This document is a wills form in Malay that collects information about the testator (person making the will), beneficiaries, guardians, assets, and instructions. It requests details like names, addresses, citizenship, religion, marital status, race, phone numbers, email addresses, ID numbers, relationship to testator, and descriptions of movable and immovable assets. The testator affirms their intent to appoint AmanahRaya as the executor and trustee to carry out the instructions in their will.
Claim intimation form seek information from the insured individual about self, illness he/ she is suffering from and kind of treatment against which the claim is filed. Apollo Munich explains the procedure to be followed while filing claim for coverage under Maxima health plan. The form is to be filled to intimate the insurer about the treatment to be availed and the related expenditure. It includes information about the policyholder, the diagnosis to be done, expected treatment expenses, address, date of birth and contact details. The claim settlement will depend on the information and documents provided by the insured. Also, the claimant must submit the claim intimation form as soon as possible, in order to allow the insurance company to work over it.
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Claim intimation form seek information from the insured individual about self, illness he/ she is suffering from and kind of treatment against which the claim is filed. Apollo Munich explains the procedure to be followed while filing claim for coverage under Maxima health plan. The form is to be filled to intimate the insurer about the treatment to be availed and the related expenditure. It includes information about the policyholder, the diagnosis to be done, expected treatment expenses, address, date of birth and contact details. The claim settlement will depend on the information and documents provided by the insured. Also, the claimant must submit the claim intimation form as soon as possible, in order to allow the insurance company to work over it.
Complete submission of the required documents is extremely important. It will affect the kind of coverage offered by the insurer.
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Application Form for DOLE registration of Job, Contractors and Sub Contractors (Semi-Annually).
Fill up this form and submit it to your RDO DOLE thru Email.
1. BORANG WASIAT
WILLS FORM
Sila gunakan HURUF BESAR dan lengkapkan borang dengan DAKWAT HITAM /
Please write in CAPITAL LETTERS and complete the form in BLACK INK.
Sila tanda ( √ ) jika berkenaan / Please tick ( √ ) where applicable.
PILIHAN BAHASA DALAM SURAT WASIAT/ LANGUAGE FOR WILL DOCUMENT :
2.0 KETERANGAN MENGENAI PEWASIAT / Particulars of Testator
Nama Penuh / FullName
(Seperti Dalam Kad Pengenalan /
AsstatedinNRIC)
No.K.P. Baru/NewNRICNo. -
-
No.K.P. Lama / Polis/Tentera/
Pasport / OldNRICNo./Police/Army/
Passport
No Tel. Rumah / HomeTelNo.
No. Tel Pejabat / OfficeTel.No.
No. Tel. Bimbit /
HandphoneNo.
E-mel / E-Mail
1/5
JPP004/D1 (S5/2013)
Lelaki / Male Perempuan / Female
Jantina / Sex:
Alamat Surat Menyurat /
CorrespondenceAddress
Poskod / Postcode. Bandar / Negeri /
Town/State
Alamat Tetap/
PermanentAddress
Poskod / Postcode. Bandar / Negeri /
Town/State
Warganegara / Citizenship: Malaysia / Malaysian Lain-lain /
Others (Sila nyatakan / Pleasespecify)
Agama / Religion : Buddha /
Buddhist
Islam /
Muslim
Hindu /
Hindu
Kristian /
Christian
Lain-lain /
Others
(Sila nyatakan / Pleasespecify)
Bahasa Malaysia / Malay Language Bahasa Inggeris / English Language
Taraf Perkahwinan / MaritalStatus Bujang / Single Berkahwin /
Married
Duda / Janda
Divorcee
Bangsa / Race Melayu / Malay Cina /
Chinese
India /
Indian
Lain-lain /
Others (Sila nyatakan / Pleasespecify)
No. Pendaftaran Wasiat
1.0 JENIS PERMOHONAN / Type of Application
Permohonan Baru/
NewApplication
Pindaan /
Amendment
Penyimpanan /
Custodianship
Insurans /
Insurance
Sila baca‘Panduan dan Arahan bagi Borang Wasiat JPP004/D1(S5/2013) yang
disertakan sebelum mengisi borang ini.
Please read the enclosed ’Guideline and Instruction for Will form JPP004/D1(S5/2013)’.
2. 3.0 KETERANGAN MENGENAI PENJAGA / Particularof Guardian
2/5
JPP004/D1 (S5/2013)
4.0 KETERANGAN MENGENAI PENJAGA GANTIAN / Particulars of Subtitute Guardian
5.0 KETERANGAN MENGENAI WARIS CACAT (JIKA ADA) / Particulars of Disable Beneficiary (s) (if any)
Nama Penjaga /
Name of Guardian
Nama Benefisiari /
Name of Beneficiary (s)
Hubungan dengan Pewasiat/
Relationship with Testator
Alamat / Address
No. Telefon / Tel. No.
Emel / Email
No. K.P / No.K.P. Lama/Polis/Tentera/
Pasport /NRICNo. /OldNRICNo./Police/Army/Passport.
No. Faks / Fax No.
Nama Penjaga /
Name of Guardian
Nama Benefisiari /
Name of Beneficiary (s)
Hubungan dengan Pewasiat/
Relationship with Testator
Alamat / Address
No. Telefon / Tel. No.
Emel / Email
No. Faks / Fax No.
Bil/No. Nama / Name Jenis Kecacatan /
Type of Disablement
HubungandenganPewasiat/
RelationshipwithTestator
No. K.P / No.K.P. Lama/Polis/Tentera/
Pasport /NRICNo. /OldNRICNo./Police/Army/Passport.
No. K.P / No.K.P. Lama/Polis/Tentera/
Pasport /NRICNo. /OldNRICNo./Police/Army/Passport.
Nama Penuh / FullName
Alamat Surat Menyurat /
CorrespondenceAddress
Poskod / Postcode. Bandar / Negeri /
Town/State
No Tel. Rumah / HomeTelNo. No. Tel. Bimbit /
HandphoneNo.
Hubungan dengan Pewasiat /
RelationshipwithTestator:
Nama orang untuk dihubungi bagi mengesahkan kematian / Name of person to be contacted for death confirmation.
3. 3/5
6.0 KETERANGAN MENGENAI HARTA PEWASIAT DAN MAKLUMAT PENERIMA / Particulars of Assets and Recipient (s)
6.1 HARTA TAK ALIH / Immovable Assets
Bil /
No.
Nama / Name
Maklumat Penerima / Particulars of Recipient (s)
Keterangan Harta Tak Alih
Particulars of Immovable Assets
Hubungan dengan
Pewasiat /
Relationship with Testator
Bahagian /
Share
No. K.P / No.K.P.
Lama/Polis/Tentera/ Pasport
/NRICNo. /OldNRIC/Police/Army/
Passport.
Bahagian Pewasiat /
Testator’s Share
JPP004/D1 (S5/2013)
4. 4/5
6.2 HARTA ALIH / Movable Assets
Bil /
No.
Nama / Name
Maklumat Penerima / Particulars of Recipient (s)
Hubungan dengan
Pewasiat /
Relationship with Testator
Bahagian /
Share
Keterangan Harta Alih
Particulars of Movable Assets
Bahagian Pewasiat /
Testator’s Share
No. K.P / No.K.P.
Lama/Polis/Tentera/Pasport
/NRICNo. /OldNRICNo./Police/Army/
Passport.
JPP004/D1 (S5/2013)
5. 7.0 LAIN-LAIN ARAHAN PEWASIAT / Other Instruction (s) of Testator
5/5
JPP004/D1 (S5/2013)
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8.0 AKTA PERLINDUNGAN DATA PERIBADI 2010 / The Personal Data Protection Act 2010
Dengan menyempurnakan borang ini anda membenarkan maklumat peribadi anda untuk digunakan oleh AmanahRaya dan/atau anak syarikatnya untuk memberikan anda
perkhidmatan AmanahRaya dan/atau anak syarikatnya yang bersesuaian dengan anda. Maklumat peribadi yang diberikan oleh anda akan digunakan untuk pentadbiran dan
pengurusanperkhidmatanyangdiberikankepadaanda.Maklumatperibadiandabolehdigunakanuntukmemberiandamaklumatlanjutmengenaiprodukdanperkhidmatan
yang sesuai dengan anda daripada AmanahRaya dan / atau anak syarikatnya Maklumat tersebut adalah sulit dan persendirian dan tidak akan dikemukakan kepada pihak
ketiga tanpa kebenaran anda. Semua maklumat yang diberikan oleh anda dalam borang ini adalah tepat, lengkap dan terkini. Jika anda ingin mengemaskini maklumat
peribadi anda, sila hubungi kami di talian 03-20729999/ 03-20557388.
In completing this form you consent for the personal information contained in this form to be used for the purposes of providing you with the relevant services of AmanahRaya and/or its
subsidiaries. The personal information provided by you will also be used to administer and manage the service that is provided to you. The personal information may be used to provide you
with further information about AmanahRaya and/or its subsidiaries, its products and services that may be of interest to you. The said information will be kept as private and confidential
and will not be disclosed to third parties without your consent. All personal information provided by you in this form is accurate, complete and up-to-date. If you require for your personal
information to be updated or corrected please contact us at 03-20729999/ 03-20557388.
______________________________________
Tandatangan Pewasiat / Signature Of Testator
Tarikh / Date :
9.0 PENGESAHAN PEWASIAT / Affirmation by Testator
SAYA _______________________________________ No. K.P/No.K.P. Lama/Polis/Tentera/Pasport _________________________ bersetuju melantik
AmanahRaya sebagai Wasi dan Pemegang Amanah bagi Wasiat saya.
I ___________________________________________ NRIC No./Old NRIC No./Police/Army/Passport _________________________ hereby agree to
appoint AmanahRaya as the Executor and Trustee for my Will.
______________________________________
Tandatangan Pewasiat / Signature of Testator
Tarikh / Date :
Ya / Yes Tidak / No
Penyimpanan Wasiat di Amanah Raya Berhad /CustodyofWillatAmanahRayaBerhad
Tahunan/
Yearly
Sepanjang Hayat/
Lifetime
________ Tahun / Years
(Sila Nyatakan/Please indicate)
10.0 UNTUK KEGUNAAN PEJABAT SAHAJA / For Official Use Only
AMANAH RAYA BERHAD
Tingkat 14 ,Wisma AmanahRaya, No.2, Jalan Ampang
50508 Kuala Lumpur Malaysia
Tel : 03-2055 7388 / Faks : 03-2070 1703 / 03-2055 7594
Website : www.amanahraya.com.my
Sila nyatakan tempoh penyimpanan / Please Indicate period of custody