cBs 01

BANK NEGARA MALAYSIA

CENTRAL BANK OF MALAYSIA

Hantarkan permohonan melalui I Submit application via: hnm.mvlLIUK

Sila lengkapkan sepenuhnya dan tandakan { di dalam kotak I I Ptease fill up comptetety and tick",l in fhe box I
EORANG PERMOHONAN I APPLICATION FORM
Bahasa / Language

fl Pendattaran eccRls I eccRls Registration*

, . sarinan bir rELCo adarah wAJrB / copy
n Bahasa Melayu
f eCCRIS: Pertukaran Nombor Telefon Bimbit / , of TELCo bil rs coMPULsoRY

Change of tlabile Telephone Number" tr English

fl eCCRIS; Pengaktifan Semula Akaun/Jana Semula PIN / Reacllvate Account/Regenerate PIN

Q Laporan Kredit (CCRIS) / Credit Report (CCRIS)

Tujuan Permohonan /
Nama pemoh on t Name or Appticant' 4,&li1i.Y{1.p-...ltli:Y!.....Hlh...ft*P.\:.k....19*.l.{t$...... Purpose of Application

Nombor MyKad/Pasport / I untrr. semakan

Irtl yKad N u m be r/P a ssporl N u m be r , ..'i.l.o.i.e.:.... d7 - maklumat / Check
credit status

Tarikh Lahir I Date of Birth :

fU" iCr'irl.-t L
f] n*rou belum dikemas
kini / Record not
Nombor Telefon Bimbitl Mobite Tetephone Number, ....O-!.t..:..1..( 5q +- ?l{;. f updated

E-mel lE-mail il coY,, n Permohonan pinjaman

ditolak / Loan rejected

Permohonan bagi pihak I Application oo behalf of l Permohonan AKPK /

App{ication for AKPK
f Perniagaan / Buslness

Nama Ferniagaan I Name of Eusrness: ...

a Permohonan oleh pihak
ketiga / Application
from other parties

Nombor Pendaftaran Perniagaan / Laln-lain. Sila nyatakan

Bus,ness Registration N u mber: tr / Others. Please speci{y

f Si mati / Deceased

Nama si mati / Name ofdeceased:

Nombor MyKad si mati / MyKad Number of deceased

No. lnstitusi Kewangan Jenis Pinjaman Jumlah / Had

No. Name of Financial Loan Loan / Credit Limit
pLrBLtc BAN& (AP LOAN 5i k
AM BA^}K ASB trilv/tfucrAL r25 k

1. Merujuk kemudahan kredit sedia ada seperti, pinjaman peribadi, perumahan, pinjaman sewa beli, kad kreditdll, / Refers fo the existing credit
facilities; e.g. personal loan, housing ioan, hire purchase, credit card, etc.
2. Jikaandatidakmempunyaisebarangpinjaman,silanyatakansebagai'TIADA'Myoudonothaveanyloans,pleaseindicate'NlL'.

Tandatangan:
7 icr .)c>l
Tarikh:
Signature: Date: i