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AIA PUBLIC TAKAFUL BHD (924363-W)
Wisma AIA, 99, Jalan Ampang, 50450 Kuala Lumpur.
www. aiapublic.com.my
BORANG PENCARIAN FAKTA PELANGGAN
ORANG YANG DILINDUNGI PASANGAN / PEMBAYAR
Nama Pemohon : Nama Pemohon :
No. KP (baru) :
(lama) :
No. KP (Baru) :
(lama)
Tinggi (cm) : Berat (kg) : Tinggi (cm) : Berat (kg) :
Telefon (hp) : Pejabat : Telefon (hp) : Pejabat :
E-mail : E-mail :
Alamat : Alamat :
Pekerjaan :
Kelas : Pendapatan (RM) :
Pekerjaan :
Kelas : Pendapatan (RM) :
Nama Majikan :
Alamat Majikan :
Nama Majikan :
Alamat Majikan :
Merokok : (Ya /Tidak) Bil batang/ hari Merokok : (Ya /Tidak) Bil batang/ hari
Rawatan Akhir : Tarikh :
Klinik :
Rawatan Akhir : Tarikh :
Klinik :
MAKLUMAT ANAK DAN TANGGUNGAN
Nama Tarikh Lahir No. KP/ Sijil Lahir Tinggi Berat Catatan / Rawatan Akhir
RUJUKAN
Nama :
Pekerjaan : Telefon :
Alamat :
Nama :
Pekerjaan : Telefon :
Alamat :
MAKLUMAT WARIS HIBAH (bagi kes A-MAS sahaja)
Nama :
Pekerjaan :
No. KP : Telefon :
Alamat :
Nama :
Pekerjaan :
No. KP : Telefon :
Alamat :
MAKLUMAT KAD KREDIT / DEBIT
No. Akaun :
Tarikh Tamat Tempoh Kad :
Nama Bank :
No. Akaun :
Tarikh Tamat Tempoh Kad :
Nama Bank :
T/T PEMOHON T/T PESERTA CATATAN RM :
(M-Q-S-A)

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Borang pencarian fakta pelanggan

  • 1. AIA PUBLIC TAKAFUL BHD (924363-W) Wisma AIA, 99, Jalan Ampang, 50450 Kuala Lumpur. www. aiapublic.com.my BORANG PENCARIAN FAKTA PELANGGAN ORANG YANG DILINDUNGI PASANGAN / PEMBAYAR Nama Pemohon : Nama Pemohon : No. KP (baru) : (lama) : No. KP (Baru) : (lama) Tinggi (cm) : Berat (kg) : Tinggi (cm) : Berat (kg) : Telefon (hp) : Pejabat : Telefon (hp) : Pejabat : E-mail : E-mail : Alamat : Alamat : Pekerjaan : Kelas : Pendapatan (RM) : Pekerjaan : Kelas : Pendapatan (RM) : Nama Majikan : Alamat Majikan : Nama Majikan : Alamat Majikan : Merokok : (Ya /Tidak) Bil batang/ hari Merokok : (Ya /Tidak) Bil batang/ hari Rawatan Akhir : Tarikh : Klinik : Rawatan Akhir : Tarikh : Klinik : MAKLUMAT ANAK DAN TANGGUNGAN Nama Tarikh Lahir No. KP/ Sijil Lahir Tinggi Berat Catatan / Rawatan Akhir RUJUKAN Nama : Pekerjaan : Telefon : Alamat : Nama : Pekerjaan : Telefon : Alamat : MAKLUMAT WARIS HIBAH (bagi kes A-MAS sahaja) Nama : Pekerjaan : No. KP : Telefon : Alamat : Nama : Pekerjaan : No. KP : Telefon : Alamat : MAKLUMAT KAD KREDIT / DEBIT No. Akaun : Tarikh Tamat Tempoh Kad : Nama Bank : No. Akaun : Tarikh Tamat Tempoh Kad : Nama Bank : T/T PEMOHON T/T PESERTA CATATAN RM : (M-Q-S-A)