Suite B-11-2, Megan Avenue 1, No. 189, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia Tel: 603-2166 2728 Fax: 603-2166 2729 Website: www.planworthfactor.com APPLCATON FOR FACTORNG FACLTY Factoring Confirming Facility Bank Guarantee Facility Amount: RM A. PARTCULARS OF APPLCANT 1. Company Name: 2. Type of Company (Please tick where applicable) Sendirian Berhad Partnership Proprietorship 3. Date of ncorporation/registration: 4. ncorporation/registration Certificate No: 5. Registered Address: 6. Business Address: Telephone No : Fax No: E-mail Address. : 7. Contact Person/Contact No. (H/P): 8. Nature of Business : 9. Authorised Capital : 10. Paid-up Capital : 11. Status of Company : Bumiputra Company Non-Bumiputra Company Foreign Company 12. Company s shareholder: No Name of Shareholders NRC No. No. of Shares % 1
Factoring Finance nstitution (Schedule nstitution) under Section 19(1) Banking and Financial nstitution Act (BAFA) 1989 13. Board of Directors: No Name NRC No. Resident Address 14. Name of Company s Top Management Personnel: No Name Position Year(s) in Company 15. Bank Reference: No Name Branch A/C No. Type & Amount of Facilities Obtained Name of Contact Person & Tel. No. 16. Name of Co. Secretary: Address : Tel. No. : 2
Factoring Finance nstitution (Schedule nstitution) under Section 19(1) Banking and Financial nstitution Act (BAFA) 1989 B. PARTCULARS OF CONTRACT PURCHASE ORDER (PO) 1. CONTRACT Contract/PO No : Amount : Description : Remarks : 2. CUSTOMER Name : Address : Contact Person : Contact Number: 3. SUPPLER Name : Address : Contact Person : Tel/Fax No. : Cost of Purchase : Term of Purchase : Expected Date of Delivery : 4. CONTRACT SUMMARY 1. Contract/Po Amount 2. Total Purchase Cost 3. Gross Profit 4. Percentage of Gross Profit (i.e.item3 / item 1) % 5. Expected Repayment Period From Employer days 3
Factoring Finance nstitution (Schedule nstitution) under Section 19(1) Banking and Financial nstitution Act (BAFA) 1989 D. DOCUMENTS TO BE SUBMTTED WTH THS APPLCATON 1. A certified copy of Memorandum and Article of Association of your company (for limited company only). For sole-proprietorship or partnership, a copy of the Business Registration certificate. 2. A certified copy of Form 9, 13, 24, 34, 40, 44, 49 & Annual Return. 3. Company Profile (To include resume on directors/shareholders personnel form attached) 4. Photocopy /C of all directors and shareholders. 5. Original copy of the contract/purchase order/ letter of award. 6. A copy of the supplier s quotation or proforma invoice and the relevant catalog for the products contracted for, where applicable. 7. Audited accounts for the last 3 years, if available. 8. Latest 6 months Bank Statement. 9. A copy of Registration Certificate with Ministry of Finance/ MOF Certificate & PKK. 10. Copy of all existing banking facilities i.e. OD/Term Loans/LCTR/BG off letters. 11. List of Track Record. 12. List of anticipated contract (to include tender participation) E. Declaration Has the company, or any of its Directors & Shareholders ever filed for bankruptcy Yes No been served with a winding up / bankruptcy petition? s there any pending litigation, legal and / or administration proceeding against the Yes No company or its Directors & Shareholders? Are there any judgments pending by or against the company, directors & shareholders? Yes No That, pursuant to the Credit Reporting Agencies Act 2010 ( Act ), we and /We, the following individuals whether as ndividual or as Directors / Shareholders / Business nterest Parties do hereby give consent to Planworth Global Factoring Sdn Bhd to obtain and/or disclose any Credit nformation (as defined in the Act) relating to me/our company from and/or to RAM Credit nformation Sdn Bhd or any source deemed appropriate to verify my/our credit history as you and/or RAM Credit nformation Sdn Bhd or any source deemed appropriate may deem fit under any applicable law, regulation, guidelines, regulatory requirement or directive in relation to my/our company s credit application or transaction with you for the following purposes (but not limited to) opening of account, credit evaluation, credit/account review, credit/account monitoring, debt recovery purposes, scoring solutions, legal documentation and/or action consented to a contract or facility granted. Such consent shall remain applicable as long as /our company am/is maintaining an account/loan/credit/any transaction with you. /We certify that the above information and the fact set forth set in this application (including) any supplemental document(s), if any to and made a part of this application) are true and correct. Date: Authorised signatories(s) with Company Chop 4
PROFLE FORM PERSONAL DETALS OF DRECTORS / SHAREHOLDERS/ GUARANTORS Name : NRC No. Passport No. : Resident: Telephone No. : Date of Birth : Sex : Nationality : Race: Academic / Qualification: WORKNG EXPERENCE Period Organisation Position / Responsibility STATEMENT OF ASSETS & LABLTES Asset a) Land & Building RM b) Saving & Deposits RM c) nvestment in other Companies RM Other Assets d) RM e) RM Liabilities Tanggungan a) Amount owing to Financial nstitutions RM Other Liabilities b) RM c) RM 5
PROFLE FORM That, pursuant to the Credit Reporting Agencies Act 2010 ( Act ), we and /We, the following individuals whether as ndividual or as Directors / Shareholders / Business nterest Parties do hereby give consent to Planworth Global Factoring Sdn Bhd to obtain and/or disclose any Credit nformation (as defined in the Act) relating to me/our company from and/or to RAM Credit nformation Sdn Bhd or any source deemed appropriate to verify my/our credit history as you and/or RAM Credit nformation Sdn Bhd or any source deemed appropriate may deem fit under any applicable law, regulation, guidelines, regulatory requirement or directive in relation to my/our company s credit application or transaction with you for the following purposes (but not limited to) opening of account, credit evaluation, credit/account review, credit/account monitoring, debt recovery purposes, scoring solutions, legal documentation and/or action consented to a contract or facility granted. Such consent shall remain applicable as long as /our company am/is maintaining an account/loan/credit/any transaction with you. /We certify that the above information and the fact set forth set in this application (including) any supplemental document(s), if any to and made a part of this application) are true and correct. Date: Authorised signatories(s) 6