(Insured Copy) All Risk -Policy Debit Credit Note(3) Flipbook PDF

(Insured Copy) All Risk -Policy Debit Credit Note(3)

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LONPAC INSURANCE BHD 199401021735 (307414-T)

CONFIDENTIAL

Head Office: LG, 6th, 7th, 21st to 26th Floor, Bangunan Public Bank, No.6, Jalan Sultan Sulaiman, 50000 Kuala Lumpur. P.O.Box 10708, 50722 Kuala Lumpur. Tel: (03) 2262 8688, 2723 7888 Fax: (03) 2715 1332, 2078 7455, 2034 2654, 2715 0722, 2072 3385, 2715 0696, 2723 7886 Website: www.lonpac.com (Service Tax No. : W10-1808-31041975)

INVOICE INVOIS Name Nama

Address Alamat

Account No.

: PERBADANAN PENGURUSAN TIARA FABER &/OR CHARTWELL ASSET MANAGEMENT SDN BHD AS PROPERTY MANAGER

Policy No.

: MANAGEMENT OFFICE KONDOMINIUM TIARA FABER 456 JALAN DESA UTAMA TAMAN DESA 58100 KUALA LUMPUR

No. Invois

: W/21/GB00/165148/KUL-06

No. Polisi

Invoice No.

: W21GB00165148KUL

Date

: 12/01/2021

Tarikh

: W37115/KUL-7

No. Akaun

Class of Policy Jenis Insurans

Inception Date Of Policy

: BURGLARY

: 01/01/2021

Tarikh Mula Polisi

No.

Description

Total (RM)

1 2 3

Gross Premium Premium Kasar Bank Charges Caj Bank Service Charges Caj Perkhidmatan

75.00 0.00 0.00

4 5 6

Total (excluding Service Tax) Jumlah (tidak termasuk Cukai Perkhidmatan) Service Tax Cukai Perkhidmatan @ 6.00 % Stamp Duty Duti Setem

75.00 4.50 10.00

7

Total Due Jumlah Perlu Dibayar

89.50

Biller Code: 6288 Ref-1: W21GB00165148KUL06 Ref-2: W37115KUL7 JomPAY online at Internet and Mobile Banking with your Current, Savings or Credit Card account

DEPUTY CHIEF EXECUTIVE OFFICER IMPORTANT NOTE NOTA MUSTAHAK PREMIUM DUE (NON - MOTOR) MUST BE PAID WITHIN 60 DAYS FROM THE INCEPTION OF THIS POLICY/ENDORSEMENT

JomPay - Please refer details above. Sila rujuk butiran seperti di atas.

Signature of Card Holder / Tandatangan Pemegang Kad Name / Nama: Date / Tarikh:

M M

Y Y

NRIC No. / No. KP:

Payment Slip

Credit Card Payment - Please charge to my credit card account: Bayaran Kad Kredit - Sila caj akaun kad kredit saya Visa / Visa Master Card / Kad Master Name of Card Holder / Nama Pemegang Kad: Amount (RM) / Amaun (RM): Card Expiry Date: Card No.: Tarikh Luput Kad No. Kad

Other Payment Channels Saluran Bayaran Lain (Please login to www.lonpac.com for details) • Lonpac Website www.lonpac.com • Bill payment via www.pbebank.com • IBG to CIMB Virtual Account allotted to you • Cheque/Bank Draft/Postal Order • Bank in cheque to PBB Account No.3999208833 at Public Bank counter

21/GB00/Mar v-1.0.0

MODE OF PAYMENT CARA PEMBAYARAN

W/37115/KUL-CTJ

PREMIUM PERLU DIBAYAR (KECUALI MOTOR) MESTI DIJELASKAN DALAM MASA 60 HARI DARI TARIKH MULA POLISI/PENGENDORSAN INI.