TEMPORARY COVID-19 FINANCIAL RELIEF REQUEST FORM /

BORANG PERMOHONAN PELEPASAN KEWANGAN SEMENTARA

A. TO BE FILLED UP BY CUSTOMER/DIISI OLEH PELANGGAN
Name / Nama :
NRIC no. / No. k/p : Email / Emel :
Address / Alamat :
Bank account no. / no.bank akaun : /
Phone no. / : H/P / T.bimbit Hse / Rumah :
No. telefon Off / Pejabat
My request for deferment of monthly instalment to alleviate my financial burden due to /
Saya memohon penangguhan ansuran bulanan untuk meringankan beban kewangan saya kerana:
 I am/my family member is a COVID-19 patient1 / Saya/ahli keluarga saya ialah pesakit COVID-191
 Unexpected medical expenses2 / Belanja perubatan di luar jangkaan 2
 Spouse's business3/salary4 affected / Perniagaan 3 /gaji pasangan 4 saya terjejas
 Others / Lain-lain :
My option to settle remaining instalments and additional profit arising from such deferment /
Pilihan saya untuk menjelaskan baki ansuran dan untung tambahan akibat daripada penangguhan tersebut:
 increase financing tenure / menambah tempoh pembiayaan
 partial payment during relief period5 / bayaran separa dalam tempoh pelepasan 5
 Others: / Lain-lain :
Extension of financing tenure beyond retirement is to be made via deduction of: /  Pension fund6 /
Bayaran untuk sambungan tempoh pembiayaan selepas pesaraan akan dibuat melalui: Dana pencen 6
Compulsory documents to be attached / Lampiran wajib:
1. Confirmation letter from hospital/doctor / Surat pengesahan dari hospital/doktor
2. Hospital/medical bills / Bil hospital/perubatan
3. Registration Certification (ROC) & relevant documents showing spouse's shareholding /
Sijil Pendaftaran Perniagaan (SSM) dan dokumen berkenaan yang menunjukkan pegangan saham pasangan
4. Letter from spouse's employer / Surat daripada majikan pasangan
5. Proof of standing instruction for partial payment / Bukti arahan bayaran berjadual
6. Consent letter for pension deduction / Surat kebenaran potongan pencen
7. Any other relevant supporting documents / Lain-lain document yang berkenaan
Declaration / Pengisytiharan :
I hereby declare that the above information together with the supporting document(s) provided herein are true and accurate.
I understand that the Company has sole and absolute discretion to defer the same and repayment shall resume immediately
after the financial relief period expires. By signing this form, I have expressly agreed to pay the additional profit arising from
such deferment and consented to Company collecting, storing and processing the above data(s) in relation to this request. /
Saya dengan ini mengisytiharkan bahawa maklumat dan dokumen-dokumen yang diberikan di atas adalah benar dan tepat.
Saya memahami bahawa penangguhan bayaran adalah atas budi bicara Syarikat dan bayaran balik akan diteruskan serta
merta selepas tempoh pelepasan kewangan tamat. Dengan menandatangani di atas borang ini, saya telah memberi
persetujuan nyata untuk membayar untung tambahan akibat daripada penangguhan tersebut dan membenarkan Syarikat
untuk mengumpul, menyimpan dan memproses data berkenaan premohonan di atas.
Note / Nota :
This temporary financial relief request must be submitted before 30.04.2020 via pertanyaan
@yir.com.my/pertanyaan@yyp.com.my. Due to system limitation, customer's salary
deduction will be refunded manually subject to approval of this request. / Permohonan
pelepasan kewangan sementara ini mesti dihantar sebelum 30.04.2020 melalui pertanyaan@
yir.com.my/pertanyaan@yyp.com.my. Disebabkan had sistem, gaji pelanggan yang dipotong Signature / Tandatangan
akan dibayar balik secara manual tertakluk pada kelulusan permohonan ini. Date / Tarikh :
 TEMPORARY COVID-19 FINANCIAL RELIEF REQUEST FORM /
BORANG PERMOHONAN PELEPASAN KEWANGAN SEMENTARA
B. ASSESSMENT BY COLLECTION/RECOVERY DEPARTMENT / Penilaian oleh Jabatan Collection/Recovery
1. Account information (Refer All Financing Account Report attached) /
Maklumat akaun (Rujuk kepada lampiran All Financing Account Report)
2. Document(s) attached / Lampiran :
 Confirmation letter from hospital/doctor / Surat pengesahan dari hospital/doktor
 Hospital/medical bills / Bil hospital/perubatan
 Registration Certification (ROC) & relevant documents showing spouse's shareholding /
Sijil Pendaftaran Perniagaan (SSM) dan dokumen berkenaan yang menunjukkan pegangan saham pasangan
 Letter from spouse's employer / Surat daripada majikan pasangan
 Proof of standing instruction for partial payment / Bukti arahan bayaran berjadual
 Consent letter for pension deduction / Surat kebenaran potongan pencen
 Others / Lain-lain :
3. Verification performed on the following and no discrepancy noted /
Pengesahan telah dibuat seperti yang berikut dan tiada percanggahan didapati :
 Financing(s) have not been in arrears for >3 MIAs as at 1.04.2020 /
Pembiayaan tiada bayaran tunggakan > 3 bulan pada 1.04.2020  Yes / Ya  No / Tidak
 Customer's SDS remains active / SPG pelanggan masih aktif  Yes / Ya  No / Tidak
 Request is supported with valid supporting documents /
Permohonan ini disokong oleh dokumen yang sah  Yes / Ya  No / Tidak
 Extension of financing tenure beyond retirement is supported with consent letter for pension deduction / Sambungan
tempoh pembiayaan selepas pesaraan disokong oleh surat kebenaran potongan pencen  Yes / Ya  No / Tidak
4. Request is / Permohonan :
 Recommended for deferment of monthly instalment for /  3 months / 3 bulan  months / bulan
Penangguhan ansuran bulanan disyorkan untuk tempoh  6 months / 6 bulan
 Not recommended due to / tidak disyorkan kerana :
 Financing(s) in arrears for > 3 MIAs / Bayaran tunggakan pembiayaan > 3 bulan
 Customer is no longer in SDS / SPG pelanggan sudah berhenti
 Invalid supporting document(s) / Dokumen sokongan tidak sah
 Others / Lain-lain :
Received and assessed by /  Recommend / Permohonan disyorkan
Diterima dan dinilai oleh  Reject / Permohonan ditolak
AM/SE/Exec, COL/RCY HOD/SM/M, COL/RCY

Initial/Date: Initial/Date:
Remarks / Komen

C. APPROVAL BY TWO (2) AUTHORISED PERSONNEL / KELULUSAN OLEH 2 KAKITANGAN YANG DIBERI KUASA
 Approve / Permohonan diluluskan  Approve / Permohonan diluluskan
 Reject / Permohonan ditolak  Reject / Permohonan ditolak

CBO/SGM/GM/AGM CEO/CBO
Initial/Date: Initial/Date:
Remarks / Komen

Revision: 00 (dated 27.03.2020)