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RESHEDULING AND RESTRUCTURING REQUEST FORM
APPLICANT INFORMATION
Full Name (@s per NRICIPP): ROS AMIRA IZAYU BINTI ISMAIL
Current address: 221, JALAN BUKIT SENDAYAN 1, TAMAN BUKIT SENDAYAN, 71950 SEREMBAN, NEGERI
SEMBILAN DARUL KHUSUS.
NRICIPasspon no: 840407055276 Tel No: 01111449085
Email Address: rosamiratzayuB4@gmall.com :
oe RESHEDULING AND RESTRUCTURING REQUESTS)
Facilty (X to select)
Micro Finance ‘Account 1 ‘Account 2:
X Housing Loan/Financing Account 1: 051007271990482 ‘Account 2: |
Personal LoaniFinancing | Account 1 Account 2:
I
Hire Purchase ‘Account 1 Account 2:
REASON FOR APPLICATION
Reason (X to select):
| X | Reduction in income |
Others (please specify):
|New Monthly Installment Requested: RM300-00
I
i Individual r |
| C.By submitting this form, | hereby declare that |
|
| + Mylan financing is presently not under rehabiitation with Credit Counseling and Debt Management
“Agency (AKPA);
+ 1 om not undscharged berkrupt or subject to @ bankrust proceeding; and
+ I:de not have guarantor’ joint borower for my loan financing; OR | have obtained consent from the
uaranto/ joint borcower for tvs application,
| understand that where required, | need 10 sign relevant document to complete the legal documentation,
including those related to guarantors or joint accounts and! er variation agreements for Hire Purchase OF
fixed rate loan financing, | RESHEDULING AND RESTRUCTURING REQUEST FORM BSN
i n_{for Company Applicat
(By submitting this form, | hereby declare that;
‘+ The Company's business is affected by the movement restictions and | have difficulties meeting my
epaymenv’ payment obligations;
+The Company is not wound up or subject to an existing winding up petition’ notice, |
+ The Company's loan’ financing is presently not under rehabilitation with Credit Co unseling and Debt
Management Agency (AKPK),
+ I declare that | am the culy authorized empowered director! partner! sole-proprielor to request for opt
in of the above package; and
+ Hdonot have 2 guarantor joint borrower for my loan financing: my guarantor is CGC! SIPP; OR 1 |
| hhave obtained consent from the guarantor! joint borrower for this application.
| understand thet where required, I need to sign relevant documents to complete the legal documentation,
including those related to guarantors or joint accounts snd/or variation agreements for Hire Purchaso! Fixed
rate loan/financing:
REQUESTED BY : z i
| acknowledged the above details ere accurate and in order. i
——_-_
| (Customers signature)
Date : 28/12/2021
‘The request submitted is stil subject to Bank's approval. Supporting documents required:
1 Copy IC
12 Additional supporting documents (if required by the BSN)
Please forward complete document to r&r@bsn.com.my,
