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Ref No : DFD-SM-CF-LAF1/PGPP-10/2/2011-R5
Particulars of Guarantors/Partners/Proprietor
A. Name of Applicant Company/Firm*:
Date of Birth (dd/mm/yy):
Citizenship:
Name of Guarantor/Partner/Proprietor
Residential Address:
Telephone No. Home: ______________________________
Mobile: ______________________________
Identity Card(new) &International Passport No.:
(Please attach photocopy)
B. PROFESSIONAL/ACADEMIC QUALIFICATIONS:
Professional/Academic Qualifications Institution Attended Year
of Graduation
1)
2)
3)
C. PROFESSIONAL AND BUSINESS EXPERIENCE:
Year Name of Establishment Position Held
1) To
2) To
3) To
4) To
D. TOTAL PERSONAL ASSETS & LIABILITIES:
Assets Value (RM) Liabilities Balance Owing (RM)
Landed Properties Owing to Banks
Shares In Public Companies Owing to Other Financial
Institutions
Shares In Private Businesses Other Liabilities
Other Assets ______________ ______________
Total========== ===========
NOTE: Further details of Total Personal Assets and Liabilities
are provided in the next page.
I hereby:i. certify that the particulars given in this form and
any other information and documents or copies of documents enclosed
herein or subsequently
submitted are true and correct to the best of my knowledge. I
further declare that there are no legal proceedings, current or
intended instituted
against me by any bank, financial institution or any other
bodies.ii. expressly consent to and authorize you to disclose, as
you shall in your absolute discretion deem fit, to Bank Negara
Malaysia, any other bodies,
authorise (CAGAMAS, debt collection agents) and the companies
within MIDF Group including but not limited to their respective
agents independentcontractors and/or associates for the purpose of
providing integrated services, maintaing records (financial or
otherwise), marketing, distributionand/or other programmes at any
time and without notice or liability, any information and
particulars (financial or otherwise) relating to our affairs
and
accounts, facilities or conduct thereof.iii. authorise MIDF to
verify the information and to conduct any necessary credit checking
on my behalf from whatever sources deemed.
Signature :
Name: Date: ..
*Delete whichever is not applicable
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1. MAJOR LANDED PROPERTIES & OTHER ASSETS:
Type of Property/OtherAssets
Address/Lot Identification/Particulars
Year ofPurchase
Purchase Cost(RM)
MarketValue (RM)
2. HOLDINGS OF SHARES IN PUBLIC COMPANIES:
Name of Company Number of Shares Held
3. HOLDINGS OF SHARES IN PRIVATE BUSINESSES:
ShareholdingsName of Co./Firm
Value (RM) %
Position Held Type of Business
4. MAJOR PERSONAL LIABILITES:
Name of Creditor Bank Or Institution
Type of Facility
(e.g. Term Loan, OD etc)
Amount Owing
as at ..//
