MFBBCC RETAIL MALL SDN BHD SM-03

SALES MANAGEMENT DEPARTMENT

Tenant Billing & Refund Information

Part I: Company Details
Lot No. Shop Name
Company Company Registration No.
Name TAX/VAT Registration No.
Billing Address
Company Address ( please tick (√) if same as company address )

Address Address

State Postcode State Postcode

Part II: Bank Information

Bank Name Swift Code
Bank Account Bank Account No.
Name

Part III: Company Contacts (Finance / Accounts)

Name 1 Office Phone No.

Designation Mobile No.

Email 1 Fax No.

Name 2 Office Phone No

Designation Mobile No.

Email 2 Fax No.

Part IV: Certifications

1. Kindly attached the header of Bank Account Statement for verifications.
2. By submitting this form, you hereby agree that MFBBCC may collect, obtain, store and process your personal
data that you provide in this form for the purpose of receiving updates, news, or materials from MFBBCC. For
the avoidance of doubt, Personal Data includes all data defined within the Personal Data Protection Act 2010
including all data you had disclosed to MFBBCC in this form.
You hereby give your consent to MFBBCC to:-
 Store and process your Personal Data;
 Disclose your Personal Data tot eh relevant governmental authorities or third parties where required by
law or for legal purposes.
3. By signing this form, you further confirm that all personal data that you have provided are all true, up-to-date and
accurate. Should there be any changes to any of personal data, kindly notify MFBBCC immediately.

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 MFBBCC RETAIL MALL SDN BHD SM-03
Signature Company Stamp

Name:
Designation:
Department:

For further enquiries, kindly contact: Sales Management Department at sm-lalaport@mfbbcc.com.my

For Office Use Only

Processed by: Verified by: Approved by:

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