‘A’ PERMIT VEHICLE RISK ASSESSMENT FORM

BORANG IZIN PENILAIAN RISIKO 'A' PERMIT

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    Proposer’s Details (Butiran Pencadang)

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    Vehicle Details (Use attachment list if necessary) Butiran Kenderaan (Gunakan senarai lampiran jika perlu)

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    Risk Management - Vehicle (Pengurusan Risiko - Kenderaan)

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    Risk Management - Driver (Pengurusan Risiko - Pemandu)

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    Insured’s Total Business Support (Jumlah Sumbangan Premium Pencadang)

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    Non motor insurance support for this application (Sumbangan Premium Bukan Motor insuran untuk aplikasi ini)

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    Agent’s Details (Butiran Ejen anda)

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    For HQ U/W Use Only (Untuk Kegunaan Pengunderitan HQ )

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    Signature of Underwriter

    Date of Underwriter Signature

    Important Note : (Nota Penting)

    Logistic, Forwarding & Transportation Company, Lorry carrying Construction materials, Palm Oil, Waste & Garbage material are strictly declined. Please chop and signed the Undertaking Letter for acceptance of ‘A’ Permit Vehicle. (Lojistik, Forwarding & Syarikat Pengangkutan, Lorry Pembawa Bahan Pembinaan, Minyak Kelapa Sawit, Hasil Pembuangan & Bahan Sampah secara ketat ditolak Sila Cop dan menandatangani Surat Penerimaan Syarat Permit 'A' Keizinan Kenderaan)
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