APPLICATION FORM

This form contains two pages. All fields are mandatory. Please complete in black color ball pen.
MY PERSONAL DETAILS
Title: Mr Mdm Ms Dr Others: ________________________________
Full Name as in NRIC: ___________________________________________________________________
New NRIC: ______________________________ Old NRIC: __________________________________
Marital Status: Single Divorced Education Level: SPM Diploma
Married Widowed STPM Degree
No Of Dependants:
E-mail: _________________________________ Spoken Language: ___________________________
Current Home Address: ____________________ Length of Stay at Current Residence: Years
________________________________________ Months
________________________________________ Residential Status: Own Rented
Home Tel No: ____________________________ Parents Company
Mobile No: ______________________________ Relative Others: ______
Mother Full Name: ________________________ Mother Mobile No: ___________________________

MY SPOUSE DETAILS
Full Name as in NRIC: ___________________________________________________________________
New NRIC: _____________________________ Mobile No: _______________________________
Company Name: _____________________________________ Position: ________________________

EMERGENCY CONTACT (who is not staying together)

Full Name as in NRIC: ___________________________________________________________________
Mobile No: _______________________________ Relationship: ________________________________
Present Home Address: _________________________________________________________________
_________________________________________ Home Tel No: _______________________________

EMPLOYMENT DETAILS
Company Full Name: ___________________________________________________________________
Position Held: ____________________________ Business Nature: ____________________________
Business Entity: Enterprise Sdn. Bhd. Bhd M.N.C Gov. Others
Company Address: _____________________________________________________________________
_____________________________________________________________________________________
Office Tel ( HR ):_______________________________ Ext. Line: _______________________________
Employment Status: Employee Businessman Joining Date: _______/___________/___________
Monthly Basic Salary: ______________________ Bonus & Allowance: _________________________
*Loan Disbursement Bank & Account Number : ______________________________________________
I hereby affirm that all the information provided on this form is true and accurate to the best of my knowledge,
and understand that any deliberate falsification, misrepresentations, or omissions of fact may be grounds for
rejection of my application or dismissal from subsequent employment.

_______________________________ _______________________________
Applicant’s Signature Date
1
BANK FACILITIES / COMMITMENTS
PERSONAL LOAN (PL)
BANK LOAN AMOUNT MONTHLY PAYMENT START DATE

CAR LOAN (CL) / HOUSING LOAN (HL)

CAR LOAN / HOME LOAN BANK MONTHLY PAYMENT NUMBER OF NAME START DATE

CREDIT CARDS (CC)

BANK LIMIT OUTSTANDING MONTHLY PAYMENT START DATE

What have you applied with REJECTED result within the latest one year?
(House loan/Car loan/Credit card/Personal loan/SME loan)
FACILITIES BANK MONTH OF APPLY WHAT DOCUMENT USED TO APPLY
Eg. Personal loan CIMB May 2013 EPF, pay slip, bank statement, EA form

Have you got any late payments within the latest one year for the commitments above?
HL/CL/PL/CC BANK LENGTH OF OVERDUE HL/CL/PL/CC BANK LENGTH OF OVERDUE
Eg. Car Loan CIMB 1 month

Any CTOS/ C-CRIS / BLACKLIST before? No Yes, how long ago? __________________________
How much is the loan amount requested? For what purpose? (50K – 300K is recommended)
_____________________________________________________________________________________
Is your company admin able to process verification for you through the phone calls? Yes No
CHECKLIST (for office use only)
IC photocopy * Remarks:
[
IC photocopy With Signature
[T
EPF Statement x 2 Years
[Ty
Pay Slip x 6 Months
[Ty
p Bank Statement(Credited Salary) x 6 Months
[Ty
p
e[ Bank Book 1st Page/ Bank Statement
Typ
e[ EA x Latest 2 Years
Typ
e[a E-Filing & Receipt x 2 Years Submission Date: ________________________
Typ
e[a Application Form
Typ
ea[ Agreement Form Financial Consultant: _____________________
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