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id	Invoice Date	Debtor Code	Invoice No.	Effective Date	Expiry Date	Renewal	Class Code	Policy No.	Principal Code	Gross Amount	Net Amount

Insured Details

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Age

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Occupation

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Postcode

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Contact No. 1

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Policy

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Invoice No.

Invoice Date

Company Code *

Reference No.

Insured Name

Cover Note No.

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Internal Remarks

Principal Code *

Class Code *

Effective Date *

Expired Date *

Policy No.

Policy Date

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Policy Type *

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Type

Total Comm. %

Sum Insured

Premium

Total Comm. RM

Total Rebate %

Insurer Rebate

Total Rebate RM

Premium Adj.

Comm. After Rebate RM

Other Premium with Comm.

Other Premium without Comm.

Company Comm. %

Gross Premium Adj.

Company Comm. RM

Gross Premium

Company Rebate

Debtor Comm.

Tax

Introducer Comm.

Tax Amount

Stamp Duty

Principal RM

Total Pemium

Principal Adj.

Other Service Amount

Principal Payment Mode

Total Amount

Insured A/C

DATE	DN / CN / OR / PV	CLASS / VEHICLE	DESCRIPTION	BANK A/C	DEBIT	CREDIT	BALANCE

Agent A/C

DATE	DN / CN / OR / PV	CLASS / VEHICLE	DESCRIPTION	BANK A/C	DEBIT	CREDIT	BALANCE

Principal A/C

DATE	DN / CN / OR / PV	CLASS / VEHICLE	DESCRIPTION	BANK A/C	DEBIT	CREDIT	BALANCE

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Endorsement Listing

Id	Date	D/C Note	Endorsement No.	Gross Premium	Net Premium	Status	Action

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CN No.

CN Date

Company Code *

Reference No.

Insured Name

Cover Note No.

External Remarks

Internal Remarks

Principal Code *

Class Code *

Effective Date *

Expired Date *

Endorsement No.

Endorsement Date

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Premium

Endorsement Type

Total Comm. %

Premium

Total Comm. RM

Total Rebate %

Insurer Rebate

Total Rebate RM

Premium Adj.

Comm. After Rebate RM

Other Premium with Comm.

Other Premium without Comm.

Company Comm. %

Gross Premium

Company Comm. RM

Gross Premium Adj.

Company Rebate

Debtor Comm.

Tax

Introducer Comm.

Tax Amount

Stamp Duty

Principal RM

Total Pemium

Principal Adj.

Other Service Amount

Principal Payment Mode

Total Amount

Insured Details

Insured Details

Attn:

Type

Insured Name

NRIC/ ID

Date of Birth

Age

Gender

Race

Marital Status

Occupation

Address

Postcode

City

State

Email

Contact No. 1

Contact No. 2

Contact No. 3

Fax No.

Remarks

Insured Details

Type

Insured Name

Mother Company

Business Nature

Company No.

SST No.

SST Date

Person Contact

Remarks

Address & Contacts

Address

Postcode

City

State

Email

Contact No. 1

Contact No. 2

Contact No. 3

Fax No.

Risk Address & Contacts

Address

Postcode

City

State

Contact No. 1

Contact No. 2

Fax No.

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