KHTAR FACTORNG SDN.BHD (507971 X) No. 10 G, Persiaran 65, Pekeliling Business Centre, Off Jalan Pahang Barat, 53000 Kuala Lumpur. Tel: 603-4024 6455, 4022 6455, Fax: 603-4022 4020 Email : sera@ikhtiarfactroing.com / norliza@ikhtiarfactoring.com Website: www.ikthiarfactoring.com (NRA AGENCY ) 1) Noor Rozita Binti Alias 0192863769 2) Salim Bin Ahmad 0122945452 (CORPORATE OFFCE) Al-jarah Leasing and Factoring Finance nstitution (Schedule nstitution) under Section 19(1) Banking and Financial nstitution Act (BAFA) 1989 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 : Email Addres : Fax No. : 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
Al-jarah Leasing and Factoring Finance nstitution 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 Company Auditor: 2
Al-jarah Leasing and Factoring Finance nstitution B. PARTCULARS OF CONTRACT PURCHASE ORDER (PO) 1. CONTRACT Contract/PO No : Amount : Description : Remarks : 2. EMPLOYER Address : Contact Person : Contact Number: 3. SUPPLER 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
Al-jarah Leasing and Factoring Finance nstitution 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, 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. 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 3 months Bank Statement. 9. A copy of Registration Certificate with Ministry of Finance. 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. NON-REFUNDABLE APPLCATON FEE OF RM100.00 S TO BE FOWARDED TOGETHER WTH THS APPLCATON RM 100.00 YURAN PEMPROSESSAN HENDAKLAH DSERTAKAN BERSAMA PERMOHONAN N. (YANG TDAK AKAN DKEMBALKAN) /We certify that the above information and the facts set forth set in this application (including any supplemental document(s), if any attached to and made a part of this application) are true and correct. /We hereby you to obtain any Credit nformation related to my / our company from RAM Credit nformation Sdn Bhd and others credit reporting agencies or any source deemed appropriate to verify my / our credit history as it may deem fit under any applicable law, regulation, guidelines, regulatory requirement or directive inn respect of any credit application or credit evaluation purpose. Saya / Kami mengesahkan maklumat di atas itu dan fakta dikemukakan dalam permohonan ini (termasuk apa-apa tambahan document, jika mana-mana, dikepilkan bersama dan menjadi daripada permohonan ini) benar dan betul. Saya / kami dengan ini menguatkuasakan anda memperoleh mana-mana nformasi Kredit berkaitan dengan saya / syarikat kami dari RAM Credit nformatiion Sdn Bhd dan agensi-agensi laporan kredit lain atau apa-apa sumber dianggap sesuai untuk mengesahkan saya / sejarah kredit kami sebagai ia boleh fikir sesuai di bawah sebarang hokum berkkenaan, peraturan, garis panduan, keperluan kawal selia atau arahan dalam hubungan daripda mana-mana bagi tujuan permohonan kredit atau untuk penilaian kredit. Date: Authorised signatories(s) with Company Chop 4
PROFLE FORM PERSONAL DETALS OF DRECTORS / SHAREHOLDERS 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