Assessment and Consent Form - Retail Financing CMD / DSU / Ver. 1.

Customer Full Name Introducer Name

NRIC No. / ID No. NRIC No.
Date of Birth (dd/mm/yyyy) Staff ID No.
Branch
Contact No. (mobile)
PART A : APPLICANT BACKGROUND INFO
i) Name of Employer ii) Position _____________________________
iii) Employment Status Permanent Contract Temporary Self Employed Others:____________________
iv) Education Qualification Professional Degree Diploma Others : _________________________
v) Marital Status Single Married Others : ___________________________
vi) Spouse-Name of Employer (if any) vii) Spouse Position (if any) __________________________________

PART B : FACILITY APPLICATION DETAILS Primary Joint Application Guarantor

i) Facility Type Application
(Please select)
ii) Product Application
iii) Product Profit Rate
Application (Please select)
Name:__________________________ Name:____________________________
Mortgage Personal Financing-i Others :______________________________
___________________________________________ (i.e. MBSB Super Ultimate, Vaganza, Exec-I etcs)
Fixed Rate Profit Rate : __________________% (i.e. 3.99, 4.20 etcs)
Variable Rate Profit Rate : Base Rate + _________________% (i.e. 2.5, 4.5 etcs)

iv) Financing Amount RM , , . (i.e. 10,000.00 etcs) v) Financing Tenure : mth (i.e. 24, 120 etcs)
PART C : APPLICANT INCOME / COMMITMENT DETAILS
i) Gross Income RM _____________ per month ii) Net Income RM_____________ per month
iii) Other Income (if any)
DSR SPECIALIST UNIT USE
Type of Income Income
a) RM per month DSR STATUS : PASS / FAIL
REMARKS :
b) RM per month
c) RM per month
d) RM per month
e) RM per month

ASSESSED BY:
iv) Financing Commitment (with Financial Institutions / Cooperatives / Credit companies etcs) (if any) DATE:
Type of Financing Financing Amount Tenure Financial Institution Name
a) RM month
b) RM month
c) RM month
d) RM month
e) RM month
v) Financing Settlement (with Financial Institutions / Cooperatives / Credit companies etcs) (if any)
Type of Financing Deduction Amount Outstanding Balance Financial Institution Name
a) RM per mth RM_________________
b) RM per mth RM_________________
c) RM per mth RM_________________
d) RM per mth RM_________________
e) RM per mth RM_________________

PART D : CCRIS INFORMATION

(Introducer to fill-up for
i) Application Ref No. / CIF No. ii) Purpose of Financing
Mortgage facility)
iii) Priority Sector iv) Financing Concept
v) Location of Financing Utilisation vi) Purchase Price (for mortgage) RM , , .
vii) Property Type
PART E : DECLARATION
I/We hereby acknowledge that MBSB Bank reserves the absolute right to approve or reject my/our application as MBSB Bank deems fit, without assigning any reason. Copies of documents submitted are returnable
upon receipt of my/our written request. MBSB Bank is irrevocably authorised to disclose all information or particulars given by me/us herein or arising from or pursuant to my/our application (within and outside of
Malaysia) at it deems fit at any time and for such purposes as MBSB Bank deems necessary. Notwithstanding the generality of the foregoing, I/we confirm that MBSB Bank is irrevocably authorised to verify and/or
make any checks and/or obtain any information and/or confirmations, with or from any credit reference agencies and/or from any financial institutions, on me/us and/or any other person, individual and/or entity as
MBSB Bank may deem fit, for any purpose which MBSB Bank deems fit. I/We confirm that the information given is true, correct and complete and declare that I/we have not been adjudged a bankrupt.

NOTE :
1) Please attach copy of applicant NRIC / ID card and latest month payslip
(copy of payslip is compulsory for Personal Financing-i application)
2) This form is used for preliminary assessment of customer’s application with
MBSB Bank. Full documentation are required to be submitted within 1 month
(Applicant Signature) (Introducer Signature) from the above assessment date prior to final decision by MBSB Bank.
Name : Name : 3) For joint application, each applicant is to complete and sign the
assessment and consent form separately.
Date : Date :