|Customer Address||Customer Mobile Number|
|Customer E-Mail||Customer Gender|
|Customer Age||Start Date- End Date & No of Days|
|Hospitalization and Surgical Expenses||RM3,000.00|
|Weekly Benefits(Up to maximum of 15 weeks)||RM120.00|
|Personal Accident Insurance|
|Medical Expenses-excess RM 50.00||RM750.00|
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