Date:

_______________________________
_______________________________
_______________________________
_______________________________
Tel. No. ____________________ (HP) __________________ (O/H)
E-mail Address: __________________________________

Maybank
______________________________
______________________________ (Address as per RAQM office)
______________________________

Sir,
APPLICATION FOR REPAYMENT ASSISTANCE PACKAGE
Name :
Loan Account No :
________________________________________________________________________________________
Due to financial constraint, I/We as below name/names is/are applying for Repayment Assistance Package as
I/We am/are having difficulty in paying the current instalment amount due to following reason:

Unemployed / Terminated

Pay-cut / Loss of Allowance

Business Down / Closed

Other: _______________________________________

Attached herewith is/are my/our income document/documents for your perusal.

I/We hereby confirm that the information provided herein is correct and that the documents submitted
along with this application form are genuine. I/We understand that this application is subject to the BANK’s
discretion to approve or to defer and the Bank reserves its right to rescind the Repayment Assistance
Package in the event the information and documents submitted for this application are found to be incorrect
or has been misrepresented.

Yours faithfully,

_____________________________________ ____________________________________
Name : Name :
I/C No : I/C No :