Referral Template for ASB Financing

Part I: Partculars of CIMB Wealth Advisors Berhad’s Representatve (“CWA ’s Representatve ”)

Name
Agent Code
NRIC No
Contact No
Date of Referral
Part II: Partculars of CIMB Bank Berhad’ s ASB Financing Applicant(s) (“Applicant(s)”)
First Applicant
Name
NRIC No
Contact No
Requested ASB Loan Amount
Other Remarks
Second Applicant
Name
NRIC No
Contact No
Requested ASB Loan Amount
Other Remarks
Part III: Declaraton Secton by Applicant(s)

I/We hereby agree and authorise CIMB Wealth Advisors Berhad (Company No: ) to provide my/our
personal particulars contained in this document, submit my/our ASB Financing/ Term Financing-i Secured by
ASB Certificate Application Form together with the required supporting documents to CIMB Bank Berhad
(13491-P) (“CIMB Bank”).

I/ We hereby agree and aware that CIMB Bank has the absolute right to perform verification on the
information provided by me/ us in any manner satisfactory and acceptable to CIMB Bank including but not
limited to making phone call(s) to me/us.

I/We hereby acknowledge that I/we have accessed and/or read the Privacy Notice issued by CIMB Group
(which is available at all CIMB branches as well as at the CIMB website at www.cimbbank.com.my or
www.cimbislamic.com.my or has otherwise been made available to me/us) and confirm my/our agreement
to the same.

Applicant’s Signature

______________________
Name:
Date:
Part IV: Declaraton Secton by CWA’s Representatve
I hereby confirm the following:
(Please tick (√) in the relevant boxes)

I have interviewed the Applicant(s) in person in regards to this Term Financing-i Secured by ASB Certificate
application and extended the Product Disclosure Sheet for his/her understanding and retention.
 I met the Applicant(s) at __________________________________(please specify) on
dd/mm/yyyy__________.
Customer’s Ofce/ Premise Corporate Talk Others
Please specify:
Shopping Mall Café/ Restaurant
___________________________
______________________
I have sighted the original copy of the supporting documents submitted by the Applicant(s) as indicated in
the Term Financing-i Secured by ASB Certificate Application Form.

Source of downpayment/deposits ____________________________(e.g the funds from salary, business

proceeds, sale of shares, rental income, etc)

Funds from Salary Sale of Shares Others

Please specify:
Business Proceeds Rental Income
__________________________
_______________________

___________________
Agent Name:
Agent code:

Part V: For Internal Use (To be completed by CIMB Bank’s Business Development Manager ( “BDM ”)
I/ We hereby confirm and acknowledge receipt of the Applicant(s) ’ Financing-i Secured by ASB Certificate
Application Form together with the required supporting documents from CWA ’s Representative.

BDM’s Signature

______________________
Name of BDM:
Staff ID No:
Date of Receipt:
RED Centre: