Ver:AF-04-01

MELATI PANORAMA SDN BHD (1316296-M)

APPLICATION FORM
APPLICANT'S INFORMATION
Title: Mr / Mrs / Miss
Name:
NRIC No.: Old No.: Contact No.:
Marital Status: Single / Married / Divorced Mother’s Maiden Name:
Highest Education Level: Professional / Degree / Diploma / Technical / Post Tertiary / Secondary / Primary
Email address:
Residential Address:
Postcode:
City: State: Country:
Mailing Address: Home / Office Residence Since (mm/yyyy)
Ownership Status: Owner / Parents / Relatives / Rented / Provided by Employer
EMPLOYMENT INFORMATION
Type Of Company: Multinational Company / Public Listed Company / Government/ Sdn Bhd / Enterprise
Nature of Business: Permanent Staff / Contract Staff
Employment Type: Salaried / Self-employed
Basic Salary: RM Fix Allowance: RM
Company Name:
Company Address:
Postcode:
Start working date: Office number:
I/we hereby declare that all the information contained herein together with the attached documents are true and complete. I/we
undersigned do hereby give consent to Melati Panorama Sdn Bhd and your appointed registered credit reporting agency under the
Credit Reporting Agency Act 2010 to obtain any credit information to/from any registered Credit Reporting Agencies as defined
under the Credit Reporting Agency Act 2010 for the purposes of opening of account, credit/account evaluation and review including
Bank Negara Malaysia’s Central Credit Reference Information System (CCRIS), credit/account monitoring and debt recovery, if any.
Apart from that, I/we undersigned do give our consent to you and your appointed registered credit reporting agency to process
my/our personal data as per Personal Data Protection Act 2010.

https://www.mpsbcredit.com.my/termandconditions

I/we hereby agreeable to the terms and conditions stated in this application form.
Sign by Applicant,

…………………...…………………………………..
Name:
IC No:
Designation:
Date:
Company Stamp (if any):

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