1

CONSENT AND AUTHORIZATION FORM

To: ORIX Leasing Malaysia Berhad Group of Companies (“ORIX”):

1. ORIX Leasing Malaysia Berhad; 7. ORIX Insurance Agencies Sdn. Bhd
2. ORIX Credit Malaysia Sdn. Bhd.; 8. ORIX Equipment Rental Sdn. Bhd.;
3. ORIX Factoring Malaysia Sdn. Bhd.; 9. ORIX Protect Sdn. Bhd.;
4. ORIX Car Rentals Sdn. Bhd.; 10. ORIX Risk Management Sdn. Bhd.;
5. ORIX Rentec (Malaysia) Sdn. Bhd.; 11. ORIX Asset Management Malaysia Sdn. Bhd.; and
6. ORIX Auto Leasing Malaysia Sdn. Bhd.; 12. ORIX Energy Malaysia Sdn. Bhd.
From: Individual Name Any/all individual(s) named below.
Company/Business

For the purpose of considering my/our/the above-named Company/Business’s application to ORIX for
any of ORIX’s facility/service (hereinafter referred to as “Purpose”), we the above-named
individual/Company/Business hereby voluntarily, irrevocably and unconditionally give our consent to
ORIX to do any or all of the following pertaining to my/our/our Company/Business information and/or
data, including personal data and credit information within the meaning of the Personal Data Protection
Act 2010 and the Credit Reporting Agencies Act 2010 (“information and/or data”): -
(a) to obtain, verify and process any information and/or data about me/us/our Company/Business, at
ORIX’s absolute discretion and as it deems fit in relation to the Purpose for so long as there is an
existing business relationship;
(b) to disclose and release to any credit reporting agency or agencies including FIS Data Reference
Sdn. Bhd., Credit Bureau Malaysia Sdn. Bhd. and CTOS Data Systems Sdn. Bhd., any and all
information and/or data pertaining to me/us/our Company/Business, within ORIX’s possession,
whether such information is furnished by me/us/our Company/Business to ORIX or otherwise in
relation to the Purpose for so long as there is an existing business relationship; and
(c) to keep any information and/or data relating to me/us/our Company/Business, so long as such
information and/or data is necessary for the fulfillment of the Purpose and for so long as there is an
existing business relationship, and subject to the requirements for data retention under any law(s) of
Malaysia.
I/We hereby give my/our unconditional and unequivocal consent to any credit reporting agency or agencies
including FIS Data Reference Sdn Bhd, Credit Bureau Malaysia Sdn. Bhd. and CTOS Data Systems Sdn.
Bhd., which services ORIX may subscribe to or utilize for providing any information and/or data about
me/us/our Company/Business in relation to the Purpose, to:
(a) disclose or continue disclose any information and/or data and/or to generate credit report(s) about
me/us, my/our Company/Business to ORIX at anytime;
(b) process or continue to process my/our information and/or data in accordance to the provisions of the
Credit Reporting Agencies Act 2010;
(c) conduct or continue to conduct credit checks on me/us for credit review, credit evaluation, debt
recovery purposes, and legal documentation consequent to the facility/service granted or to be or
continue to be granted by ORIX.
Signed by Company/Business:

Authorize signatory (Name):

NRIC No.:
Designation:
Date:
Email /Home Address:
Mobile No.:
Signed by:
(Individual)

Name:
NRIC No.:
Designation:
Date:
Email / Home Address:
Mobile No.:
 2

Signed by:
(Individual)

Name:
NRIC No.:
Designation:
Date:
Email / Home Address:
Mobile No.:
Signed by:
(Individual)

Name:
NRIC No.:
Designation:
Date:
Email / Home Address:
Mobile No.:
Signed by:
(Individual)

Name:
NRIC No.:
Designation:
Date:
Email / Home Address:
Mobile No.:
Signed by:
(Individual)

Name:
NRIC No.:
Designation:
Date:
Email / Home Address:
Mobile No.:
Signed by:
(Individual)

Name:
NRIC No.:
Designation:
Date:
Email / Home Address:
Mobile No.:
Signed by:
(Individual)

Name:
NRIC No.:
Designation:
Date:
Email / Home Address:
Mobile No.: