BORANG PERMOHONAN PEMBIAYAAN Perbankan …

1 Perbankan Komersial BORANG PERMOHONAN PEMBIAYAAN Commercial Banking FINANCING APPLICATION FORM. Kepada / To : Bank Islam Malaysia Berhad Kami ingin memohon PEMBIAYAAN perniagaan dari Bank Islam Malaysia Berhad seperti berikut:/ We wish to apply for business financing as follow from the Bank Islam Malaysia Berhad as follows: Huraian Perniagaan/Kontrak yang diterima /. No. / No. Kemudahan / Facility Tujuan / Purpose Description of Business/ Contract Undertaken Jumlah (RM) / Amount (RM). Dengan ini, kami sertakan maklumat berikut untuk tindakan lanjut pihak bank.

2 Sekiranya pihak bank memerlukan maklumat/ penjelasan lanjut, sila hubungi As such, we enclosed herewith the following information for your further action. Should you need further information/ clarification, kindly contact Nama / Name : Jawatan / Position : No. Telefon / Contact No. : BAHAGIAN A: BUTIRAN PEMOHON/. SECTION A: PARTICULAR OF APPLICANT. Pelanggan/ Customer : No. Pendaftaran Syarikat/ Company Registration No. : Alamat Berdaftar/ Registered Address : Alamat Operasi/ Main Operating Address : Dimiliki/ Owned : Ya/ Yes Tidak/ No (Jika Tidak: Sila isi ruang di bawah)/ (If no: Please fill in the below column).

3 Pemilik/ Owner : Hubungan dengan Pemilik/ Relationship with owner : Tempoh Sewaan/ Tenancy Period : Aktiviti Perniagaan/ Business Activity : Tarikh Ditubuhkan/ Date Incorporated : Hari/ Date Bulan/ Month Tahun/ Year Tarikh Mula Perniagaan/ Business Commenced Date : Hari/ Date Bulan/ Month Tahun/ Year Modal Dibenarkan/ Authorised Capital : Modal Berbayar/ Paid Up Capital : Telefon Contact No. : Faks Fax No. : Bank Utama/ Main Bankers : Bilangan Pekerja/ No. of Staff : BAHAGIAN B: BUTIR-BUTIR PEMEGANG SAHAM. SECTION B: PARTICULARS OF SHAREHOLDERS.

4 No. Kad Pengenalan/ No. Pendaftaran Syarikat/. No. Passport/ No. / Pegangan Saham (RM)/ Pegangan Saham (%)/. Nama/ Name Identity Card Co. Registration Shareholdings (RM) Shareholdings (%). Passport ID No. Jumlah/ Total 03-26 900 900. BAHAGIAN C: BUTIR-BUTIR PENGARAH/. SECTION C: PARTICULARS OF DIRECTORS. * Nilai bersih atau Pendapatan Tahunan Tahun Tahun (RM'000)/. Dalam Perniagaan/ Dalam Industri/. Nama/ Name * Networth or No. Kad Pengenalan/ Identity Card No. Years in Business Years in the Industry Annual Income (RM'000). BAHAGIAN D: BUTIR-BUTIR KUMPULAN PENGURUSAN/.

5 SECTION D: PARTICULARS OF MANAGEMENT TEAM. Tahun Tahun Dalam Perniagaan/ Dalam Industri/. Nama/ Name Jawatan/Position No. Kad Pengenalan/ Identity Card No. No of Years No of Years in in Business the Industry BAHAGIAN E: BUTIR-BUTIR ANAK SYARIKAT DAN/ ATAU SYARIKAT-SYARIKAT YANG BERKAITAN/ BERSEKUTU*. SECTION E: DETAILS OF SUBSIDIARY COMPANIES AND/OR RELATED / ASSOCIATED COMPANIES*. Nama/ Name Pegangan Saham/ Shareholdings Jenis Perniagaan/ Nature of Business * Potong yang mana tidak berkenaan/ * Delete whichever not relevant BAHAGIAN F: BUTIR-BUTIR PEMBELI.

6 SECTION F: PARTICULARS OF BUYERS. Nama/ Tempoh Hubungan/ Terma Kredit/ Peratusan/ Percentage Komentar/. Name Years of Relations Credit Terms (%) Remarks BAHAGIAN G: BUTIR-BUTIR PEMBEKAL. SECTION G: PARTICULARS OF SUPPLIERS. Nama/ Tempoh Hubungan/ Terma Kredit/ Peratusan/ Percentage Komentar/. Name Years of Relations Credit Terms (%) Remarks Nota: Tambahan pembekal-pembekal/pembeli-pembeli utama adalah seperti lampiran/. Note: Addtional key suppliers/buyers are as per attachment Perbankan KOMERSIAL. COMMERCIAL BANKING. BAHAGIAN H: BUTIR-BUTIR KEMUDAHAN-KEMUDAHAN KREDIT.

7 SECTION H: DETAILS OF CREDIT FACILITIES. i. Bank Islam Syarikat / Pengarah Kemudahan/ Kadar/ Had/ Kos Belum Jelas (RM)/ Sekuriti/ Sejak/. Company / Director Facility Rate Limit Cost Outstanding (RM) Security Since Komentar/. Remarks ii. Dedahan Pelanggan Dengan Institusi Kewangan Yang Lain/ Customer's Exposure With Other Financial Institutions Syarikat / Pengarah Kemudahan/ Kadar/ Had/ Kos Belum Jelas (RM)/ Sekuriti/ Sejak/ Komentar/. Company / Director Facility Rate Limit Outstanding Cost (RM) Security Since Remarks Nota: Sila senaraikan semua kemudahan Perbankan yang telah ditawarkan kepada pengarah/penjamin/ syarikat-syarikat berkumpulan/.

8 Note: Please list all banking facilities granted to directors/ guarantor/ group of companies BAHAGIAN I: PENERANGAN TERPERINCI SEKURITI YANG TELAH DITAWARKAN. SECTION I: DETAILS OF OFFERED SECURITY. No. Huraian/ Description Nilai (RM)/ Value (RM). BAHAGIAN J: BUTIR-BUTIR HARTANAH. SECTION J: DETAILS OF LANDED PROPERTY. Jenis Harta/. Type Of Property Keterangan Hakmilik/. Title Particulars HS(D)/ HS(M)/ QT(R)/ QT(M)/ PM/ GM : PT/LOT : Mukim : Daerah/ District : Negeri/ State : Alamat / Lokasi/. Address / Location Pemilikan/. Tenure Pegangan Kekal/ Freehold Pegangan Pajakan/ Leasehold tahun/ years (Tarikh Luput/ Expiry Date) : Hari/ Date Bulan/ Month Tahun/ Year Keluasan Tanah/ Pemilik Berdaftar/.

9 Land area Registered Owner Nilai Jualan Terpaksa/ Nama Penilai/. Force Sale Value Name of Valuer Sekatan/ Tarikh Penilaian/. Encumbrances Date of Valuation Jumlah diinsuranskan/ Pembatasan Dalam Sum Insured Kepentingan / Syarat Restriction in Interest / Conditions BAHAGIAN K: BUTIR-BUTIR PENJAMIN. SECTION K: PARTICULARS OF GUARANTOR. * Nilai bersih atau No. Pendaftaran Syarikat/ No. Kad Pengenalan/. Pendapatan Tahunan (RM'000)/ No. Pasport/ Lain-lain ID/. Nama/ Name * Networth or Co. Registration Identity Card No/. Annual Income (RM'000) Passport Other ID.

10 Nota: Jika penjamin yang dicalonkan tidak seperti di bahagian B, C and D/ Note: If the proposed guarantor is not as per section B, C and D. BAHAGIAN L: PENGESAHAN PIHAK-PIHAK YANG BERKAITAN. SECTION L: DECLARATION OF CONNECTED PARTIES. Mana-mana Pemegang Saham/ Pengarah/ Penjamin/ Pemilik syarikat atau entiti perniagaan yang mempunyai hubungan samada dengan Pengarah Bank/ Pemegang Saham yang mengawal/. Pekerja atau mana-mana saudara terdekat. Sila tanda ( ) di mana Any of the Shareholders/ Directors/ Guarantors/ Owner of the company or business entity that has relationship either with the bank's Directors/ Controlling Shareholders/ Employees or their close relatives?