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Level 31, Menara Ambank,

50450 Kuala Lumpur

03-9078 2009

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9 AM - 5.30 PM

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Home
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03-9078 2009

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Basic Information
Source of Income
Other Source of Income
Credit Facilities

Full Name

Date of Birth

Mobile Number

Email

Marriage Status

Source of Income

Employment Income

Full Commission Income

Business Income

Other Income (Rental, Pension, Dividend, Interest)

Company Name

Position Held

Length of Service

Monthly Basic Salary (Before Deduct EPF, SOCSO, etc)

RM

Monthly Fixed Allowance

RM

Monthly Commission & Overtime

RM

Yearly Contractual Bonus

RM

Yearly Performance Bonus

RM

Latest 6 Months Average Commission

RM

Nature of Business

Business Type

Business Name

Percentage of Company Share Ownership (%)

Length of Service

Latest 6 Months Average Bank Credits/Turnover

RM

Total Previous Year Income As Declared in Income Tax

RM

Total Monthly Rental Income

RM

Total Monthly Pension Income

RM

Total Monthly Dividend Income

RM

Total Monthly Bank Interest Income

RM

Do you have another source of income?

Yes

No

Another Source of Income

Employment Income

Full Commission Income

Business Income

Other Income (Rental, Pension, Dividend, Interest)

Company Name

Position Held

Length of Service

Monthly Basic Salary (Before Deduct EPF, SOCSO, etc)

RM

Monthly Fixed Allowance

RM

Monthly Commission & Overtime

RM

Yearly Contractual Bonus

RM

Yearly Performance Bonus

RM

Latest 6 Months Average Commission

RM

Nature of Business

Business Type

Business Name

Percentage of Company Share Ownership (%)

Length of Service

Latest 6 Months Average Bank Credits/Turnover

RM

Total Previous Year Income As Declared in Income Tax

RM

Total Monthly Rental Income

RM

Total Monthly Pension Income

RM

Total Monthly Dividend Income

RM

Total Monthly Bank Interest Income

RM

Total Credit Card Balance

RM

Total Car Loan Monthly Repayments

RM

Total Personal Loan Monthly Repayments

RM

Total Housing Loan Monthly Repayments

RM

Total Non Residential Loan Monthly Repayments

RM

Total ASB Loan Monthly Repayments

RM

Total Overdraft Outstanding Balance

RM

Total Share Margin Outstanding Balance

RM

Other Monthly Repayment (Not mentioned Above)

RM

Existing Number of Housing Loan

0

1

2 and Above

Confirmation

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LELONG COM SDN. BHD. (1600161-X)
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Level 31, Menara Ambank, Jalan Yap Kwan Seng, 50450 Kuala Lumpur
+603-9078 2009
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