SULIT Private and Confidential

INSTRUCTIONS TAKING FORM BORANG ARAHAN MENULIS WASIAT (670367-D)

Sila gunakan HURUF BESAR/Please fill using BLOCK CAPITAL

Wasiat Language Bahasa Wasiat

[ [

] Bahasa Melayu ] English

Sila tanda (  ) jika perlu /Please tick (  ) relevant UNTUK DIISI OLEH IEP [WAJIB] TO BE FILLED BY IEP [COMPULSORY] Name Penuh / Syarikat Full Name / Company No. utk .dihubungi Contact No.

Tel. Bimbit Handphone

Faks Fax

Alamat Email Email Address

[email protected]

Rumah House

SEKSYEN 1 – MAKLUMAT PERIBADI [WAJIB] SECTION 1 – PERSONAL PARTICULARS [COMPULSORY] @@@@ 1.

Name Penuh Full Name

ABDUL KADIR BIN ABDULLAH

2.

No. K/P Baru New NRIC No.

5

0

0

3

2

0

-

0

1

-

No. K/P Lama Old NRIC No. 4.

Tarikh Lahir Date of Birth

2

6.

Agama Religion

ISLAM

8.

Alamat Address

9.

0

/

0

3

/

1

9 7.

5

0

6

1

1

3.

Jantina Sex

3 Lelaki Male Bangsa Race

5.

Kewarganegaraan Citizenship

√

Perempuan Female

MELAYU

MALAYSIA

3-0-10, KENANGA 3, JALAN 19/56, KERAMAT WANGSA 54200 KUALA LUMPUR

No. utk .dihubungi Contact No.

Rumah House

03-79556351

Bimbit Handphone

Alamat Email Email Address

10.

Status Perkahwinan Marital Status

√

11.

Perlukan Terjemahan Translation required

Penterjemah Translator

NIL

Dialek Dialect

NIL

12.

Wasiat dit/t oleh Sigining Will by

13.

Keadaan Khas Special Condition



Pejabat Office

Berkahwin Married

Duda/Janda Divorcee

Bujang Single No. KP NRIC No.

Tanda Tangan Signature

Cap Jari Thumprint

Buta Huruf Illiterate

Buta Blind

Copyright reserved © 2005 as-Salihin Trustee Berhad Instructions taking form

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SULIT Private and Confidential

SEKSYEN 2 – KETERANGAN WASI & PEMEGANG AMANAH [WAJIB] SECTION 2 - PARTICULAR OF EXECUTOR & TRUSTEE [COMPULSORY] @@ Dicadangkan dua Wasi (atau Syarikat Pemegang Amanah) jika ada benefisiari di bawah umur. It is strongly recommended that two Executors be appointed (unless appointing a Trust Corporation) if there is a minor beneficiary. Disyorkan supaya meletakkan sekurang-kurangnya dua Wasi (Bersama atau gantian) untuk mengelakkan permohonan untuk Surat Kuasa Mentadbir. It is advisable to appoint at least two Executors (either jointly or as substitute) to prevent the need for applying of Letter of Administration.

WASI & PEMEGANG AMANAH NO.1/EXECUTOR & TRUSTEE NO.1 Nama Penuh FATIMAH BEE BINTI JAILANI Full Name No. K.P. Hubungan 550210-10-1124 WIFE NRIC / Passport No. Relationship Alamat 3-0-10, KENANGA 3, JALAN 19/56, KERAMAT WANGSA 54200 KUALA LUMPUR Address No. utk. dihubungi Alamat Email 03-79556351 Contact No. Email Address WASI & PEMEGANG AMANAH NO.2/EXECUTOR & TRUSTEE NO.2 Nama Penuh Bersama MUSA BIN ABU √ Full Name Joint No. K.P. Hubungan 610304-10-6613 COUSIN NRIC / Passport No. Relationship Alamat Address No. utk. dihubungi Alamat Email Contact No. Email Address WASI & PEMEGANG AMANAH NO.3/EXECUTOR & TRUSTEE NO.3 Nama Penuh OMAR BIN HASSAN Bersama √ Full Name Joint No. K.P. 641013-10-1213 Hubungan COUSIN NRIC / Passport No. Relationship Alamat Address No. utk. dihubungi Alamat Email Contact No. Email Address WASI & PEMEGANG AMANAH NO.4/EXECUTOR & TRUSTEE NO.4 Nama Penuh Bersama Full Name Joint No. K.P. Hubungan NRIC / Passport No. Relationship Alamat Address No. utk. dihubungi Alamat Email Contact No. Email Address



as-Salihin sebagai Wasi as-Salihin as the Executor

Utama Main



Ganti Substitute

Ganti Substitute

Ganti Substitute

Ganti Substitute

* as-Salihin does not act as co-executor. Copyright reserved © 2005 as-Salihin Trustee Berhad Instructions taking form

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SULIT Private and Confidential

SEKSYEN 3 – PENJAGA [JIKA ADA ANAK DI BAWAH UMUR] - HANYA PERLU DIISI PEWASIAT LELAKI SECTION 3 – GUARDIAN OF MINOR CHILDREN [OPTIONAL]- TO BE FILLED ONLY BY MALE TESTATOR

PENJAGA NO. 1 / GUARDIAN NO. 1 Nama Penuh Full Name No. K.P. NRIC / Passport No. Alamat Address No. utk. dihubungi Contact No.

FATIMAH BEE BINTI JAILANI

@

Hubungan WIFE Relationship 3-0-10, KENANGA 3, JALAN 19/56, KERAMAT WANGSA 54200 KUALA LUMPUR Alamat Email 03-79556351 Email Address 550210-10-1124

PENJAGA NO. 2 / GUARDIAN NO. 2 Nama Penuh Full Name No. K.P. NRIC / Passport No. Alamat Address No. utk. dihubungi Contact No.

ABDUL KARIM BIN ABDULLAH 490220-01-3115

Alamat Email Email Address

as-Salihin sebagai penjaga harta as-Salihin as a guardian for property Elaun sebagai Penjaga Allowance to act as Guardian

Bersama Ganti √ Joint Substitute Hubungan BROTHER Relationship

(a) Elaun sekali bayaran One-off allowance

Utama Main

Ganti Substitute

RM 25,000 @

Bulanan Monthly

(b) Elaun bertempoh Periodic allowance

Cara bayaran elaun Allowance mode for

√

Lain-Lain Others

Sumber Source

SAVING ACCOUNT NO. 204017-003-5997

RM @ Umur Age

SEKSYEN 4 – KETERANGAN MENGENAI BENEFISIARI [WAJIB] SECTION 4 – DETAILS OF BENEFICIARIES [COMPULSORY]

BENEFISIARI NO. 1/BENEFICIARY NO. 1 Nama Penuh ZUBAIDAH BINTI MOHAMAD Full Name No. K.P. 881201-10-3356 NRIC / Passport No. Alamat Address No. utk. dihubungi Contact No.

Copyright reserved © 2005 as-Salihin Trustee Berhad Instructions taking form

Hubungan Relationship

ADOPTED DAUGHTER

Alamat Email Email Address

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SULIT Private and Confidential BENEFISIARI NO. 2/BENEFICIARY NO. 2 Nama Penuh MARIAM BINTI ZULKIFLI Full Name No. K.P. 490505-03-2211 NRIC / Passport No. Alamat Address No. utk. dihubungi Contact No.

BENEFISIARI NO. 3/ BENEFICIARY NO. 3 Nama Penuh Full Name No. K.P. NRIC / Passport No. Alamat Address No. utk. dihubungi Contact No.

BENEFISIARI NO. 4/ BENEFICIARY NO. 4 Nama Penuh Full Name No. K.P. NRIC / Passport No. Alamat Address No. utk. dihubungi Contact No.

BENEFISIARI NO. 5/ BENEFICIARY NO. 5 Nama Penuh Full Name No. K.P. NRIC / Passport No. Alamat Address No. utk. dihubungi Contact No.

BENEFISIARI NO. 6/ BENEFICIARY NO. 6 Nama Penuh Full Name No. K.P. NRIC / Passport No. Alamat Address No. utk. dihubungi Contact No.

Copyright reserved © 2005 as-Salihin Trustee Berhad Instructions taking form

Hubungan Relationship

ADOPTED SISTER

Alamat Email Email Address

Hubungan Relationship

Alamat Email Email Address

Hubungan Relationship

Alamat Email Email Address

Hubungan Relationship

Alamat Email Email Address

Hubungan Relationship

Alamat Email Email Address

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SULIT Private and Confidential SEKSYEN 5 - PEMBERIAN SECTION 5 - GIFTS Setiap kotak hanya diisi dengan satu pemberian sahaja / Each box is for only 1 gift to beneficiary (s) Gunakan seksyen ini untuk menyatakan Asset kepada benefisiari / Use this Section when specifying assets to beneficiary(s)

Keterangan asset Description of asset

Benefisiari Beneficiary(s)

SAVING ACCOUNT AT BANK RAKYAT ACCOUNT NO. 204802004-7959

ZUBAIDAH BINTI MOHAMAD

Bahagian Share

Syarat Condition

1/3 @ @

@

@

Keterangan asset Description of asset

Benefisiari Beneficiary(s)

Bahagian Share

1 ACRE LAND IN RAUB HELD UNDER H.S(D) 75784 P.T. NO. 23413 MUKIM TENGAH, NEGERI PAHANG.

MARIAM BINTI ZULKIFLI

100%

Syarat Condition PURPOSE OF BUILDING A KEROPOK FACTORY

@ @ @

@

Keterangan asset Description of asset

Benefisiari Beneficiary(s)

RM50,000 FROM UNIT TRUST FUND

ZUBAIDAH BINTI MOHAMAD

Bahagian Share

Syarat Condition

100%

FOR HER EDUCATION UNTIL SHE REACHES 30 YRS OLD @ @

@

Keterangan asset Description of asset

@

Benefisiari Beneficiary(s)

Bahagian Share

Syarat Condition @ @

@

Keterangan asset Description of asset

@

Benefisiari Beneficiary(s)

Bahagian Share

Syarat Condition @ @

@

Keterangan asset Description of asset

@

Benefisiari Beneficiary(s)

Bahagian Share

Syarat Condition @ @

@

Keterangan asset Description of asset

@

Benefisiari Beneficiary(s)

Bahagian Share

Syarat Condition @ @

@

Copyright reserved © 2005 as-Salihin Trustee Berhad Instructions taking form

@

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Keterangan asset Description of asset

Benefisiari Beneficiary(s)

Bahagian Share

SULIT Private and Confidential Syarat Condition @ @

@

Keterangan asset Description of asset

@

Benefisiari Beneficiary(s)

Bahagian Share

Syarat Condition @ @

@

Keterangan asset Description of asset

@

Benefisiari Beneficiary(s)

Bahagian Share

Syarat Condition @ @

@

Keterangan asset Description of asset

@

Benefisiari Beneficiary(s)

Bahagian Share

Syarat Condition @ @

@

Keterangan asset Description of asset

@

Benefisiari Beneficiary(s)

Bahagian Share

Syarat Condition @ @

@

Keterangan asset Description of asset

@

Benefisiari Beneficiary(s)

Bahagian Share

Syarat Condition @ @

@

@ @

Commorientes: Bilangan hari benefisiari wajib hidup sebelum pembahagian aset Numbers of days for beneficiary(s) must survive before inheriting assets

Hari @ Days

@ setiap permberian dan setiap syarat / @ per gift and condition Nota untuk diisi di dalam Seksyen 5 / Notes to fill up Section 5  Jika ada benefisiari ganti untuk setiap pemberian, tuliskan ‘SB’ selepas nama benefisiari utama / If there is a substitute beneficiary for each individual gift, indicate ‘SB’ after the name of the main beneficiary  Bagi rumah kediaman dan harta-harta komersial, tuliskan alamat dan sekiranya boleh, tuliskan nombor hak milik / For residential and commercial property, provide address and if possible, title no.  Bagi tanah tuliskan nombor hak milik tanah dan lokasi / For pieces of land, provide land title no. and location  Lain-lain: Jika perlu: Tulis diskripsi item berkenaan / Others: if specifying: Provide description of the item

Copyright reserved © 2005 as-Salihin Trustee Berhad Instructions taking form

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SULIT Private and Confidential SEKSYEN 6 A– KUASA TAMBAHAN WASI & PEMEGANG AMANAH [PILIHAN] SECTION 6 A – ADDITIONAL POWER OF EXECUTOR & TRUSTEE [OPTIONAL] Memberi kuasa tambahan kepada Executor dan Pemegan Amanah yang tidak diberi oleh Akta Pemegang Amanah 1949. Giving the Executor and Trustee additional powers not given by the Trustee Act 1949

√

Kuasa untuk membayar zakat/kaffarat/ haji yang belum ditunaikan/fidyah puasa Power to pay zakat/kaffarat/unperformed pilgrimage/fidyah on unperformed fast Kuasa untuk memberi resit yang sah Power to give good receipt

@

Kuasa-kuasa lain Other powers

@

SEKSYEN 6 B – KUASA TAMBAHAN WASI & PEMEGANG AMANAH [PILIHAN] TETAPI HANYA TERHAD KE ATAS ASET YANG DIKHUSUSKAN DI DALAM WASIAT DAN TERTAKLUK KEPADA SATU PERTIGA DARIPADA HARTA PEWASIAT SAHAJA SECTION 6 B – ADDITIONAL POWER OF EXECUTOR & TRUSTEE [OPTIONAL] BUT LIMITED TO ASSETS SPECIFIED IN THE WASIAT AND SUBJECT TO ONE THIRD OF TESTATOR ESTATE ONLY

√

Kuasa untuk membeli insurans bagi melindungi kerosakan selain daripada akibat kebakaran Power to insure against losees other than fire

@

Kuasa untuk meminjam duit dengan mencagarkan harta Power to borrow money using assets in the estate as collateral

@

Kuasa untuk melabur secara bebas termasuk pelaburan tak terjamin Power to invest freely including unsecured investments

@

Kuasa untuk memberi resit yang sah Power to give good receipt

@

SEKSYEN 7 – LAIN-LAIN PERKARA SECTION 7 – OTHER MATTERS [OPTIONAL] Arahan tambahan Additional instruction (if any)

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Pesanan terakhir Terms of Endearment

@

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Kesemua waris akan menerima lebihan/ baki/ semua harta dalam jumlah yang sama (tertakluk kepada semua waris selepas kematian pewasiat) All heirs to receive residue/ remainder/ whole estate in equal shares (subject to consent of all heirs after the death of testator) @

Copyright reserved © 2005 as-Salihin Trustee Berhad Instructions taking form

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SULIT Private and Confidential

SEKSYEN 8 – WAKAF SECTION 8 – WAKAF [OPTIONAL] 1 ACRE LAND IN JASIN MALACCA. Keterangan mengenai Harta Descriptions of Asset

H.S.(D) 77784 P.T NO 22213 MUKIM MALIM, NEGERI MELAKA

@ Nama penuh/ Organisasi Full Name/Organisation

MAJLIS AGAMA ISLAM MALACCA @

Benefisiari Beneficiary

No KP/No. Syarikat NRIC No./No. Company Alamat Address

No utk dihubungi Contact No. FOR BUILDING A MOSQUE

@

Syarat Condition

@ @

SEKSYEN 9 – AMANAH WASIAT TERHAD KEPADA SATU PERTIGA DARIPADA HARTA PEWASIAT SECTION 9– TESTAMENTARY TRUST [OPTIONAL] LIMITED TO ONE THIRD OF TESTATOR ESTATE ONLY Penuhkan semua maklumat di bawah / Provide all the information required below (a) Siapakah Benefisiari / Who is the beneficiary(s)? Name / Name(s)

@

Bahagian / Share

(b) Untuk tujuan / What is the Purpose

@

Nafkah Maintenance Kesihatan Health Pendidikan Education Lain-lain Others

Jika benefisiari menderita akibat tiada upaya dan memerlukan nafkah/ kesihatan/ pendidikan walaupun selepas umur 18 tahun dan unit amanah akan membiayai seumur hidup If the beneficiary is suffering from any disability and would require maintenance/ health/ education even after the age of 18 then the trust be continued through out the lifetime of the beneficiary @

Copyright reserved © 2005 as-Salihin Trustee Berhad Instructions taking form

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SULIT Private and Confidential (c) Aset yang mahu diletakkan di dalam amanah (yang tidak dinyatakan di Seksyen 5) What Asset(s) to set aside for the trust (must not have been stated in Section 5)

@

(d) Berapa lamakah tempoh amanah ini / What is the duration of this trust @

(e) Pembayaran untuk Benefisiari / Payment to the Beneficiary(s) Pengawasan pemegang amanah Discretion of the Trustee Or Jumlah Dibayar Amount Payable

RM

Cara Pembayaran Payment Mode

Bulan Monthly

Lain-Lain Other

(f) Pemegang amanah (selain yang dinyatakan di dalam Seksyen 2)? Who is the Trustee (s) (if it is different from those in Section 2)?

PEMEGANG AMANAH NO.1 / TRUSTEE NO.1 Nama Penuh Full Name No. K.P. NRIC / Passport No. Alamat Address No. utk. dihubungi Contact No. PEMEGANG AMANAH NO.2 / TRUSTEE NO.2 Nama Penuh Full Name No. K.P. NRIC / Passport No. Alamat Address No. utk. dihubungi Contact No.

Hubungan Relationship

Alamat Email Email Address

Hubungan Relationship

Alamat Email Email Address

(g) Siapakah yang akan menerima baki Amanah apabila ia berakhir / Who gets the Balance of the trust when it ends. Main Beneficiary (s) Name (s) Share

@

Copyright reserved © 2005 as-Salihin Trustee Berhad Instructions taking form

Substitute Beneficiary (s) No. 1 Name (s) Share

@

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SULIT Private and Confidential SEKSYEN 10 – PEMBAYARAN HUTANG SECTION 10– PAYMENT OF DEBTS [OPTIONAL] Untuk diisi oleh Pewasiat bagi membuat pembayaran hutang To be filled when Testator wants to make special allocation for the payment of debts Aset khas yang disediakan untuk pembayaran hutang / To provide particular assets for the payment of debts. 

Aset-aset (tertentu) yang diasingkan untuk membayar hutang (yang tidak disebut di dalam Seksyen 5) Asset(s) to set aside for the payment of debts? (Must not have been stated in Section 5)

@

Sila nyatakan / Please specify SAVINGS ACCOUNT AT SOUTHERN BANK NO. 114161443474 AND FIXED DEPOSIT ACCOUNT FROM MAYBANK BHD NO. 642113



Ingin menyenaraikan aset tersebut bagi melangsaikan hutang Want to list down the sequence of assets used for payment of debts

@

Sila nyatakan / Please specify 1. 2. 3.

TERRACE HOUSE IN KLALNG 2 UNITS OF FLATS IN BANGI PERDANA CAR WGT 1993

4. 5.

UNTUK DIISI OLEH IEP [WAJIB] TO BE FILLED BY IEP [COMPLUSORY]

Terjemahan Wasiat Written Wasiat Translation

Tidak No

Ya Yes

Bahasa Inggeris English Language Bahasa Melayu Malay Language

Bayaran Penulisan Wasiat Wasiat Writing Fees SILA HANTAR MELALUI FAKS ATAU EMAIL BORANG ARAHAN MENULIS WASIAT KE JABATAN UNDANG-UNDANG PLEASE FAX OR EMAIL THIS WASIAT WRITING INSTRUCTION FORM TO THE LEGAL DEPARTMENT: Nombor Faks Jabatan Undang-undang / Fax Numbers at Legal Department: 03-7957 0993

Copyright reserved © 2005 as-Salihin Trustee Berhad Instructions taking form

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SULIT Private and Confidential SEKSYEN 11 – PENYIMPANAN WASIAT PROFESIONAL [WAJIB] SECTION 11 – PROFESSIONAL WASIAT CUSTODY [COMPULSORY]

/

Copyright reserved © 2005 as-Salihin Trustee Berhad Instructions taking form

Semumur Hidup (RM 800.00) Lifetime

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