KOPERASI Personal Financing4 Application Form / orang Permoonan Pemlavaan Peril) uid one tar: / Pandan mee orang {Peat ue oa tk ot pen So guna pon mala bua yang Dhan 2. Pans o/s rebar box Stanko (pl yong bran 3. lease thine retevarparcare wan Bock ta Sia an prar ang bekanan dengan haben * Manat ae For K ‘AC ERASI's_Use Only / Untuk Kegunaan KOPERASI 62 fo 0.4 i Facilty Amount / Jumiah Pembiayaan : RM. 1idak melebini amaun tersebut sobelumnya seperti yang diluluskan approved / atau mana-mana amaun y Profit Rate Payment Period / Jangkamasa ‘Seling Price” Pembayaran Installment Amount” [] TJ Months /butan | * Subject to Approval Advice 2a 22 ID Type / Jenis Pengenalan Dir * New IC / KP Baru Birth Cent. iit Kelahiran Police ID / KP Polis New IC No. / No. Kad Pengenalan Baru* [1 Armed Forces 1D / KP Tentara — (] OW IC/KP Loma (1d IC / Birth Cert / Army IC / Police IC IKP Lama /S. Kelahiran /KP Tentera / KP Polis * [ate {s| LT | 23. Date of Bith / ‘Tarikh Lahir (DDIMMYYYY) * Eire 24 Full Name as in IC (undertine sumame) Nama Peniuh seperti dalam KP (gariskan nama keluarga) * ae TI 7 TT CI i LOT Z L L_ | LJ} 25 Tite/Goleran* [J meen =] mémiPuan =] Miss ik (1 ote /Lainian 26 Gender Jantina Oy Mate Lon 1 Female Poremousn 2:7 Marital Status / Tart Perkahwinan “= [“] Single! Buiang Mand /Berkshnin (Cl wicowed Bots Divorced /Bercera Othed Lainain 28 Reco! Bangsa * [] Bumiputra [7] Chinese ina (] Indiana] Other Lainioin 2.9 Religion / Agama * Other /Lain-ain Mustim stam (] Chistian Kristian (C euctnist/eucare — ] Hinduism Hina 2.10 Academic Qualification / Kelayakan Akademik Primary/Rendah— [“] Professional / Profesional /Menergar —— ] Teray/ Tngoi Others / Lain-tain 2.14. Mother's Malden Name / Name lou Pelanggan* L] LITT 3.1 Present Residential Address / Alamat Kediaman Terkini * 7 Trae 1 3.2 Correspondence Address. /Alamat Surat Menyurat * KPO2 (Jul07)3.3 Tel (Home / Rumah)* | __| Mobile No. / Bimbit * Tel (Office / Pejabat)* 7 | Fax/ Faks Email / E-met 4.2 Occupation Sector * Government Servant / Kakitangan Kerajaan Others / Lain-lain 4.3 Occupation [_] Clerk / General Admin / Kerani / Pekerja Am Professional / Profesional / Pekerjaan * Officer / Executive / Pegawai / Eksekutif Teacher / Lecturer / Pendidik / Pensyarah Manager & Above / Pengurus & ke atas Potice / Polis Other / Lain-lain 4.4 Employer's Address / Alamat Majikan 4.5 Length of Service / Tempoh daiam Jawatan * 4.6 Monthly Income / Pendapatan Bulanan * Month 8 lary. Gayl Poke Balerer eee _| | Monthly Fixed Allowance /Elaun Tetap Bulanan Total /Jumlah _ 4.7 Status / Taraf* [_] Permanent / Tetap 4.8 Employment Date / Tarikh Mula Bekerja (DD/MMIYYYY) * 5.1 Spouse's Name / Nama Suami / isteri Old IC / Birth Cert. / Army IC / Police IC |_KP Lama / Sil Kelahiran /KP Tentera / KP Polis. i TT 4 PPP yp yp ye ell - 5.3 Tel (Office / Pejabat)* — |__| Mobile No. / Bimbit * 5.4 No. of Dependants / Bi Tangunggan 5.4 Residence / Kediaman Owned / Sendiri Rented / Menyewa 5.5 Length of Stay at current accommodation / Tempeh menetap di kediaman sekarang