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Customer Declaration Form

Fill in the particulars, tick the declarations and the relevant banks, then generate the link for your customer to sign. All details will be locked and shown read-only to the customer.

Customer Particulars

Customer Name *

NRIC / ID No. *

Mobile Number

Declarations

Responsibility & Disclosure Acknowledgment

I hereby declare that I take full responsibility for the accuracy of the above declarations. I understand that failure to disclose any of the above will not be accepted with excuses such as "forgot", "don't remember", or "don't know", and the company reserves the right to reject my application accordingly.

Savings Account Held At (tick all that apply)

MaybankCIMBPublic BankRHBHong Leong BankAmBankAffin BankBank IslamBank RakyatBSNCitibankHSBCStandard CharteredUOBOCBCAlliance BankBank MuamalatAgrobankOthers

Repayment History (Past 10 Years)

For the past 10 years, have you had any bank facilities with repayment issues (e.g. late payment, restructuring, AKPK, legal action)?

Tip: use “Save All Detail” to store this declaration as a draft, then “Generate Link to Customer” to create the secure signing link for your customer.