1.

Profil Individu / Individual Profile

1.1 Maklumat Akaun / Account Information
Nama seperti di dalam IC / Name as stated in NRIC
SAMBASIVAM a/l POOTHAN MOOKAIAH

No. kad pengenalan (Baru) / NRIC (New)

831117055089

Emel / Email
sambasivamme@gmail.com

No. telefon bimbit / Mobile phone

60129160578

Warganegara / Nationality
Malaysian

Tarikh lahir / D.O.B.

17-Nov-1983

Umur / Age
30

1.2 Profil Peribadi / Personal Profile

Apakah pendapatan purata kasar bulanan anda? (RM/Bulan) / What is your monthly gross personal income? (RM/Month)
6,000.00

NOTA : Jumlah Pendapatan Keluarga (RM/Bulan) mesti di dalam linkungan RM 2,500 - RM 7,500. Sila rujuk kepada Kriteria
Kelayakan untuk definisi pendapatan purata kasar bulanan.
NOTE : Total Household Income (RM/Month) must be within RM 2,500 - RM 7,500. / Please refer to Eligibility Criteria on definition of
average monthly gross income.

Adakah anda pernah diisytiharkan muflis? / Have you been declared bankrupt?
Tidak / No

Pengenalan ID lain / Other ID type

Tiada / None

Gelaran / Title
En / Mr

Jantina / Gender
Lelaki / Male

Bangsa / Race
India / Indian

Taraf perkahwinan / Marital status

Bujang / Single

Adakah anda mempunyai anak? / Do you have children?

Tidak / No

Alamat Rumah / Home Address

Alamat baris 1 / Address line 1
Block D-06-11 PANGSAPURI KOI KINRARA

Alamat baris 2 / Address line 2

JALAN PIPIT, BUKIT TANDANG,

Pekan atau bandar / Town or city

PUCHONG

Poskod / Postcode
47190

Negeri / State
Selangor

Telefon rumah / Home phone

 Pemilikan kediaman di atas / Ownership of above property
Milik Sendiri / Own

Bilangan hartanah yang dimiliki anda dan/atau pasangan anda / No. of properties that are currently owned by you and/or your spouse(s)
1

Negeri kelahiran / State of birth

Selangor

Status pekerjaan / Employment status

Bekerja - Swasta / Employed - Private

Pekerjaan/Fungsi pekerjaan / Occupation/Job function

Minyak & Gas/Petroleum/Petrokimia / Oil & Gas/Petroleum/Petrochemical

Industri / Industry
Petroleum / Petroleum

Kurang upaya / Disability

Tidak berkenaan / None

1.3 Butiran Pekerjaan / Employment Details

Untuk soalan-soalan di bawah, sila isi "Tiada" untuk mana-mana yang tidak berkenaan / For questions below, please fill in "None"
whichever not applicable.

Nama organisasi atau syarikat / Organization or company name

SAPURAKENCANA PETROLEUM

No. pendaftaran organisasi atau perniagaan / Organization or business registration no.

None

Alamat pejabat / Office address

Alamat baris 1 / Address line 1
TL Offshore sdn Bhd

Alamat baris 2 / Address line 2

Sapura@Mines, No.7, Jalan Tasik

Pekan atau bandar / Town or city

Seri Kembangan

Poskod / Postcode
43300

Negeri / State
Selangor

Negara / Country
Malaysia

No. cukai pendapatan LHDN / LHDN income tax file no.

SG2059698306

No. KWSP / KWSP no.

18092550
2. Maklumat Pasangan / Spouse Information
Tiada Maklumat / No Information
3. Anak-anak / Children(s)
Tiada Maklumat / No Information
4. Maklumat Hartanah / Property Information
4.1 Tempat Tinggal Semasa / Current Accommodation
Jenis hartanah rumah semasa / Type of property you are currently staying in
Aparmen / Apartment

Saiz rumah semasa / What is the size of the current house you are staying in?
1000-1499 kaki persegi / 1000-1499 sqft

4.2 Pemilikan Hartanah / Property Ownership

Jenis hartanah / Type of property
Aparmen / Apartment

Apakah saiz hartanah / What is the size of the property

1000-1499 kaki persegi / 1000-1499 sqft

Alamat harta / Address of property

Alamat baris 1 / Address line 1
Block D-06-11 PANGSAPURI KOI KINRARA

Alamat baris 2 / Address line 2

JALAN PIPIT, BUKIT TANDANG,

Pekan atau bandar / Town or city

PUCHONG

Poskod / Postcode
47190

Negeri / State
Selangor

Negara / Country
Malaysia

Siapakah pemilik hartanah / The property is owned by

Sendiri / Myself

Bilakah hartanah ini dibeli (bulan - tahun)? / When did you purchase this property (month - year)?
April 2011
5. Rumah PR1MA / PR1MA Home
Berapa ramaikah yang akan menetap di rumah PR1MA ? / How many people in total will be staying in PR1MA home?
5

5.1 Lokasi / Location

Apakah jarak daripada bandar/pusat bandar yang anda boleh pertimbangkan untuk berpindah? / How far away from city/town centre would
you consider moving to?
Lingkaran 10-15 km / 10-15 km radius

Di manakah lokasi pilihan anda? / Where would you consider moving to?
Pilihan Pertama wajib diisi, pilihan yang seterusnya tidak wajib diisi / It is mandatory to fill up the 1st Choice, the rest is optional

Negeri / State Kawasan atau Zon / Area or Zone

(Berdasarkan Pihak Berkuasa
Tempatan (PBT) / Based on Local
Authority: Majlis Bandaraya / Majlis
Perbandaran / Majlis Daerah)
Pilihan pertama / 1st choice
Selangor Petaling Jaya
Pilihan kedua / 2nd choice
Selangor Sepang
Pilihan ketiga / 3rd choice
Melaka Hang Tuah Jaya
Pilihan keempat / 4th choice
Melaka Alor Gajah
Pilihan kelima / 5th choice
Negeri Sembilan Nilai

5.2 Spesifikasi / Specification

Apakah sebab utama anda ingin membeli rumah baru? / What are the main reasons for buying a new accommodation/house?
Kos penyenggaraan yang tinggi pada rumah sekarang / High financial maintenance of current house

Jenis hartanah yang menjadi pilihan / Type of property you will consider to buy
Rumah teres setingkat / Single Terrace linked

Bilangan bilik tidur/bilik air yang menjadi pilihan / What is your preferred rooms/bathrooms configuration?
4 bilik + 2 bilik air / 4 rooms + 2 bath rooms

Keluasan (kps) / Dimension (sqf)

1500-1999 kaki persegi / 1500-1999 sqft

5.3 Kawasan Perbandaran atau Kejiranan / Neighbourhood or Township

Nyatakan 5 kemudahan yang perlu ada dalam kawasan kejiranan anda? /
What are the top 5 most important amenities should be available in the township/place you will be staying?
Kemudahan Pertama / 1st Amenity
Kebersihan dan penyelenggaraan kemudahan yang baik. / Good maintenance of amenities and cleanliness

Kemudahan Kedua / 2nd Amenity

Pusat penjaja / Hawker centre

Kemudahan Ketiga / 3rd Amenity

Kemudahan pengangkutan awam untuk berhubung ke lokasi/bandar lain / Availability of Public transport to connect to other
location/city

Kemudahan Keempat / 4th Amenity

Pusat Perubatan / Medical centre

Kemudahan Kelima / 5th Amenity

Pasaraya/Pusat membeli belah / Shopping mall and supermarkets

Apakah 3 kriteria utama semasa memilih rumah baru?

What are the top 3 main factors/criteria when selecting a new accommodation/house?
Kriteria Pertama / 1st factor
Berdekatan dengan kemudahan seperti kedai, hospital / Close to amenities such as shops, hospital

Kriteria Kedua / 2nd factor

Berdekatan dengan sekolah / Near school
 Kriteria Ketiga / 3rd factor
Keselamatan yang lebih baik di kejiranan / Better security in the neighborhood

5.4 Keperluan Special / Special Needs

Sila nyatakan sekiranya anda mempunyai masalah kesihatan yang boleh mempengaruhi jenis pilihan hartanah anda / If you have any medical
problems that might affect the type of property you need to live in please give details
6. Lampiran / Attachment(s)
Sila muat naik dokumen sokongan dan sila rujuk Kriteria Kelayakan untuk senarai dokumen yang diperlukan/
Please upload supporting document(s) and refer to Eligibility Criteria for the list of documents required
Saiz Dokumen (kb)
Nama Fail / Jenis Dokumen /
File Name Document Type /
Document Size (kb)
PR1ma_Terms & Condition.pdf Lain-lain / Others 565.24
IC.pdf Lain-lain / Others 498.26
Surat Pengesahan dari
Employer Letter.pdf Majikan / Employer 676.99
Verification Letter
Pay Slp_Nov_2013.pdf Slip gaji / Salary slip 733.09
KWSP-2013.pdf Penyata EPF / EPF Statement 622.25
EA Form_2013.pdf Borang EA/B / EA/B Form 493.87
Penyata bank / Bank
Bank Statement.jpg 139.66
statement

Jumlah Saiz Fail (kb) / Total File Size (kb)

3,729.35
7. Lain-lain / Others
Apabila anda telah selesai mengisi borang permohonan anda, sila klik pada butang "Hantar" untuk menghantar permohonan anda
secara elektronik.

NOTA PENTING:
Sila tekan butang Hantar HANYA setelah selesai mengisi borang permohonan untuk memastikan permohonan anda adalah muktamad

Once you have completed your application, please click on “submit” to submit your application electronically.

IMPORTANT NOTE:
Please click on submit ONLY when you are sure that you have COMPLETELY finalised your application.

7.1 Maklumat Lain / Others Information

Taraf pendidikan / Education level
Ijazah / Bachelor