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Personal Details
Full Name in NRIC/Passport:
Nric / FIN No:
Date of Birth:
Nationality: EP/Fin.
Marital Status:
Contact Numbers: (Home) (Office) (Mobile)

Residential Address
Block No:
Street Name:
Unit No #:
Postal Code:
Type of residence:
Residence of ownership:

Your Employment Details
Employment Status:
Current Employer:
Job Designation:
Length of Service:
Gross Monthy Salary:
Date of Payday:

Loan Information
Loan Amount Requested:
Do you have any other outstanding loans with other Licensed Money Lenders? :

If yes, Please specify the name of the companies

Preferred Mode of Payment :

For any further clarifications or changes for the data provided by you and the purposes that it will be used for, you may contact Teh Chee Wee(Data Protection Officer) at 68845855.

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