BAHAGIAN A: BUTIRAN PEMOHON/ SECTION A: PARTICULAR OF APPLICANT. Hari/ Date Bulan/ Month Tahun/ Year
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1 BORANG PERMOHONAN PEMBIAYAAN FINANCING APPLICATION FORM Perbankan Komersial Commercial Banking 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: No. / No. Kemudahan / Facility Tujuan / Purpose Huraian Perniagaan/Kontrak yang diterima / Description of Business/ Contract Undertaken Jumlah (RM) / Amount (RM) Dengan ini, kami sertakan maklumat berikut untuk tindakan lanjut pihak bank. 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) Pemilik/ Owner : Hubungan dengan Pemilik/ Relationship with owner : Tempoh Sewaan/ Tenancy Period : Aktiviti Perniagaan/ Business Activity : Tarikh Ditubuhkan/ Date Incorporated : Tarikh Mula Perniagaan/ Business Commenced Date : Hari/ Date Bulan/ Month / Year Hari/ Date Bulan/ Month / Year Modal Dibenarkan/ Authorised Capital : Modal Berbayar/ Paid Up Capital : Telefon No./ Contact No. : Faks No./ Fax No. : Bank Utama/ Main Bankers : Bilangan Pekerja/ No. of Staff : BAHAGIAN B: BUTIR-BUTIR PEMEGANG SAHAM SECTION B: PARTICULARS OF SHAREHOLDERS No. Kad Pengenalan/ No. Pendaftaran Syarikat/ No. Passport/ No. I.D / Identity Card No./ Co. Registration No./ Passport No./ ID No. Pegangan Saham (RM)/ Shareholdings (RM) Pegangan Saham (%)/ Shareholdings (%) Jumlah/ Total
2 BAHAGIAN C: BUTIR-BUTIR PENGARAH/ SECTION C: PARTICULARS OF DIRECTORS * Nilai bersih atau Pendapatan an (RM 000)/ * Networth or Annual Income (RM 000) No. Kad Pengenalan/ Identity Card No. Dalam Perniagaan/ Years in Business Dalam Industri/ Years in the Industry BAHAGIAN D: BUTIR-BUTIR KUMPULAN PENGURUSAN/ SECTION D: PARTICULARS OF MANAGEMENT TEAM Jawatan/Position No. Kad Pengenalan/ Identity Card No. Dalam Perniagaan/ No of Years in Business Dalam Industri/ No of Years in 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* Pegangan Saham/ Shareholdings Jenis Perniagaan/ Nature of Business * Potong yang mana tidak berkenaan/ * Delete whichever not relevant BAHAGIAN F: BUTIR-BUTIR PEMBELI SECTION F: PARTICULARS OF BUYERS Nama/ Name Tempoh Hubungan/ Years of Relations Terma Kredit/ Credit Terms Peratusan/ Percentage (%) BAHAGIAN G: BUTIR-BUTIR PEMBEKAL SECTION G: PARTICULARS OF SUPPLIERS Nama/ Name Tempoh Hubungan/ Years of Relations Terma Kredit/ Credit Terms Peratusan/ Percentage (%) Nota: Tambahan pembekal-pembekal/pembeli-pembeli utama adalah seperti lampiran/ Note: Addtional key suppliers/buyers are as per attachment PERBANKAN KOMERSIAL COMMERCIAL BANKING
3 BAHAGIAN H: BUTIR-BUTIR KEMUDAHAN-KEMUDAHAN KREDIT SECTION H: DETAILS OF CREDIT FACILITIES i. Bank Islam Syarikat / Pengarah Company / Director Kemudahan/ Facility Kadar/ Rate Had/ Limit Kos Belum Jelas (RM)/ Cost Outstanding (RM) Sekuriti/ Security Sejak/ Since ii. Dedahan Pelanggan Dengan Institusi Kewangan Yang Lain/ Customer s Exposure With Other Financial Institutions Syarikat / Pengarah Company / Director Kemudahan/ Facility Kadar/ Rate Had/ Limit Kos Belum Jelas (RM)/ Outstanding Cost (RM) Sekuriti/ Security Sejak/ Since Nota: Sila senaraikan semua kemudahan perbankan yang telah ditawarkan kepada pengarah/penjamin/ syarikat-syarikat berkumpulan/ 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./ 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 / Year Keluasan Tanah/ Land area Nilai Jualan Terpaksa/ Force Sale Value Sekatan/ Encumbrances Jumlah diinsuranskan/ Sum Insured Pemilik Berdaftar/ Registered Owner Nama Penilai/ Name of Valuer Tarikh Penilaian/ Date of Valuation Pembatasan Dalam Kepentingan / Syarat Restriction in Interest / Conditions
4 BAHAGIAN K: BUTIR-BUTIR PENJAMIN SECTION K: PARTICULARS OF GUARANTOR * Nilai bersih atau Pendapatan an (RM 000)/ * Networth or Annual Income (RM 000) No. Pendaftaran Syarikat/ No. Kad Pengenalan/ No. Pasport/ Lain-lain ID/ Co. Registration No./ Identity Card No/ Passport No./ Other ID 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 bersesuaian./ 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? Please tick ( ) where is applicable. Ya/ Yes Tidak/ No Jika ya, sila berikan butir-butir tertentu seperti di bawah:/ If yes, please specify as below: Nama Individu Di Dalam Syarikat (Pemegang Saham/Pengarah/Penjamin/Pemilik Syarikat)/ Name of the Person in the Company (Shareholders/Directors/Guarantors/Owner of the company) Nama pihak-pihak yang berkaitan (Pengarah Bank/Pemegang saham yang mengawal/ Pekerja-pekerja atau saudara mara terdekat) Name of Connected Parties (Bank s Directors/Controlling Shareholders/ Employees or their close relatives) Jawatan/ Position Hubungan/ Relationship BAHAGIAN M: PENGESAHAN OLEH PELANGGAN/ SECTION M: DECLARATION FROM CUSTOMER Saya/Kami mengesahkan bahawa butir-butir dan maklumat yang saya/kami berikan kepada Bank adalah benar dan betul dan tiada sebarang liabiliti terlindung (terus/mungkin berlaku). Saya/Kami dengan ini bersetuju dan mengizinkan pihak bank atau sesiapa sahaja yang dilantik oleh pihak Bank untuk mendapatkan dan/atau mengesahkan sebarang maklumat (termasuk carian CTOS/ CCRIS keatas syarikat, pengarah, pemilik perniagaan, rakan kongsi, pemegang saham dan penjamin) yang diperlukan ke atas permohonan ini./ I/We hereby declare that all information furnished to the Bank by me/us is true and correct and that there is no undisclosed liabilities (direct or contingent). I/We hereby agree and consent that the Bank or whomever the Bank may appoint to obtain and/or verify any information required [including CTOS/ CCRIS against company, directors, business owners, partners, shareholders and guarantors (if any)] in respect of this application. Saya/Kami dengan ini membenarkan Bank untuk maklumkan atau membuka secara rahsia maklumat berkenaan kedudukan kewangan saya/kami kepada mana-mana institusi kewangan atau lain-lain pihak atas sebab-sebab yang dianggap bersesuaian bagi pihak Bank./ I/We hereby authorize you to impart or disclose in confidence any information regarding my/our financial standing to any other financial institutions or any other parties for any reasons that the Bank deems fit. Tandatangan Pemohon yang dibenarkan/ Authorized Signature of Applicant/s Tarikh/ Date : PERBANKAN KOMERSIAL COMMERCIAL BANKING
5 MAKLUMAT YANG DIPERLUKAN UNTUK PERMOHONAN PEMBIAYAAN REQUIRED INFORMATION FOR FINANCING APPLICATION Bahagian 1/ Section 1 Bahagian 2/ Section 2 No./ No. 1. Borang Permohonan Pembiayaan/ Financing Application Form 2. Dokumen-Dokumen Berkanun:/ Statutory Documents: Sendirian Berhad/ For Private Limited Borang 24, 44 dan 49 yang telah disahkan/ Certified of Form 24, 44 and 49 Sijil Perbadanan yang telah disahkan/ Certified of Incorporation Certificate Memorandum & Artikel Bersekutu terkini yang telah disahkan / Certified Latest Memorandum & Articles of Association Milikan Sendiri/ Rakan Kongsi/ Firma Profesional/ For Sole Proprietorship / Partnership / Professional Firm Borang Pendaftaran Perniagaan yang telah disahkan (Borang D)/ Certified of Business Registration Form (Form D) Sijil yang dikeluarkan oleh Badan Profesional yang telah disahkan**/ Certified of Certificate issued by the Professional Bodies** ** Untuk firma profesional sahaja/ For professional firm only 3. Maklumat Kewangan:/ Financial Information: Sendirian Berhad/ For Private Limited Akaun Beraudit untuk 3 tahun terkini yang telah disahkan dan akaun pengurusan terkini/ Certified Audited Account for the last 3 years and the latest management account.* Milikan Sendiri/ Rakan Kongsi/ Firma Profesional/ For Sole Proprietorship / Partnership / Professional Firm Akaun Pengurusan untuk 3 tahun terkini yang telah disahkan dan akaun perngurusan terkini*/ Certified Management Account for the last 3 years and the latest management account.* 4. Penyata Bank untuk 6 bulan tekini yang telah disahkan*/ Certified Bank Statement for the last 6 months.* Dokumen Dilampirkan/ Documents Attached Ya/ Yes Tidak/ No Dokumen adalah lengkap/ Documents are in order Ya/ Yes Tidak/ No Latar Belakang Syarikat termasuk:/ Background of Company which include: Ringkasan Sejarah/ Brief History Struktur Pengurusan/ Management Structure Gambarajah Proses Perniagaan/ Flowchart of the business process Senarai kontrak/ projek/ kerja yang lepas, terkini dan akan datang (contoh: nilai, maklumat kerja, prinsipal & tahun)/ List of previous, current and potential contract / project (i.e. value, job description, principal, year awarded) Cagaran:/ Collateral: Laporan Penilaian/ Valuation Report Salinan Hakmilik/ Copy of Title Perjanjian Jual & Beli/ Sale & Purchase Agreement Maklumat berkenaan pengarah :/ Information pertaining to directors which include: Salinan kad pengenalan pengarah/ pemilik/ rakan kongsi yang telah disahkan/ Certified of directors or owner or partners IC photocopies Borang Penyata Hubungan Peribadi*/ Statement of Personal Affairs Form* Salinan Borang J/ Copy of J Form Sumber Bayaran Balik/ Source of Payment 9. Senarai hutang belum terima dan hutang belum bayar beserta tempoh tamat/ Aging list for receivables and payables 10. Butir-butir kontrak/projek* / Details of contract/project* Salinan Surat Perjanjian Kontrak / A copy of Letter of Award Jangkaan Aliran Tunai / Cashflow Projection Senarai tambahan pembekal dan pembeli (sekiranya ada pertambahan dari senarai di dalam borang permohonan pembiayaan / A List of supplier and buyer (if there is any additional from the listing as per Financing Application Form) Nota/ Note: 1. *Sila rujuk pegawai Bank untuk maklumat lanjut./ *Kindly refer to Bank s Officer for further information. 2. Pemohon dikehendaki menyediakan dokumen yang diperlukan seperti di atas. Pihak Bank dianggap menerima permohonan setelah menerima semua maklumat yang diperlukan di atas dan akan memproses permohonan dari tarikh penerimaan./ Applicant needs to provide the required documents as above. The Bank shall treat the application as received upon receiving the required information and subsequently proceed to process from the date thereon. 3. Bahagian 1 perlu diisi oleh pemohon manakala Bahagian 2 diisi oleh pegawai Bank./ Section 1 needs to be filled-in by the applicant whilst for Section 2 is for Bank s officer only. Untuk kegunaan pejabat sahaja/ For internal usage only Diterima oleh/ Received by Tarikh Terima/ Date Received Permohonan pertama/ 1st application - Dokumen lengkap/ Full document - Kami mengesahkan di sini bahawa kami telah memeriksa dokumen-dokumen tersebut dan kami dapati:/ We hereby confirmed that we have screened the documents and we found that/ Dokumen-dokumen adalah lengkap/ The documents are in order. a) Terdapat dokumen yang tertinggal/ tidak lengkap/ luput. Oleh demikian, pihak kami telah menghantar surat kepada pelanggan bertarikh dan/atau menghubungi pelanggan pada untuk memohon maklumat lanjut./ There are few documents missing/ not in order/ lapsed. As such, we have sent a letter to customer dated and/ or contact customer on to request further information. b) Pada, pemohon telah menghantar dokumen tambahan untuk pemeriksaan semula./ On, the applicant has sent additional document for screening. PERBANKAN KOMERSIAL COMMERCIAL BANKING
6 Pusat Panggilan Contact Center Untuk keterangan lanjut, sila hubungi: For more information, please contact:
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