Agent Registration Form

AGENT REGISTRATION FORM
(BORANG PENDAFTARAN EJEN)

FULL NAME (NAMA PENUH)

NRIC (NO KAD PENGENALAN)

MAILING ADDRESS (ALAMAT SURAT-MENYURAT)

CONTACT NUMBER (NO TELEFON)

EMAIL (EMEL)

ACCOUNT NUMBER (NO AKAUN)

BANK NAME (NAMA BANK)

REFERENCE (RUJUKAN)

1. Work Experience/Pengalaman Kerja:
Please state your work experience (years and field)/ Sila nyatakan pengalaman kerja anda (tahunan dan bidang):

2. Involvement with Personal Loans and Financial Consultation:
Penglibatan Dalam Pinjaman Peribadi dan Konsultasi Kewangan:
Have you ever been involved in personal loan transactions and financial consultation with a bank or any financial institution?
Adakah anda pernah terlibat dalam urusan pinjaman peribadi dan konsultasi kewangan dengan bank atau mana-mana institusi kewangan?
If Yes, please elaborate/Jika Ya, sila huraikan:

Yes / Ya No / Tidak

3. How Do You Know About Urus Services?
Bagaimana Anda Mengetahui Tentang Urus Services?
Please state how you learned about Urus Services (e.g., through friends, social media, advertisements, etc.):
Sila nyatakan cara anda mengetahui tentang Urus Services (contohnya, melalui rakan, media sosial, iklan, dll.):

Through Friend/Melalui Rakan Social Media/Media Sosial Advertisements/Periklanan Others/Lain-lain

4. Do You Have Any Relations/Friends in Urus Services?
Adakah Anda Mempunyai Sebarang Hubungan Rakan di Urus Services?
If Yes, please state the name and relationship:
Jika Ya, sila nyatakan nama dan hubungan:

Yes / Ya No / Tidak

Staff Name/ Nama Kakitangan

Relationship/ Hubungan

I confirm that all information provided is true and accurate. I understand that any false information may result in my registration being cancelled/ Saya mengesahkan bahawa semua maklumat yang diberikan adalah benar dan tepat. Saya faham bahawa sebarang maklumat palsu boleh menyebabkan pendaftaran saya dibatalkan.

AGENT REGISTRATION FORM (BORANG PENDAFTARAN EJEN)

AGENT REGISTRATION FORM
(BORANG PENDAFTARAN EJEN)