Borang Permohonan Perkhidmatan Pinjaman /Lending Service Request Form - Mortgage

*Ruang mandatori / Mandatory fields

Pemegang Akaun / Account Holder Name(s)*

NRIC / Passport No. / Registration No.*

No. Telefon / Contact No.*

Nombor Akaun / Account No.*

A) Permohonan Perkhidmatan Untuk / Service Request For:
1)

Penyata Akaun (Yuran RM20 bagi setiap tempoh penyata)

/ Statement of Account (Fee of RM20 per statement cycle)

2)

Penukaran Ansuran Bulanan /

Penambahan Kepada /
Pengurangan Kepada /
Revision of Installment:
Increase to:
RM:
a
Reduce to: RM:
a
Permohonan Semakan Semula Faedah (RM50 bagi setiap permintaan yang diluluskan) /
Request for Interest Rate Revision (RM50 for each approved request)
Penyata Penebusan / Redemption Statement
(Yuran sebanyak RM50 akan dikenakan bagi setiap penyata yang dipohon / Fee of RM50 will be charged for each statement requested.)

3)
4)
5)
6)

Dari / From:

Sehingga / To:

Surat Subsidi / Subsidy Letter

(Yuran sebanyak RM20 akan dikenakan / Fee of RM20 will be charged.)
Penyata Pengeluaran KWSP / EPF Withdrawal Statement (Yuran sebanyak RM20 akan dikenakan / Fee of RM20 will be charged.)
Untuk / For:
Bayaran Pokok /Principal Payment
Ansuran Bulanan / Monthly Installment
Sekiranya ini adalah pembiayaan semula, sila nyatakan nama pembiaya terdahulu / Please provide previous financier if this is a refinanced account.

B) Permohonan Salinan Dokumen / Request For Photocopy Of Documents

(Yuran sebanyak RM20 akan dikenakan bagi salinan pertama dan RM10 bagi setiap salinan yang berikutnya /
Fee of RM20 will be charged for the first photocopy and RM10 for each subsequent photocopy.)
1)
Surat Tawaran Pinjaman / Letter of Offer
5)
Perjanjian Pinjaman / Loan Agreement Cum Assignment
2)

Surat Perjanjian Jual Beli / Sales and Purchase Agreement

6)

Borang Gadaian / Memorandum of Charge

3)

Penyata Penebusan daripada Pembiaya Terdahulu /

Redemption Statement from Previous Financier

7)

Surat Ikatan Serahan Hak (sekiranya harta tiada Geran

Hakmilik) / Deed of Assignment (if Title is not issued yet)

4)

Geran Hakmilik / Title Deed

C) Permohonan Pemulangan Wang Terlebih Bayar / Request To Refund Excess Amount

Sila lampirkan salinan muka depan Buku Akaun atau Penyata Akaun bagi tujuan pengesahan / Please enclose a copy of the front page of Passbook or
Statement of Account for verification.
Nama Penuh Penerima / Beneficiarys Full Name:
Bank Penerima / Receiving Bank:
1)

Nombor Akaun Simpanan /

Savings Account Number:
Saksi oleh Peguamcara atau Pegawai AmBank /
Witness by Solicitor or AmBanks Officer:

2)

Nombor Akaun Semasa /

Current Account Number:

(Nama Penuh / Full Name)

(Tandatangan / Signature)

D) Pelepasan Gadaian / Discharge

1)

Perlantikan Panel Peguamcara Semasa Penyelesaian Pinjaman / Appointment of Panel Solicitor Upon Settlement

2)

Sila Hantar Dokumen Ini Kepada Peguamcara / Please send the Document to my Solicitor:________________________________________
Beralamat / Addressed at :

E) Lain-Lain Perkhidmatan Sila Nyatakan / Other Services - Please Specify

Kaedah Penghantaran / Mode Of Delivery

Sila pilih kaedah penghantaran bagi perkhidmatan yang dipohon / Please choose your preferred mode of collection for the selected service request(s): *
Dikutip di cawangan/
Collect at branch:

(Sila nyatakan cawangan / Please specify which branch)

Tandatangan Pemegang Akaun / Pihak

Yang Diberi Kuasa
Account Holder / Authorised Signatory *

Hantar ke alamat surat menyurat /

Send to my correspondence address

Tarikh
/ Date*

(Jika ini adalah akaun bersama, semua pemegang akaun perlu menandatanganinya/
If this is a joint account, all account holders have to sign.)

Untuk Kegunaan Bank Sahaja / For Banks Use Only:

Semakan biometrik diperiksa /
Biometric check done:
Passed

Receiving Branch

Verified By

Attended By

Updated By

Checked By

Failed
Name & Stamp

Date & Time

Date & Time

Date & Time