Muat turun borang aduan BNM - InsuranceInfo

BANK NEGARA MALAYSIACENTRAL BANK OF MALAYSIAPROSEDUR MEMBUAT ADUANInsurans / TakafulInsurance /TakafulPERKARA-PERKARA YANG PERLU ANDA TAHU SEBELUMMEMBUAT ADUANBORANG ADUANComplaint FormPROCEDURE ON LODGING COMPLAINTTHINGS THAT YOU SHOULD KNOW BEFORE LODGINGA COMPLAINTAnda hendaklah mendapatkan penyelesaian aduan anda denganUnit Aduan syarikat insurans/takaful terbabit sebelummelengkapkan borang aduan ini.Sekiranya anda tidak berpuas hati dengan maklum balas ataukeputusan syarikat insurans/takaful terbabit, anda bolehmengemukakan aduan sama ada kepada Biro PengantaraanKewangan (BPK) atau Bank Negara Malaysia (Bank). Sila semakdengan Unit Aduan syarikat insurans/takaful terbabit tentangsaluran yang betul untuk mengemukakan aduan anda.Sekiranya anda ingin mengemukakan aduan kepada BPK, iahendaklah dikemukakan dalam tempoh enam bulan selepassyarikat insurans/takaful membuat keputusan muktamadnya.Aduan-aduan yang dikemukakan ke BPK adalah terhad kepada:• RM200,000 bagi polisi motor dan kebakaran• RM100,000 bagi lain-lain jenis polisi; dan• RM5,000 bagi kerugian atau kerosakan harta benda pihakketiga.BPK, walau bagaimanapun, tidak mengendalikan aduan yangmelibatkan harga produk insurans/takaful, isu-isupengunderaitan, kes-kes penipuan dan kes yang telah atausedang dirujuk ke mahkamah.Alamat BPK:You should try to resolve your complaint with the ComplaintsUnit of the insurer/takaful operator concerned beforecompleting this form.If you are not satisfied with the response or decision of theinsurer/takaful operator concerned, you may submit yourcomplaint either to the Financial Mediation Bureau (FMB) orBank Negara Malaysia (the Bank). Kindly check with theComplaints Unit of insurer/takaful operator concerned on theproper avenue for dealing with your complaint.If you need to submit your complaint to FMB, it must bedone within six months from the date of the insurancecompany /takaful operator’s final decision.Complaints referred to the FMB are limited to:• RM200,000 for motor and fire policies• RM100,000 for other classes of policies; and• RM5,000 for third party property damageThe FMB, however, will not handle complaintsinvolving pricing of insurance products, underwriting, fraudcases, and cases that have been or are being referredto the court.FMB’s address:Biro Pengantaraan KewanganTingkat 25, Bangunan Darul Takaful4, Jalan Sultan Sulaiman50000 Kuala LumpurNo. Telefon: 03-2272 2811No. Faksimili: 03-2274 5752Kes-kes yang tidak dikendalikan oleh BPK boleh dikemukakan keBank.Bank, walau bagaimanapun, tidak mengendalikan:• aduan yang melibatkan tuntutan yang melebihi RM500,000,kecuali ia melibatkan kualiti perkhidmatan dan pengendaliantuntutan yang tidak adil;• aduan yang telah dikemukakan kepada BPK atau mahkamahdan yang dikemukakan melalui firma-firma peguam atau yangsedang mereka kendalikan (kecuali tentang pengesahanperlindungan insurans/takaful);• aduan mengenai bengkel kereta yang tidak tersenarai dalamSkim Bengkel Pembaik Kereta Persatuan Insurans AmMalaysia (PIAM).• aduan daripada ejen terhadap prinsipalnya; dan• aduan oleh kakitangan terhadap majikan mereka.For all other cases which are not within the purview ofFMB may be referred to the Bank.The Bank, however, will not handle:• complaint involving claim exceeding RM500,000except if it relates to a complaint on the quality ofservice and unfair claim handling;• complaint which has been forwarded to FMBor the court, and referred by legal firms orunder their conduct (except on confirmation ofcover);• complaint against a motor workshop whichis not under PIAM Approved Repairers Scheme.• complaint by agent against his/her principal; and• complaint by staff against their employer.

BANK NEGARA MALAYSIACENTRAL BANK OF MALAYSIABORANG ADUANComplaint FormMAKLUMAT PENGADUComplainant’s DetailNamaNameNo. K.PI.C. No.No. Pendaftaran PerniagaanBusiness Registration No.Alamat Surat MenyuratCorrespondence AddressNo. Tel.Tel.No.FaksFaxe-mele-mailMAKLUMAT ADUANComplaint DetailsNama Syarikat insurans / Pengendali takafulName of Insurance company / Takaful operatorNo.PolisiPolicy No.Jumlah diinsurankanAmount insuredJenis Polisi Insurans / Takaful (sila tandakan )Type of Insurance Policy / Takaful (please tick )MotorMotorHayat / KeluargaLife / FamilyKebakaranFireLain-lain, sila nyatakanOthers, please specifyJenis Aduan (sila tandakan )Type of Complaint (please tick)TuntutanClaimsKelewatanDelayTidak berpuas hati dengantawaranUnsatisfactory offerJumlah yang dituntutClaim amountNo. RujukanReference no.LiabilitiLiabilityPengunderaitanUnderwritingTiada PembaharuanNon-renewalKelewatan mengeluarkan polisiDelay in policy issuancePerubatan & KesihatanMedical & HealthKemalangan DiriPersonal AccidentPemasaran & PenjualanMarketing & SalePerkhidmatan EjenAgent’s servicesTeknik jualan secara paksaPressure selling techniquesPenolakan tuntutanRepudiationLain-lain, sila nyatakanOthers, please specifyTahun kritikalCritical yearNilai serahan & bonus polisiSurrender values & policy bonusesPembatalan polisi / pemulanganpremiumPolicy cancellation / premiums refundsIllustrasi jualan & risalah yangmengelirukanMisleading illustrations & brochures

BANK NEGARA MALAYSIACENTRAL BANK OF MALAYSIAADUAN SAYA ADALAH SEPERTI BERIKUT:(Sila lampirkan salinan dokumen-dokumen yang berkaitandengan aduan ini dan pastikan fakta-fakta mengenai aduan iniditerangkan dengan jelas.)BORANG ADUANComplaint FormMY COMPLAINT IS AS FOLLOWS:(Please enclose photocopies of the relevantdocuments and ensure that the facts ofcomplaint are explained clearly)............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Saya mengaku bahawa maklumat di atas adalah benar dan diberikan secarasukarela. Saya faham adalah penting untuk memberikan maklumatsepenuhnya mengenai aduan saya supaya Bank dapat menyiasatnyadengan secepat yang mungkin. Saya juga memberi kebenaran kepadaBank untuk mengemukakan borang aduan lengkap saya bersertadokumen berkaitan kepada syarikat insurans/takaful berkenaan agaraduan saya dapat disiasat dengan sewajarnya.I hereby declare that the information above is trueand given voluntarily. I understand that it is importantfor me to provide full information of my complaint sothat the Bank can investigate my complaint as soonas possible. I also give my permission to the Bankto forward my completed complaint form and therelated documents to the insurer/takaful operatorconcerned in order for my complaint to be properlyinvestigated.TandatanganSignatureTarikhDate