QUOTE REFERENCE: 16307 Page 1

QUOTATION SLIP

TYPE: Medical Professional Indemnity Takaful (MedPro)

COVERAGE: The Takaful Operator will indemnify or pay on behalf of the Participant
against civil liability for compensation and claimant's costs and expenses in
respect of any Claims first made against the Participant during the Takaful
Period and notified to the Takaful Operator during the Takaful Period
resulting from the conduct of the Professional Healthcare Services.

TAKAFUL OPERATOR: Etiqa General Takaful Berhad

PARTICIPANT: NOR AZMI BIN MOHAMAD @GHAZALI

NRIC / PASSPORT NUMBER: 710606115125

LICENSE NUMBER: 33749

SPECIALIST (NSR Number): 130634

PLACE OF PRACTICE: MSU

FIELD: Otorhinolaryngology (ENT)

MAILING ADDRESS: E-7-9 Sri Putramas, Jalan Putramas1 off Jalan Kucing, 51200, KL

PERIOD OF TAKAFUL: Commencement Date: 01/01/2025; subject to no known claim

circumstances and/or notifications from
01/01/2025 till <date of holding cover>
Expiry Date: 31/12/2025
Both dates inclusive at 12.01 AM Local Standard Time.

LIMIT OF LIABILITY: RM 5,000,000.00

NO CLAIMS DISCOUNT (%): 0%

BASE CONTRIBUTION: RM 6,300.00
SERVICE TAX (8%): RM 504.00
STAMP DUTY: RM 10.00
TOTAL ANNUAL RM 6,814.00
CONTRIBUTION:
TERMS & CONDITIONS: As per Certificate wording

DISCLAIMER: 1. No known claims or potential circumstances as at inception of risk.

2. No material changes to the risk between date of submission and
inception of risk.

DATED: 6/11/2024
QUOTE REFERENCE: 16307 Page 2

PRODUCT DISCLOSURE SHEET ETIQA GENERAL TAKAFUL BERHAD ('' We / Us /

Our'')
Read this Product Disclosure Sheet before you decide Medical Professional Indemnity Takaful
to participate in the Medical Professional Indemnity Date: 27/1/2021
Takaful. Be sure to also read the general terms and
conditions

1. What is this product about?

Medical Professional Indemnity Takaful is a Professional Indemnity Takaful to cover medical malpractice of
medical professionals. It provides indemnity to the Participants and will respond in both defending the claims and
when necessary paying for the damages. It is also written on a "Claims Made" basis.

2. What are the Shariah concepts applicable?

Wakalah

This product applies the Wakalah (agency) concept, whereby the Participants appoint Us to act on their behalfto invest
and manage the General Takaful Fund (Fund). The Participants also agree to authorize Us to delegate Our rights,
duties and obligations to any third party as We deem fit for the purpose of achieving the objective to invest and
manage the Fund, provided that, in the event of any such delegation, We will remain liable and responsible for all
such rights, duties and obligations towards the Participant. As an agent, We are entitled to receive a Wakalah Fee
as a service charge.

Tabarru'

This plan also applies the Tabarru' (contribution) concept, whereby the Participants agree to donate or contribute
their contributions to the Fund for the purpose of mutual aid and assistance to the Participants based on the pre-
agreed events, in case of need. At the end of each financial year, any distributable surplus in the Fund, less
repayment of historic deficits, makes allowance for contingency provisions, and is subject to the surplus policy
approved by Our Shariah Committee is shared 50% among the Participants whose certificates have not terminated
and who have not made any claims within the financial year, and 50% to Us for operating and managing the Fund,
based on the contract of Ju'alah. Ju'alah is a wage contract that specifies the share of the distribution of surplus on
this basis. If the surplus is less than RM10.00, it will be credited to charitable fund which will be utilized as 'amal
jariah' on behalf of the participant. The charitable fund will be distributed to eligible recipients as approved by Our
Shariah Committee for charitable purposes.

3. What are the Covers / Benefits provided?

The Certificate will indemnify or pay on behalf of the Participant against civil liability for compensation and claimant's
costs and expenses in respect of Claims resulting from the conduct of the Professional HealthcareServices of the
Participant.

The duration of cover is for one year. You need to renew your Takaful cover annually.

Note: Please refer to the takaful certificate for more information on the above benefits.

4. How much contribution do I have to pay?

• The annual contribution will be as stated per the generated quotation slip.
• All contributions (if applicable) will be subjected to relevant charges or taxes including Service Tax as deemed
necessary by the Malaysia tax authorities. It is important to keep any receipt that you receive as proofof payment of
contributions.

DATED: 6/11/2024
QUOTE REFERENCE: 16307 Page 3

5. What are the fees and charges that I have to pay?

Type Amount (RM)

Service Tax (ST) 8% of the contribution

Wakalah Fee 22% of contribution of which:

• Commission paid to the intermediary – 15%
• Management expenses – 7%

Stamp Duty RM10

6. What are some of the key terms and conditions that I should be aware of?

Importance of Disclosure:

a) Pursuant to Paragraph 5 of Schedule 9 of the Islamic Financial Services Act 2013, if you are applying for this
takaful wholly for purposes unrelated to your trade, business or profession, you have a duty to take reasonable
care not to make a misrepresentation in answering the questions in the Application Form (or when you apply
for this takaful). You must answer the questions fully and accurately.

b) Failure to take reasonable care in answering the questions may result in avoidance of your contract of takaful,
refusal or reduction of your claim(s), change of terms or termination of your contract of takaful.

c) The above duty of disclosure shall continue until the time your contract of takaful is entered into, varied or
renewed with us.

d) In addition to answering the questions in the Application Form (or when you apply for this takaful), you are
required to disclose any other matter that you know to be relevant to our decision in accepting the risks and
determining the rates and terms to be applied.

e) You also have a duty to tell us immediately if at any time after your contract of takaful has been entered into,
varied or renewed with us any of the information given in the Application Form (or when you applied for this
takaful) is inaccurate or has changed.

Terms and Conditions - We reserve the right to amend the terms, exclusions and conditions of this certificateby
giving you thirty (30) days prior notice in writing by ordinary post to your last known address in our records. You
shall give thirty (30) days written notice to us immediately if at any time after your contract of takaful has been
entered into, varied or renewed with us any of the information given in this Application Form is inaccurateor has
changed.

Claims – The Participant shall give written notification of any Claims to the Takaful Operator as soon as
practicable after the Participant becomes aware of the Claim and if Extension 7.1.9 Sixty (60) Day Reporting
Period is provided, the Participant may continue to notify the Takaful Operator of Claims up to sixty days (60)
after the expiry of the Takaful Period but only for Claims first made against the Participant during the Takaful
Period and based on any act, error or omission committed or alleged to have been committed prior to expiry of
the Takaful Period.

Note: This list is non-exhaustive. Please refer to the Takaful Certificate for the full list of Conditions under the
Certificate.

7. What are the major Exclusions under this Takaful Certificate?

a) Prior Claims or Known Circumstances Exclusion

b) Asbestos Exclusion
c) Intoxicants and Drugs Exclusion
d) Terrorism Exclusion
e) War Exclusion
f) Molestation and Sexual Abuse Exclusion
g) Any other Events prohibited by Shariah Principles.
Note: This list is non-exhaustive. Please refer to the Takaful Certificate for the full list of Exclusions under the
Certificate.

DATED: 6/11/2024
QUOTE REFERENCE: 16307 Page 4

8. Can I cancel my Certificate?

You may cancel your certificate at any time by giving written notice to us. The Takaful Operator will retain the
Contribution calculated at pro-rata proportion of the Full Annual Contribution for the time it has been on risk plus
10% of Full Annual Contribution and the Participant will receive a refund of any balance of the Contribution actually
paid, unless there have been any notifications during the Takaful Period, in which case no refund shall be given.

9. No Claim Discount on Renewal

In the event of no claim having been made on this Certificate, and the renewal of this takaful being effected with the
Takaful Operators hereon, the Takaful Operators will allow the Participant a No Claim Discount of 5.0% of the
Contribution paid on the next renewal hereon.

10. What do I need to do if there are changes to my contact details?

It is important that you inform us of any changes in your contact details to ensure that all correspondences reach
you in a timely manner.

11. Where can I get further information?

Should you require additional information about the Medical Professional Indemnity Takaful, please refer to the
Medical Professional Indemnity Takaful online portal or Etiqa agents.

Alternatively, you may also contact us at:

Etiqa General Takaful Berhad (201701025031)

(Licensed under Islamic Financial Services Act 2013 and regulated by Bank Negara Malaysia)

Level 13, Tower B, Dataran Maybank

No. 1, Jalan Maarof
59000 Kuala Lumpur, Malaysia.

Telephone Number: +603 2297 3888

Facsimile Number: +603 2297 3800
Etiqa Oneline: 1300 13 8888

E-mail: info@etiqa.com.my

Homepage: www.etiqa.com.my

IMPORTANT NOTE:

YOU SHOULD READ AND UNDERSTAND THE TAKAFUL CERTIFICATE AND DISCUSS WITH THE
INTERMEDIARY OR CONTACT US DIRECTLY FOR MORE INFORMATION.

The information provided in this disclosure sheet is valid as at 27/1/2021.

DATED: 6/11/2024