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									ORIX LEASING MALAYSIA BERHAD (Co. No:15741-D) ORIX CREDIT MALAYSIA SDN BHD (Co No. 67108-U)
12th Floor, Menara Promet, Jalan Sultan Ismail, 50250 Kuala Lumpur
Tel: 03-2418355 Fax: 03-2485713 E-Mail: info1@orix.com.my


APPLICATION FORM

TYPE OF FACILITY                           HIRE PURCHASE                       LEASING

1. COMPANY

NAME OF COMPANY: ______________________________________________________________________________________
BUSINESS ADDRESS : ______________________________________________________________________________________
___________________________________________________________________________________________________________
POST CODE : ________________________                  STATE : ________________________         TYPE OF ORGANISATION : _______
CAPITAL AS AT : ____________________                  AUTHORISED : __________________          PAID UP : _______________________
TELEPHONE NO : ____________________                   DATE OF INCORP : ______________          REGISTRATION. No : _____________
NO. OF YEARS THERE : ______________                      OWN PROPERTY                   MORTGAGED           RENTED ______MTH
NATURE OF BUISNESS : ____________________________________________________________________________________
SHAREHOLDERS/DIRECTORS/PARTNERS/SOLE PROPRIETOR
             NAME                           CO. REG.NO./I/C NO                    DESIGNATION              SHAREHOLDINGS




2. INDIVIDUAL

NAME : _______________________________________________________________                          MALE          FEMALE
I/C / PASSPORT NO. (OLD) : ___________________                       (NEW) : ____________________ DATE OF BIRTH : _____________
MARITAL STATUS : _________________                    NO. OF DEPENDENTS : __________           NATIONALITY : ________________
HOME ADDRESS : _________________________________________________________________________________________
__________________________________________________________________________________________________________
POST CODE : ________________________                  STATE : _______________________
TELEPHONE NO : HOUSE_____________                     OFFICE _______________________           HANDPHONE ___________________

NO. OF YEARS THERE : ______________                       OWN                   MORTGAGED        RENTED             PARENTS/
                                                          PROPERTY                               RM______MTH        RELATIVE

OCCUPATION                                 EMPLOYED                                  SELF-EMPLOYED
EMPLOYER : ______________________________________________________________________________________________
ADDRESS : ________________________________________________________________________________________________
__________________________________________________________________________________________________________
POST CODE : _________________________                  STATE : _________________________
TELEPHONE NO : _____________________                   FAX NO : ________________________         E-MAIL: ______________________
POSITION HELD : _____________________                  MONTHLY INCOME / SALARY :                 NO. OF YEARS IN COMPANY :
                                                       RM __________________                     _________
SPOUSE
NAME : __________________________________________________________________                        NATIONALITY : ______________
I/C / PASSPORT NO. (OLD) : __________________                   NEW : ______________________ DATE OF BIRTH : ______________
EMPLOYER : _____________________________________________________________________________________________
ADDRESS : _______________________________________________________________________________________________
POST CODE : _________________________                  STATE : _________________________
TELEPHONE NO : _____________________                   FAX NO : _______________________          E-MAIL : _________________
POSITION HELD : _____________________                  MONTHLY INCOME/SALARY :                   NO. OF YEARS IN COMPANY :
                                                       RM ______________________                 ___________
3. BANKING FACILITES (LOANS/OVERDRAFT/LEASE/HIRE PURCHASE)
   LENDER &       TYPE OF         A/C /       LOAN       BALANCE                                                    SECURITY
    BRANCH        FACILITY     VEHICLE No.  AMOUNT     OUTSTANDING



4. BUSINESS (SUPPLIER & CUSTOMER) /PERSONAL REFERENCE
   COMPANY/INDV. NAME                ADDRESS          CONTACT PERSON                                                   TEL. NO.



5. PROPOSED GUARANTOR(S) (USE ATTACHMENT, IF NECESSARY)
A. INDIVIDUAL
NAME : ________________________________________________________________                        MALE           FEMALE
I/C / PASSPORT NO. (OLD) : ___________________ (NEW) : ____________________ DATE OF BIRTH : _________________
MARITAL STATUS : __________________               NATIONALITY : ________________              RELATIONSHIP : ________________
HOME ADDRESS : __________________________________________________________________________________________
POST CODE : ____________________                  STATE : ______________________              CONTACT NO : _________________
EMPLOYER : _______________________________________________________________________________________________
ADDRESS : _________________________________________________________________________________________________
POST CODE : ________________________              STATE : ________________________
TELEPHONE NO : ____________________               FAX NO: _______________________             E-MAIL : _______________________
POSITION HELD : ____________________              MONTHLY INCOME/SALARY :                     NO. OF YEARS IN COMPANY :
                                                  RM _________________                        ____________________
B. CORPORATE
NAME OF COMPANY: ______________________________________________________________________________________
BUSINESS ADDRESS : ______________________________________________________________________________________
POST CODE : ________________________             STATE : _______________________
CAPITAL AS AT : ____________________             AUTHORISED : _________________             PAID UP : _______________________
TELEPHONE NO :____________________               DATE OF INCORP/REG : __________            CO. REG. No : ____________________
NATURE OF BUISNESS : ____________________________________________________________________________________

6. DESCRIPTION OF GOODS
SUPPLIER                                       DESCRIPTION OF GOODS                              PURCHASE COST


REPAYMENT TERM ____________                    LOAN AMOUNT : RM___________                       TOTAL COST : RM ___________

7. EQUIPMENT TO BE LOCATED AT:
8. DECLARATION
    I/We hereby declare that the information supplied in this application form is true and correct.
    I/We hereby authorise you to obtain any information you may require from any source in connection with this application.

    IMPORTANT : ORIX LEASING MALAYSIA BERHAD / ORIX CREDIT MALAYSIA SDN BHD reserves the right to reject
                the application without assigning any reasons thereof.

    DATE : _____________________                  SIGNATURE OF APPLICANT : ________________________________
9. DOCUMENTS TO BE SUBMITTED WITH APPLICATION FORM
1         M& A/BUSINESS REGISTRATION                             8         PAYSLIP (LAST 3 MONTHS) *
2         PRACTISING CERTIFICATES, IF ANY                        9         INCOME TAX FORM J (LAST 2 YEARS) *
3         FORM 24                                                10        CURRICULUM VITAE, IF ANY
4         FORM 49                                                11        LIST OF CONTRACTS/PROJECTS, IF ANY
5         BANK STATEMENT (LAST 6 MONTHS)                         12        IDENTITY CARD OF APPLICANT – PHOTOCOPYY *
6         BANK OFFER LETTER, IF ANY                              13        IDENTITY CARD OF GUARANTOR – PHOTOCOPY *
7         AUDITED ACCOUNTS (LAST 1 YEAR)                         14        SUPPLIERS QUOTATION

N.B. * THE ABOVE DOCUMENT REQUIREMENT APPLIES TO INDIVIDUAL APPLICANT & PROPOSED GUARANTOR.

								
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