Allianz General Insurance Company (Malaysia) Berhad (735426-V)

No. 9-1, First Floor, Pusat Perniagaan Raub
27600 Raub, Pahang Darul Makmur
Our Ref : VRB9001095
 
24 APRIL 2019
 
AMIN MOTOR SERVICE
NO 6,LORONG BBKL 2/2/2
BANDAR BARU KUALA LIPIS
27200 KUALA LIPIS
PAHANG DARUL MAKMUR

Dear Sirs
 
REF: INSURED : ADNAN BIN KAMARUDIN
POLICY NO. : 18VRB0000708-00
ACCIDENT TO VEHICLE NO. VQ4456 ON 24/12/2018
 
We refer to our representative's recent inspection of the above mentioned vehicle and confirm you may proceed with the repairs
with our approval at amount of RM792.09 gross. Upon deduction of policy excess(2f) of RM100.00 and nett liability will be
RM692.09.
 
Please be informed that we have confirmed that the market value of this vehicle should be at least RM6,500.00. As this vehicle
is under insured we have apportioned liability as follows:
 
Sum Insured RM3,000.00 x RM 1,716.20
Market Value RM6,500.00
 
Gross RM 792.09
Less Excess RM 100.00
Less Excess 2(f) RM 0.00
Nett RM 692.09
* Please note that the offer amount includes system usage of RM0.00 paid on our behalf.
 
To be borne by Insured:
 
Excess RM 100.00  
Under-insurance RM 924.11  
 
This offer is only valid once we have verified all relevant documents and the validity of the claim is confirmed. We reserve the
right to investigate/repudiate or rescind this offer if the claim is not in order. You must comply with the requirements of the Road
Transport Act and its subsidiary legislations in carrying out the repairs.
 
Upon completion of repairs to the satisfaction of our Insured, kindly collect the duly signed discharge voucher and the excess
amount (as stated) and the underinsurance difference from Insured. You may then send us the bill for RM692.09 together with
the duly signed Discharge Voucher for our attention. Please be informed that your compliance of the above is a condition
precedent to our liability to pay your bill.
 
Any comments or objection raised pertaining to the repair will not be regarded after seven (7) days hereof and the company
shall presume that the offer is accepted by all concerned.

Thank you.
 
Yours faithfully,
ALLIANZ GENERAL INSURANCE COMPANY (MALAYSIA) BERHAD
 
 
NUR MAYANTI SAHARUDIN TAMZIL
EXECUTIVE
CLAIMS
(This is a computer generated form, no signature required.)
 
 
Note: For offer amount above RM5,000.00, you are required to submit reinspection photographs on the repaired
vehicle for our further action.
 
cc Insured -  Kindly take note that upon your satisfaction of the repairs, please sign the attached Discharge Voucher and
pass them to the repairer concerned at the time you collect the vehicle.
 HEAD OFFICE - CLAIMS CUSTOMER SERVICE
Level 21, Menara Allianz Sentral  Tel: 03-2264 1188 Level 10, Menara Allianz Sentral  Tel: 03-2264 0700
203 Jalan Tun Sambanthan 03-2264 0688 203 Jalan Tun Sambanthan Fax: 03-2264 0602
Kuala Lumpur Sentral Fax: 03-2264 0402 Kuala Lumpur Sentral Toll Free: 1-300-88-1028
50470 Kuala Lumpur www.allianz.com.my 50470 Kuala Lumpur customer.service@allianz.com.my
 
 

Allianz General Insurance Company (Malaysia) Berhad (735426-V)

No. 9-1, First Floor, Pusat Perniagaan Raub
27600 Raub, Pahang Darul Makmur

MOTOR CLAIM DISCHARGE

 
INSURED : ADNAN BIN KAMARUDIN VEHICLE REGN. NO : VQ4456
CLAIM NO : VRB9001095 POLICY NO : 18VRB0000708-00

I/We confirm that I/we have taken delivery of Car/Lorry/Motor Cycle Registration No.  VQ4456 from the repairer, Messrs  AMIN

MOTOR SERVICE and that all repairs as a result of an accident in which the said vehicle was involved on or about the  24 day
of December 2018 have been completed to my/our satisfaction, and I/we have no further claims on the above Insurers in
respect thereof.
 
It is hereby agreed and understood that upon settlement of this claim the said Insurer will be subrogated to all my/our rights and
remedies in respect of the said damage and will be authorized to make use of my/our name for the purpose of any proceedings
or otherwise which the said Insurers deem fit to take for the enforcement of such rights or remedies and accordingly I/We
undertake to furnish all documents and correspondence and to make such affidavits or declarations and to give and generally
render such assistance as the said Insurer may require from time to time in connection with any such proceedings.
 
Dated ___________day of ____________(Month) _________ (Year)
WITNESS
Signature : Signature :
I/C No : I/C No :
Name : Name :
Address : Address :

Note: We hereby confirm that there is a warranty period of 90 days for any unsatisfactory repairs from the date of this duly
signed Discharge Voucher.
Enclosed herewith List of Approved Parts Breakdown for your perusal

*THIRD PARTY VERIFICATION

 
I_________________________NRIC No.______________________of____________________________
Hereby certify that the customer's / beneficiary's original NRIC / Business Registration Cerificate was verified and authenticated
prior to / at the time of payment of monies due under this claim. I further confirm that the relevant documents were sighted and
verified and there is no reason to suspect money laundering or financing of terrorism.
 
____________________________________
Signature
Date
 
Note: For insurance policies with annual premium exceeding RM50,000.00 and RM100,000.00 in respect of individual and
group policies respectively, a copy of the verified documents have been retained for record purposes.
 
*Third Party herein refers to an employee / an Agent of Allianz General Insurance Company (Malaysia) Berhad / a Broker / an
Adjuster / a Workshop Personnel acting on behalf of the insurers.

HEAD OFFICE - CLAIMS CUSTOMER SERVICE
Level 21, Menara Allianz Sentral  Tel: 03-2264 1188 Level 10, Menara Allianz Sentral  Tel: 03-2264 0700
203 Jalan Tun Sambanthan 03-2264 0688 203 Jalan Tun Sambanthan Fax: 03-2264 0602
Kuala Lumpur Sentral Fax: 03-2264 0402 Kuala Lumpur Sentral Toll Free: 1-300-88-1028
50470 Kuala Lumpur www.allianz.com.my 50470 Kuala Lumpur customer.service@allianz.com.my
 
 

Allianz General Insurance Company (Malaysia) Berhad (735426-V)

No. 9-1, First Floor, Pusat Perniagaan Raub
27600 Raub, Pahang Darul Makmur

 
Claim No: VRB9001095 Date: 24/04/2019
Repairer: AMIN MOTOR SERVICE   
REFERENCE
Insured: ADNAN BIN KAMARUDIN Policy No: 18VRB0000708-00
Date of Loss: 24/12/2018 Nature of Claim: OD
Sum Insured: RM 3,000.00 Market Value :  RM 6,500.00
DESCRIPTION & IDENTIFICATION OF VEHICLE
Reg. No: VQ4456 Type: BIKE - STANDARD
Make & Model: HONDA RS150R, 149CC Reg. Date: 09/02/2017
FS150FH2 [16-]
Engine No: KC27E2009321 Chassis No: PMKKC27C0HB004450
 
 
REPAIR DETAILS
Recommended Parts 
No. Qty Part No. Particulars Src Condition Svg %Depr Amount
1 1 *COVER SET F Broken - 0.00 Replace FS
2 1 *RADIATOR F Visually Intact - 0.00 Reuse  
3 1 *FORK F Bent - 0.00 Replace FS
Front LH
4 1 *T FORK F Visually Intact - 0.00 Reuse  
5 1 *BEARING F Visually Intact - 0.00 Reuse  
6 1 *HANDLE F Visually Intact - 0.00 Reuse  
7 1 *SIDE MIRROR F Cracked - 0.00 Replace FS
RH
8 1 *FOOTREST FRONT & BRACKET F Bent - 0.00 Replace FS
9 1 *GEAR LEVER F Bent - 0.00 Replace FS
10 1 *LAMP SIGNAL FRONT F Dropped off - 0.00 Replace FS
LH
11 1 *LAMP SIGNAL REAR F Bracket Broken - 0.00 Replace FS
LH
12 1 *NUMBER PLATE REAR F Broken - 0.00 Replace FS
13 1 *NUMBER PLATE FRONT F Grazed - 0.00 Replace FS
14 1 *COVER RADIATOR F Visually Intact - 0.00 Reuse  
15 1 *COVER ENGINE FRONT F Visually Intact - 0.00 Reuse  
16 1 *SPORT RIM F Dented - 0.00 Repair  
17 1 *DISC BRAKE FRONT F Visually Intact - 0.00 Reuse  
18 1 *CALIPER FRONT F Visually Intact - 0.00 Reuse  
19 1 *LEVER BRAKE F Visually Intact - 0.00 Reuse  
20 1 *INNER CENTER F Cracked - 0.00 Replace FS
21 1 *VAISOR FRONT F Cracked - 0.00 Replace FS
22 1 *FAN RADIATOR F Visually intact - 0.00 Reuse  
23 1 *AIR COOLANT F Not Necessary - 0.00 Serviceable  
24 1 *SKRU COVER F Visually Intact - 0.00 Reuse  
25 1 *MASTER KEY F Visually Intact - 0.00 Reuse  
Supplementary #1
26 1 *COVER SET RS150 F Broken - 0.00 Replace FS
Price difference RM 480.00 - RM 350.00
27 1 *FORK RS150 F Bent - 0.00 Replace FS
Front RHS
28 1 *HANDLE RS150 F Bent - 0.00 Replace FS
29 1 *THROTTLE F Necessary - 0.00 Replace FS
30 1 *TUBE THROTTLE F Necessary - 0.00 Replace FS
31 1 *SIDE MIRROR 1 SET F Cracked - 0.00 Repeat  
32 1 *GEAR LEVER RS150 F Bent - 0.00 Replace FS
Price difference RM 18.00 RM 16.80
33 1 *LAMP SIGNAL FRONT (L) F Bent - 0.00 Replace FS
Price difference RM 60.00 - RM 46.70
34 1 *BRACKET FOOTREST (L) F Bent - 0.00 Replace FS
35 1 *RUBBER FOOTREST FRONT F Torn - 0.00 Replace FS
Price difference RM 20.00 - RM10.80
36 1 *LAMP SIGNAL FRONT (R) F Visually Intact - 0.00 Reuse  
37 1 *FRONT PLATE NUMBER F Required - 0.00 Repeat  
38 1 *REAR PLATE NUMBER F Required - 0.00 Repeat  
39 1 *CENTER INNER F Broken - 0.00 Replace FS
Price difference RM 35.00 - RM 25.00
40 1 *FRONT VISOR F Cracked - 0.00 Replace FS
Price difference RM 25.00 - RM 18.00
41 1 *SCREW COVER SET & CLIP F Necessary - 0.00 Replace FS
42 1 *STICKER COVER SET F Necessary - 0.00 Replace FS
Src=Price Source (F=MRC Franchise,NF=MRC Non-Franchise,O=Others). F=Franchise part. S=SpcDisc. 
Allianz General Insurance Company (Malaysia) Berhad/VQ4456/24/04/2019 09:17

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