8/12/2019 MBSB Assessment & Consent Form Retail Financing v1.2

1/1

Assessment and Consent Form - Retail Financing CMD / DSU / Ver. 1.2Customer Full Name Introducer Name

NRIC No. / ID No. NRIC No.

Date of Birth (dd/mm/yyyy) Staff ID No.

Branch

Contact No. (mobile)

PART A :APPLICAN BAC!"R#$ND INF#

i) Name of %m&lo'er ii) Position _____________________________

iii) %m&lo'ment Status Permanent Contract Temporary Self Employed Others:____________________

iv) %ducation (ualification Professional Degree Diploma Others : _________________________

v) )arital Status Single arried Others : ___________________________

vi) S&ouse-Name of %m&lo'er (if any) vii) S&ouse Position(if any) __________________________________

PART ! :FACILI* APPLICAI#N D%AILS Primar' +oint A&&lication "uarantor

"ame:__________________________ "ame:____________________________

i))BSB Facilit' '&e A&&lication ortgage Personal #inancing$i Others :______________________________(Please select)

ii) )BSB Product A&&lication ___________________________________________ (i.e. MBSB S!er Ultimate" Va#an$a" %&ec' etcs)

iii) )BSB Product Profit Rate #i%ed Rate &nt ' Profit Rate : __________________( (i.e. .**" +.2, etcs)

A&&lication(Please select) aria*le Rate &nt ' Profit Rate : BLR pl+s ' min+s : _________________( (i.e. 2.-" +.- etcs)(!lease select)

iv)Financing Amount R (i.e. 1,",,,.,, etcs) v) Financing enure: mth (i.e. 2+" 12, etcs)

PART C , APPLICAN INC#)% / C#))I)%N D%AILS

i) "ross Income R _____________ per month ii) Net Income R_____________ per month

iii) #ther Income(if any)

'&e of Income Income

a) R per month

*) R per month

c) R per month

d) R per month

e) R per month

DSR SP%CIALIS $NI $S%

DSR SA$S , PASS / FAILR%)AR!S ,

ASS%SS%D B*,

.

iv) Financing Commitment (it 0inancial nstittions / Coo!eraties / Credit com!anies etcs) (if any)

Financing Amount

a) R month

*) R month

c) R month

d) R month

e) R month

v) Financing Settlement(it 0inancial nstittions / Coo!eraties / Credit com!anies etcs) (if any)

Deduction Amount

a) R per mth R_________________

*) R per mth R_________________

c) R per mth R_________________

d) R per mth R_________________

e) R per mth R_________________

PART D : CCRIS INF#R)AI#N

i)A&&lication Ref No. / CIF No. ii) Pur&ose of Financing

iii) Priorit' Sector iv) Financing Conce&t

v) Location of Financing $tilisation vi) Purchase Price(for mort#a#e) R

vii) Pro&ert' '&e

PART E :D%CLARAI#N/e ereby ac3noled#e tat MBSB reseres te absolte ri#t to a!!roe or re4ect my/or a!!lication as MBSB deems fit" itot assi#nin# any reason. Co!ies of docments sbmitted are retrnable !on

recei!t of my/or ritten re5est. MBSB is irreocably atorised to disclose all information or !articlars #ien by me/s erein or arisin# from or !rsant to my/or a!!lication (itin and otside of Malaysia)

at it deems fit at any time and for sc !r!oses as MBSB deems necessary. 6otitstandin# te #enerality of te fore#oin#" /e confirm tat MBSB is irreocably atorised to erify and/or ma3e any cec3s

and/or obtain any information and/or confirmations" it or from any credit reference a#encies and/or from any financial instittions" on me/s and/or any oter !erson" indiidal and/or entity as MBSB

may deem fit" for any !r!ose ic MBSB deems fit. /e confirm tat te information #ien is tre" correct and com!lete and declare tat /e ae not been ad4d#ed a ban3r!t.

(7!!licant Si#natre) (ntrodcer Si#natre)

enure Financial Institution Name'&e of Financing

'&e of Financing Financial Institution Name#utstanding Balance

N#% ,

Please attach co&' of a&&licant NRIC / ID card and latest month &a'sli&

0co&' of &a'sli& is com&ulsor' for Personal Financing-i a&&lication

1 his form is used for &reliminar' assessment of customer2s a&&lication

3ith )BSB. Full documentation are re4uired to 5e su5mitted 3ithin

month from the a5o6e assessment date &rior to final decision 5' )BSB,

7 For 8oint a&&lication each a&&licant is to com&lete and sign the

ASS%SS%D B*,

DA%,

.

(ntrodcer to fill'! for

Mort#a#e facility)

Date : Date :

month from the a5o6e assessment date &rior to final decision 5' )BSB,

7 For 8oint a&&lication each a&&licant is to com&lete and sign the

assessment and consent form se&aratel'.

9 Please scan this form 3ith co&' of a&&licant NRIC / ID card / latest month

&a'sli& and email to dsrs&ecialist:m5s5.com.m' 0DSR S&ecialist $nit