LFR/PROJECT-REFUND/2021-001

CONSTRUCTION/ RENOVATION REFUND APPLICATION

APPLICATION DATE :

Name of Plot Owner :

PTD/ Lot No. :

Precinct :

Address :

Name of Contractor :

Beneficiary Name :

Account No. :

Bank Name :

Required Documents: Please enclose a copy of the statement of account for account number
confirmation.

Signature by,

____________________________
Plot Owner
Name:

OFFICE USE ONLY

Received by : (Customer Service)

Date : _____________________________________________

Verified by : (Front of House Department)

Date : _____________________________________________

Acknowledged by : (Accounts Department)

Date : _____________________________________________

LEISURE FARM RESORT SERVICES SDN. BHD. (109759-U)

No. 8, Jalan Peranginan, 81560 Gelang Patah, Johor Darul Takzim
T +60 7 556 3002 F +60 7 556 3160
W www.leisurefarm.com.my E property@mulpha.com.my VER 1.0 - JAN 2021