Hire Purchase Application Form (Applicant) - Hire Purchase Malaysia (PRD)

PICKLES ASIA SDN. BHD.

Applicant Information

Full Name (as per NRIC)

Gender

Male Female

Date of Birth

Marital Status

NRIC

Home Phone

Mobile Phone

Office Phone

Residential Information

Type of Housing

Address

Postal Code

City

State

Employment / Income / Business Information

Type of Employment

Name of Employer / Business

Position/Title

Period of Service

year(s)

Monthly Income

Address of Employer / Business

Postal Code

City

State

Sales Details

Sales Order Number

Purchase Price

Make

Model

Year of Manufacture

Registration Number (for used car)

Requested Loan Amount (Maximum 80% of Purchase Price)

Requested Loan Tenure

Month(s)

Interest Rate

Estimated Monthly Instalment

Documents

NRIC Front and Back
Income Proof - Latest 3 months payslip and latest 3 months bank statement, and latest 12 months EPF
Vehicle Sales Order
Guarantor NRIC Front and Back (if any)
Guarantor Income Proof, If any (Latest 3 months payslip and latest 3 months bank statement, and latest 12 months EPF)

Declaration by Applicant

By clicking the 'Submit' button, I agree to the following terms and conditions:

[I am / we are] of full age and have the legal capacity to enter into a Hire Purchase Agreement with Goldbell Capital Sdn Bhd (the “Owner”) and [am / are] not prohibited in any way from doing so or from driving, operating or possessing any vehicle.
[I / We] acknowledge that the information provided by [me / us] in this application is true, complete and accurate and [I am / we are] aware that the Owner will use, rely and / or act on such information to review and / or assess this application and as such if such information is at any time found to be in complete, untrue or inaccurate, the Owner is entitled to withdraw / cancel any approval granted for hire purchase.
[I / We] confirm that at the time of this application:
1. [I am / we are] not [an] undischarged bankrupt[s];
2. [I am / we are] not insolvent;
3. [I am / we are] not in liquidation;
4. [I / we] have not entered into any arrangement with [my / our creditors]; and
5. [I am / we are] not aware of any current, pending, or threatened legal, enforcement, bankruptcy, winding-up, or insolvency proceedings against [me / us] and [I / we’ further confirm that [I am / we are] not subject to any debt repayment scheme.
[My / our] application for hire purchase is made on the terms herein and in accordance with the Owner’s Hirer Purchase Standard Term and Conditions and is subject to such variation or such other term and conditions as the Owner may notify [me / us].
[I / we] confirm that all documents signed / pre-signed for this application including but not limited to the Hire Purchase Agreement signed / pre-signed are subjected to the Owner’s approval and until these are approved, accepted, completed and signed by the Owner, the Owner shall not be bound in any way to approve [my / our] application as such. Where the Hire Purchase Agreement is duly completed and signed by the Owner, [I / we] shall be bound by the Hire Purchase Agreement.
[I / we] understand that the Owner has the absolute discretion to grant or refuse this application or to extend its processing time or withdraw any offer without notice to [me / us] without the need to provide any reason.
Upon activation of the Hire Purchase Agreement, [I / we] note that all cheques, cashier’s orders, banker’s drafts and other instruments for payment from [me / us] to the Owner are to be made out strictly to ‘GOLDBELL CAPITAL SDN BHD’ as named payee and any cheque, cashier’s order, banker’s draft or other instrument stating an abbreviation of the aforementioned name shall be made at [my / our] own risk.
[I /we] authorize and give [my / our] consent to the Owner to make any inquiries with my respect to [my / our] employment or employer(s) / business for verification of such or further information as the Owner deems necessary for the purposes of this application.
[I / we] authorize and give [my / our] consent to the Owner to obtain, collect, use, disclose and / or verify any information relating to [me/us] from / with any party or authority as the Owner deems necessary for the purposes of this application or as may be required by any applicable law, rule or regulation without the need to give further notice to or obtain further consent from [me / us], such party or authority including but not limited to the Owner’s head office, its parent or holding company, representative and branch offices, and related or associated companies, any government or regulatory agency or authority, or any other person to whom disclosure is permitted or required by any statutory provision or law.
That, pursuant to the Credit Reporting Agencies Act 2010 (“Act”), I the following individual do hereby give consent to you to obtain or disclose any Credit Information (as defined in the Act) relating to me to Experian Information Services Sdn. Bhd. (“EXPERIAN”), FIS Data Reference Sdn Bhd (“FIS”), CTOS Data Systems Sdn Bhd (“CTOS”) or any source deemed appropriate to verify my credit history as you and EXPERIAN or any source deemed appropriate may deem fit under any applicable law, regulation, guidelines, regulatory requirement or directive in relation to my credit application or transaction with you for the following purposes (but not limited to) opening of account, credit evaluation, credit review, credit monitoring, debt recovery purposes, scoring solutions, legal documentation and action consented to a contractor facility granted. Such consent shall remain applicable as long as I am maintaining any transaction with you. I understood the Privacy Policy and the CRA Policy. Pursuant to the CRA Act and Central Bank of Malaysia Act, I/we the undersigned do hereby give my/our consent to EXPERIAN, a registered credit reporting agency under the CRA Act to conduct credit/trade checks, CCRIS and DCHEQUE checks on us/me and where applicable, our director(s), shareholder(s) and guarantor(s) (collectively the “Parties”), at any time for as long as I/we have a trade relationship with you or where any dues remain unpaid and outstanding with you. Apart from the above, the Parties undersigned do give our consent to you and the EXPERIAN, to process my/our personal data as per the CRA Act 2010 and PDP Act 2010.
I am authorized to submit this application on behalf of Company/Business and I have the full authority of the Company to make this application and declaration on its behalf.
I hereby give consent to the Owner to collect, use and disclose the information, including all personal data and my IP address (3.139.86.189), provided for the purposes of processing this loan application, provision of the products or services being applied for hirein and complying with applicable laws and regulation ("Purposes"). Insofar as personal information of any individuals are provided to the Owner herein, adequate consent has been obtained for the Owner to process the personal information for the Purposes, as well as to disclose such information to its branches, subsidiaries, affiliates, or representative offices in any jurisdiction for the Purposes.
I declare that the information submitted in this application is true, complete, and accurate.

I was served by

Occupation Categories

Categories	Description
Legislators, Senior Oficials and Managers	To classify those who manage organisations with at least 2 managers reporting to them and operate within guidelines from their boards or councils
Professionals	Required to apply scientific & artistic concepts & theories to the solution of problems at work. High level of specialised knowledge & ability in physical & life science social sciences & humanities Teaching at primary level and higher
Associate Professionals and Technicians	Requiring tertiary education leading to an award not equivalent to a first university degree: Technical work connected with application of concepts & operational methods Requires technical knowledge & ability in physical & life science, social science & humanities teaching at extra-curriculum and below primary level
Clerical Support Works	Requiring secondary or post secondary education: - Entering data into computers; carrying out secretarial duties; recording and computing numerical data, keeping records; filing documents
Services and Sales Workers	Requiring secondary or post secondary education: - Provision of personal and protective services :- Travel, Housekeeping, Catering, Personal Care" Demonstrate and sell good in wholesale or retail shops and similar establishments"
Agricultural and Fishery Workers	Requiring secondary or post secondary education. Plan & carry out operations to grow/harvest crops for sale.
Craftmen and Related Trades Workers	Requiring secondary or post secondary education Work is carried out by hand and by handpowered and other tools Apply specific knowledge and skills in:- Construct and maintain buildings, Erect metal structures, Set maintain or repair machinery, printing work Process foodstuffs, textiles, or wooden, metal and other articles, including handicraft goods
Plant and Machine Operators and Assemblers	Requiring secondary or post secondary education Operate and monitor industrial and agricultural machinery and equipment on the spot or by remote contro Drive and operate trains, motor vehicles and mobile machinery and equipment Assemble products from component parts according to strict specifications and procedures
Cleaners, Labourers and Related Workers	Requiring primary or no education: Perform simple and routine tasks, physical effort is required with minimal judgment: - Cleaning, Washing, Food Preparation, Delivery goods, carrying luggage
Workers Not Elsewhere Classified	Information on job duties are difficult to obtain
Taxi Driver