceased Executor will be distributed equally among any ii) permanent total loss of use of a foot
surviving Executors, who will then act as Executors to distribute
the proceeds.
Right to revoke a nomination
A nomination shall be revoked: Medical Practitioner means a legally qualified medical practitioner
other than yourself or a member of your immediate family.
a) Upon the death of all Nominees during the Participant.slifetime;
b) By a notice in writing from the Participant to Us; or Hospital Confinement means an admission or a series of
c) By any subsequent nomination by the Participant to Us. admissions from the same cause except that if admissions from
the same cause are separated by twelve (12) months or more
A nomination shall not be revoked by a will or by any other act, then each such admission shall constitute a separate Hospital
event or means. Confinement.
DEFINITIONS A day of Hospital Confinement is defined as a day of which the
Hospital makes a charge for room and board to the Insured
You/ Your means the Covered Person named in the Schedule. Person(s) for admission as an in-patient for a minimum period of
twenty four (24) hours on the recommendation of a Medical
Us/ We/ Our/Takaful Operator means Etiqa General Takaful Practitioner.
Berhad (1239197-A).
Hospital means any institution which fully meets all of the
Participants following criteria:
The Participant or Persons under this Certificate are identified by
the Scheme Selected as shown on the Schedule. a) maintains permanent and full-time facilities for care of
The Scheme Selected definitions are as follows: overnight resident patients;
a) Individual Scheme means only the Participant is covered.
b) has diagnostic and therapeutic facilities for surgical and
b) Individual and Spouse Scheme means Participant & his/her medical diagnosis and treatment and care of injured and sick
Spouse are covered. persons by or under the supervision of a staff of Medical
Practitioners;
c) continuously provides 24 hours a day nursing service
supervised by qualified nurses; and
11 PMG/EGTB/CW/PPAPPADUAL/1808v1.6
9225-374210
d) is not other than incidentally a mental institution or a place for d) Any sports whether mentioned above or not when engaged as
rest or a place for the aged or for drug addicts or for professional or semi-professional;
alcoholics.
e) Engaging in flying or other aerial activities other than in a fully
Public Transport means any bus, taxi, train, ship, ferry, boat, licensed passenger carrying power driven aircraft as a
hovercraft or any scheduled or chartered airliner operated by a passenger but not;
licensed carrier for regular passenger service.
i) as a member of the crew;
Endorsement means written evidence of an agreed change to the ii) for the purpose of any trade or technical operation in or on
Certificate.
the aircraft ; or
Period of Takaful
f) Engaging in diving, mining, logging, underground works,
a) Monthly Contribution explosive making or handling or custodians or blasters, gas
manufacturing or whilst on duty as a ship crew or fisherman or
It means monthly extension starting from the effective date oil rig crew; or
stated in the Certificate Schedule. This Certificate is extended
on monthly basis automatically subject to the payment of g) Whilst taking part in naval, military, air force, police force, fire
Contribution. No further endorsement will be issued as the service department or any armed forces operation or any
Schedule attached to this Certificate shows no expiry date. armed occupation.
b) Yearly Contribution Claims
i) One year starting from the effective date; or If an accident happens which gives rise to a claim and in respect
ii) One year starting from the renewal date. of which We make a payment under Death or Permanent
Disability Benefits items 1a, 2a, 2b or 2c in the table of Benefits
This Certificate will be renewed automatically on the anniversary this Certificate, shall thereafter cease, to apply to that Covered
date subject to the payment of Contribution. We have the right to Person.
renew, cancel or amend on the Certificate.s anniversary. No
further document will be issued on renewal as The Schedule Other Takaful/Insurance
attached to this Certificate shows no expiry date.
No person shall be covered under more than one Takaful PA
Schedule means the information page that contains the details of Plus, Takaful Privilege Certificate or is equivalent Takaful
the Participant, Benefit, Contribution and Period of Takaful Certificate or insurance policy issued by Etiqa Group. In the event
attached to this Certificate. the Participant is covered under more than one such Certficate or
Policy, We shall consider that person to be covered under the
Application means the Application that You signed and any other Certificate or Policy which was issued first (where the Benefit
information that You or anyone acting on You has given to Us. provided under each such Certificate or Policy are identical) or
which provides the greatest amount of Benefit and We shall
Nominee means the person or persons named by You in the refund any duplicated Contribution or premium payment which
nomination form form to receive the Benefit. may have been made by or on behalf of that Participant.
Wakalah means the nomination by one party of another to act on Individual limitations
his or her behalf. In the Takaful context, Etiqa General Takaful
Berhad manages the Fund on behalf of the Participant. We will not pay any Benefit if the Participant:
Tabarru. means An Arabic word meaning donation, gift, a) Sustains Bodily Injury as the result of committing or attempting
Contribution. In the Takaful contract this means donation for the to commit suicide, intentional self-inflicted injury or.insanity;
purpose of Takaful.
b) Suffers Permanent Disability, Death or Hospitalisation as the
Overseas Trip means travel or trip outside Malaysia, Singapore, result of or which is contributed to by the Participant having
Brunei and not being the Participant's home country. taken a drug unless it is taken on proper medical advice and
for the treatment of drug addiction;
Personal Data means any information that relates directly or
indirectly to You and extends to any individual whose personal c) Suffers Permanent Disability, Death or Hospitalisation as the
data has been provided by You, who is identified or identifiable result of or which is contributed to by pregnancy or childbirth;
from that information or from that and other information in Our
possession, including any sensitive personal data and expression d) Suffers from HIV (Human Immune Deficiency Virus) and/or
of opinion about You and the individual. For clarity purposes, any HIV related illness including AIDS (Acquired Immune
Your personal data may have otherwise been provided to Us by Deficiency Syndrome) and/or any mutant derivative or
an authorised third party. variations thereof however caused;
EXCEPTIONS e) Sustains Bodily Injury directly or indirectly caused by or
contributed to by or arising from
Activity limitations i) ionising radiations or contamination by radioactivity from
We will not pay any Benefit if the Covered Person sustains Bodily any nuclear fuel or any nuclear waste from the combustion
Injury whilst: of nuclear fuel. Solely for the purpose of this exclusion,
a) Whilst engaged in any illegal act; combustion shall include any self-sustaining process of
b) Under the influence of alcohol; nuclear fission; or
c) Engaging in (or practicing for or taking part in training peculiar ii) nuclear weapons materials
to) extreme sports, scuba diving mountaineering, mountain or f) Suffers Permanent Disability, Death or Hospitalisation directly
offroad biking, skateboarding, roller skating, bungee jumping, or indirectly caused by or resulting from or traceable to
rock or cliff climbing pot-holing, parachuting, underwater sickness, disease, parasite, bacterial or viral infection even if
activities involving the use of underwater breathing apparatus, contracted by accident; or
winter sports (excluding curling and skating), association or
rugby football, racing other than on foot; g) Sustains bodily injury as a result of or contributed to by any
pre-existing condition.
12 PMG/EGTB/CW/PPAPPADUAL/1808v1.6
9225-374211
War Risks TERMINATION OF CERTIFICATE
We will not pay any Benefits if the Participant sustains Bodily 1. Termination by the Participant
Injury consequent upon war, invasion, act of foreign enemy, If the Participant gives notice in writing to Us to terminate this
hostilities or warlike operations (whether war be declared or not), Certificate, or to terminate the coverage with respect to a
civil war, mutiny, military or popular rising, insurrection, rebellion, Covered Person, such termination shall become effective on
revolution, act of terrorism, military or usurped power, martial law the date the notice is received or on the date specified in
or state of siege or any of the events or causes which determine such notice, whichever is the later.
the proclamation or maintenance of martial law or state of siege.
Any Act of Terrorism 2. Automatic Termination
All coverage under this Certificate will be terminated:
For this purpose an act of terrorism means an act, including but
not limited to the use of force or violence and/or the threat a) upon the death of the Participant;
thereof, of any person or group(s) of persons, whether acting
alone or on behalf of or in connection with any organization(s) or b) on the expiry of the extension date or renewal period
government(s), committed for political, religious, ideological or during which the Participant ceases to be eligible when
similar purposes including the intention to influence any he/she attains the age of 70 (follow birth date);
government and/or to put the public, or any section of the public
in fear. c) when neither the Participant nor Spouse are eligible as
Participant; or
Residential Qualifications
d) when Participant is no longer resident in Malaysia,
This Certificate only applies while the Covered Person is a Singapore or Brunei.
resident of Malaysia, Singapore or Brunei.
3. Termination by Us
Subject to the provisions of this Certificate, We may give
notice of termination hereof by registered post to the
Participant at his or her last known address. Such termination
shall become effective not more than fourteen (14) days
following the date of such notice.
4. Non Payment of Contribution (applicable to monthly)
a) If the initial Contribution charged to the Participant's
account is not paid, this Certificate will be deemed to be
void from inception.
b) If one or more Contribution payments have been made,
non payment of subsequent s will result in termination of
the Certificate as of the date unpaid was due. No further
refund will be made.
5. Effective Time of Termination
This Certificate in respect of any individual Participant
hereunder, shall terminate at 12:01am Malaysian Time on the
relevant date specified above.
6. Contribution Position Upon Termination
In the event of the Contribution having been paid for any
period beyond the date of termination of this Certificate, or
beyond the date of termination of Takaful in respect of an
Participant, the relevant proportion there of shall be refunded
to the Participant. If Contribution has not been paid for any
period up to the date of termination, the Participant shall be
liable for the payment of such Contribution.
12 PMG/EGTB/CW/PPAPPADUAL/1808v1.6
9225-374212
PROSEDUR ADUAN Alamat surat-menyurat adalah seperti berikut:
Sekiranya Anda dapati perkhidmatan Kami memerlukan Pengarah
penambahbaikan, sila berikan Kami maklum balas Anda Jabatan LINK dan Pejabat Wilayah
dengan menghubungi Kami melalui pos di: Bank Negara Malaysia
Jalan Dato.Onn
Unit Pengurusan Aduan 50480 Kuala Lumpur
Etiqa General Takaful Berhad (201701025031) Nombor Telefon: 1300 88 5465
Level 5, Tower B, Dataran Maybank Nombor Faksimile : +603 2174 1515
No. 1, Jalan Maarof E-mel: bnmtelelink@bnm.gov.my
59000 Kuala Lumpur, Malaysia;
COMPLAINT PROCEDURES
Atau melalui telefon 1300 13 8888 atau +603 2780 4500
(Luar Negara) If You feel that Our service to You needs improvement,
Nombor Faksimile: +603 2785 3093 please let Us have Your feedback by contacting Us by post
E-mel: cmu@etiqa.com.my at:
Kami akan memastikan maklum balas Anda dilayani.
Complaint Management Unit.
Ombudsman Perkhidmatan Kewangan (OPK) dan Biro Etiqa General Takaful Berhad (201701025031)
Perkhidmatan Pelanggan (BPP) Bank Negara Malaysia juga Level 5, Tower B, Dataran Maybank
menyediakan pendekatan alternatif dalam memberikan No. 1, Jalan Maarof
peluang kepada ahli di kalangan orang ramai untuk 59000 Kuala Lumpur, Malaysia;
membetulkan amalan pasaran yang tidak adil.
Or by telephone on 1300 13 8888 or +603 2780 4500 (Overseas)
PROSEDUR MEMBUAT ADUAN KEPADA OPK Facsimile Number: +603 2785 3093
E-mail: cmu@etiqa.com.my
Ombudsman Perkhidmatan Kewangan (OPK) boleh
dihubungi oleh Pihak Menuntut atau Peserta, sekiranya We assure You that Your feedback will be looked into.
Pihak Menuntut atau Peserta tidak berpuas hati dengan
keputusan Kami terhadap sebarang pertikaian, atau The Ombudsman for Financial Services (OFS) and Bank
kegagalan Kami untuk memberi maklum balas balas Negara Malaysia.sCustomer Services Bureau (CSB) provide
terhadap sebarang aduan dalam tempoh enam puluh (60) alternative avenues for members of the public to seek
hari. Anda boleh menghubungi OPK melalui: redress against unfair market practices.
E-mel: enquiry@ofs.org.my PROCEDURE FOR COMPLAINT TO OFS
atau
Nombor Faksimile: +603 2272 1577 The Ombudsman for Financial Services (OFS) may be
atau contacted by the Claimant or Participant, in the event that
Alamat Pos: the Claimant or Participant is dissatisfied with Our decision
had to a dispute, or Our failure to respond to a complaint
Ketua Pegawai Eksekutif within sixty (60) days. The OFS contact details are as
Ombudsman Perkhidmatan Kewangan follows:
(Dahulu dikenali sebagai Biro Pengantaraan Kewangan)
Tingkat 14, Blok Utama Email: enquiry@ofs.org.my
Menara Takaful Malaysia or
No.4, Jalan Sultan Sulaiman Facsimile Number: +603 2272 1577
50000, Kuala Lumpur. or
Postal address:
Sebagai alternatif, Pihak Menuntut atau Peserta boleh
memfailkan pertikaian itu secara peribadi di pejabat OPK. Chief Executive Officer
Ombudsman for Financial Services
OPK perlu dihubungi dalam tempoh enam (6) bulan dari (Formerly known as Financial Mediation Bureau)
tarikh keputusan muktamad dari Kami berkenaan pertikaian Level 14, Main Block
yang dibuat Pihak Menuntut atau Peserta. Menara Takaful Malaysia
No.4, Jalan Sultan Sulaiman
Untuk maklumat lanjut mengenai OPK, sila dapatkan risalah 50000, Kuala Lumpur
maklumat daripada Kami atau layari laman web OPK di
www.ofs.org.my Alternatively, the Claimant or Participant may file the dispute
in person at the OFS office.
Penglibatan OPK adalah tertakluk kepada terma-terma
rujukan menurut Seksyen 138 Akta Perkhidmatan Kewangan The OFS must be contacted within six (6) months from the
Islam 2013. Menghubungi OPK tidak akan menjejaskan hak date of the final decision from Us to the dispute of the
Pihak Menuntut atau Peserta untuk mengambil tindakan Claimant or Participant.
undang-undang terhadap Kami sekiranya mereka tidak
berpuas hati dengan keputusan oleh OPK. For further details on the OFS, please obtain the information
pamphlets from Us or visit the OFS website at
PROSEDUR MEMBUAT ADUAN KEPADA BPP www.ofs.org.my
Mana-mana Pihak Menuntut atau Peserta yang tidak Engagement of the OFS is subject to the terms of reference
berpuas hati dengan Pengendalian sesebuah Pengendali pursuant to section 138 of the Islamic Financial Services Act
Takaful boleh menulis kepada BPP dengan menberikan 2013. Contacting the OFS does not affect the Claimant.s or
butiran tentang aduan, nama Syarikat Takaful dan nombor Participant.sright to take legal action against Us should they
Sijil atau nombor Tuntutan. be dissatisfied with the outcome by the OFS.
Salinan surat-menyurat (jika ada) antara Pihak Menuntut
atau Peserta dengan Pengendali Takaful juga boleh
disertakan untuk memudahkan kerja mencari fail kes yang
disimpan oleh Syarikat Takaful.
13 PMG/EGTB/CW/PPAPPADUAL/1808v1.6
9225-374213
Alternatively, the Claimant or Participant may file the dispute in PROCEDURE FOR COMPLAINT TO CSB
person at the OFS office.
Any Participant or Claimant who is not satisfied with the
The OFS must be contacted within six (6) months from the date conduct of the Takaful Operator may write to CSB, giving
of the final decision from Us to the dispute of the Claimant or details of the complaint, the name of the Takaful Operator
Participant. and the Certificate number or the claim number.
For further details on the OFS, please obtain the information Copies of the correspondence (if any) between Claimant or
pamphlets from Us or visit the OFS website at www.ofs.org.my Participant and the Takaful Operator also be sent to facilitate
tracing the case file kept by the Takaful Operator.
Engagement of the OFS is subject to the terms of reference
pursuant to section 138 of the Islamic Financial Services Act The contact details are as follows:
2013. Contacting the OFS does not affect the Claimant.sor
Participant.sright to take legal action against Us should they Director
be dissatisfied with the outcome by the OFS. Jabatan LINK dan Pejabat Wilayah
Bank Negara Malaysia
P. O. Box 10922
50929 Kuala Lumpur
Telephone Number: 1300 88 5465
Facsimile Number: +603 2174 1515
E-mail: bnmtelelink@bnm.gov.my
9225-374214
Privacy Notice
Our commitment to your privacy
This Privacy Notice outlines how Etiqa collects, uses, maintains and discloses your personal data in respect of
commercial transactions and how Etiqa safeguards the personal data in pursuant to the Personal Data Protection Act
2010.
"Etiqa" or "We" in this notice refers to Etiqa General Insurance Berhad, Etiqa General Takaful Berhad, Etiqa Life
Insurance Berhad, Etiqa Family Takaful Berhad, Etiqa Life International (L) Ltd or Etiqa Offshore Insurance (L) Ltd
("Etiqa"), including its branches in Malaysia and in other countries as well as its local and overseas subsidiaries or, as
the context may require, any of them.
"Maybank Group" in this notice refers to Malayan Banking Berhad ("Maybank"), including its branches in Malaysia and
in other countries as well as its local and overseas subsidiaries or, as the context may require, any of them.
Your consent is important
When you request information or sign up for our products and services, you will be required to provide Etiqa with your
personal data. In doing so, you consent to its use by Etiqa in accordance with this Privacy Notice.
We collect your sensitive personal data (including data relating to your physical or mental health, the commission or
alleged commission of offences etc.) when you apply for certain products such as health or life insurance/ family
Takaful products, which require you to disclose such sensitive personal data to us. We will only use your sensitive
personal data to provide the service(s) you signed up for. If we collect, use, maintain or disclose your sensitive personal
data, we will ask for your expressed consent.
You have the choice, at any time, not to provide your personal data/sensitive personal data or to revoke your consent to
Etiqa processing of your personal data/sensitive personal data. However, this may result in Etiqa being unable to
provide you with the offered services.
What types of personal data do we collect?
Personal data refers to any information that relates directly or indirectly to an individual, who is identified or identifiable
from that information or from that and other information in the possession of Etiqa, including any sensitive personal data
and expression of opinion about the individual.
The types of personal data / sensitive personal data we collect may include, but is not limited to your name, address,
your identity card or passport number, other contact details (including family/employee information), age, occupation,
place of birth, marital status, medical history, health status, and financial reference and information such as your
income or income tax particulars.
The personal data we collect can be either obligatory or voluntary. Obligatory personal data are those that we require in
order to provide you with our products and services. If you do not provide us with obligatory personal data, we would not
be able to provide you with our products and services. Voluntary personal data are those that are not mandatory in
order for us to provide you with our products and services. If you do not provide us with voluntary personal data, you
can still sign up for our products and services. Obligatory and voluntary personal data differ for each products and
services and will be indicated in the application forms.
If you are supplying personal data of other parties such as your family members, legal guardians, nominees, directors,
shareholders or officers, please do ensure that you have obtained their consent and bring this Notice to their attention.
9225-374215
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29 SEPT 2022
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