SPECIMEN FORM 34 - FOR LAND CHARGE [OPEN MONIES] UNDER THE NATIONAL LAND CODE 1965 [JAN 2003]

FORM 34
Section 108(1) and 110(1)

Companies Act 1965 Company No.

STATEMENT OF PARTICULARS TO BE LODGED WITH CHARGE ...(name of company which executes the Charge )......(NAME OF COMPANY)
To the Registrar of Companies,

1.

The charge is created by:

[name of company which is executing [registered address]

the Charge ]
2. 3. 4. The *charge was created on : [date of the Charge ] The charge is *fixed/*floating/*fixed and floating: Fixed

* [First/Second etc.] Legal Charge under the National Land Code 1965 dated _______ (the Charge).
The description of the instrument(s) creating or evidencing the charge is: The liability (whether present or prospective) secured by the charge is:

5.

All sums of money and liabilities whether present, future, actual or contingent including all principal sums, interest (including default and capitalised interests), costs, charges and expense whatsoever which are now or shall from time to time or at any time hereafter become owing or remaining unpaid or incurred by [ insert name of Borrower] to Hong Leong Bank Berhad under any account, loans, credits or advances or in any manner whatsoever.
6. The liability secured is for the benefit of : [name and NRIC number of the

Borrower if individual] [name and company number of Borrower if company]

7. 8. 9. The creation of subsequent charges is restricted or prohibited. A short description of the property affected is:
[ Insert title details ]

The name and address of the chargee is:

[address of branch]

10.

Some salient covenants or terms and conditions in the instrument of charge:

All the terms and conditions set out in the Charge.

The instrument of charge or a copy thereof is kept at the registered office of the company and is open to the inspection of any creditor or member of the company without fee or of any other person on the payment of a fee of RM2-00. day of , 20

11.

Dated this

....................................................................
*Director/*Secretary/*Agent in Malaysia *Strike out whichever is applicable.