Application for Special Relief Facility 2020

…………………………………
………………………………… Name & address
………………………………… of Customer
………………………………….

Date:

The Manager
Public Bank Berhad / Public Islamic Bank Berhad
…………………. Branch

Dear Sir/Madam,

Application for Special Relief Facility 2020 (for businesses affected by COVID-19)

I/We wish to apply for loan/financing limit of Ringgit Malaysia ……………… under the
Special Relief Facility 2020 to alleviate the financial burdens of my/our business which
has been affected by the COVID-19 outbreak:

………………………………………………………………………………….………………….
……………………………………………………………………………………………………..
……………………………………………………………………………………………………..
……………………………………………………………………………………………………..
(customer’s explanation on how it is affected by COVID-19)

Thank you for your kind consideration.

______________________________________________________________________

Written Permission to Consent to the Disclosure of Information

I/We ______________________________________ (the Customer) hereby irrevocably

consent to and authorise:

i) the PFIs to disclose to Bank Negara Malaysia (BNM); and

ii) BNM to disclose to any PFIs of the Special Relief Facility 2020 (SRF) for COVID-19
affected businesses,

at any time and without notice and liability, any information relating to the customer’s
affairs, banking accounts and conduct thereof (including the customer’s credit standing)
pertaining to all matters relating to SRF 2020, to such extent and for such purposes as
the PFIs or BNM may in their absolute discretion deem necessary or expedient.

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I/We hereby consent and authorise you to forward, make known, disclose or obtain for
your verification and/or retain all my/our Personal Data and/or the Personal Data of
Partner(s)/Business/Company/company director(s)/guarantor(s)/security party(ies)
and/or shareholder(s) in Public Bank Group of companies/branches’ normal course of
business.

…………………………………… ………………………………………
(signature, name & designation) (rubber stamp of business)

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