FORI,I REN 01

THE BOARD OF VALUERS' APPRAISERS, ESTATE AGENTS AND PROPERTY

MAHAGERS MATAYSIA
A-19-13A Tower A, L€n el Xg, ltfenara UOA Bangsar, No. 5 Jalan Banglar Utama 1, Bangsar,
59tEO Kuata Lumpur Malaysia
Telephone:03-2287 6655 | Faoimile: O3-2288 8819 | Email: lppeh@po.iarine.my
wekig http//wr*nr.lppeh6ur.my

APPLICATION FOR REGISTRATION AS NEGOTIATOR

{7) *"o REN Registration

Full Name (As in NRIC) BADRUL HISYAM BIhI ARIFFIN

Name on Business Cards Gender

Date of Birth 25 Jul 1981 Place of Birth

NRIC No. a!4725L43427 (new) {ald}

Nationality MALAYSIAN *Passport No +Expiry

Permanent Residential Address

NO. 1.3, JALAN PUTRA PERDANA 8/2 TAMAN PUTRA PERDANA47130 PUCHONG SELANGOR

Correspondence Address 1it aitfererafrem the above)

H/P No. {1) oL221s18OO H/P No. (2) Office 0389576608

Email Address badrulhisyam.ariffin@gmail.com

Highest Academic Qualification Obtained DEGREE

Name of Registered *Agenoy/ Company

AFZ REALTY SDN BHD

Board Reg. No. VEPM {1} 0006 Year Join

Name of **Supervising Registrant Member Reg. No E2569

AFIZAN BIN MOHKTAR

Office Address

8-1, JALAN EQUINE 1E TAMAN EQUINE,433OO SERI KEMBANGAN SELANGOR

Tel. No. 0389576608 Email afzrealty@gmail.com

* Delete whichever is not dpplicsble

** SupeNising Registrdnt shdll refer to the Registront whom the Applicent repofts to.
 FORM REN 01

To: The *Principal / Director,

Name of Agency/Company AFZ REALTY SDN BHD

Board Reg. No. VEPM (1) 0006 Branch (if applicable)

Address
8-1, JATAN EQUINE 1E TAMAN EqUINE,433OO SERI KEMBANGAN SELANGOR

l, the undersigned, hereby apply for registration as a Negotiator and do declare that;
(a) I have attained the age of 18 years and am of sound mind, good character and have not been
convicted of any offence involving fraud, dishonesty or moral turpitude during the TWO years
immediately before the date of this apptication; and
{b} I am not an undischarged bankrup!

I attach herewith a copy each of the followings:

(a) Certified true copy of my ldentity Card"
tb) Latest passport size photograph.
(c) Letter of Engagement
{d} Administrative fee of RM50 by cash / cheque
(anly qppticqble to existing regist"red REN whose qpplietion is dre to Change of Agency)

(e) CertificateofAttendanceNo
pl? 117,
issued by:
mrER/ Lfrt1t

I am futly aware and informed of the Malaysian Estate Agency Standards, the Rules and the Valuers,
Appraisers & Estate Agents Act 1981 (as amended 2012) and shall strictly adhere to it.

lls.lt D w
5i g notu re of N eg oti otot

We, the undersigned, hereby certifo that all the informatio* provided by the above fiarfied appticant is tn e

a*d co.rect. This applicant is the ..,....,!.fr-.. / *6130 negotiators und€r rny supervision.

SECltOtl !: Signature a{ $incipol./6arerya*y Directar IECROAI !: Sigrcture oJ Suparuising fte6ristrant

Ssrn€:

ffi t :'n$lf.f!U
"J,irr*r-rro*o, F? II ll 8"H,Tlt S'
l/tr, t"8'

S'6'YAIOFY'AISTAU Cf I C}IIS :
t y/*lzre t*te Saperyisr'/€r Seglrlsfrc&t rt tfre SAMf Fers$rl af lhe Prtreip*!/Canp*rry Directo{, er,y O{r}f $$rr{rsry on SECTlOil t slroll u:f$ce,
r t#ias the &{peryising ftegistrfint is NOT tt € Ptlt,fjipel/&nperry *ire*far, &otl SECTTOI9 I *ftd SfCTtOtt 2 siSilct{lries *re requked.

FOfl orficE us[o{*rY

FEiYIogAlo"..,, . Osd$erfalJtlo
frEN Tag M*ary 8ate................,..

* Delete whichever is not qpplicqble

** Superuisinq Registront sholl refer to the Registrant whom the Applicont reports to.