RETAIL COLLECTION CONFIRMATION LETTER REQUEST FORM

Property Financing Conventional Property Financing - i Personal Financing - i Auto Finance

Source: Walk in Inbound Call Email

A. Customer’s Personal Information

Account Number: x Vehicle Registration Number (for Auto Finance Only):

Principal Customer
Full Name x MyKad No. x

Joint Holder x
Full Name MyKad No. x

Guarantor
Full Name MyKad No.

Correspondence Address (tick if information needs to be updated in the system)

Contact Number (tick if information needs to be updated in the system)

Home : x Mobile : x Office: x

Method to collect: Personal Pick-up Send to Email: By Post:

Email Address :
………………………………………………………………………………….
x x x

Signature Principal Customer Signature Joint Holder Signature Guarantor

Date: ___/___/________ Date: ___/___/________ Date: ___/___/________

B. Particulars of Third Party Addressee (if any):

Bank Name:
…………………………………………………………………………………………………………………………………………………………………………………………………………………
Bank Address:
……………………………………………………………………………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
Contact Person (if any): …………………………………………………………………………………………………………………………………………………………………………………………………
C. Acknowledgement (MBSB INTERNAL USE ONLY – TO BE FILL UP BY PERSON ATTENDED)

Attended by Team Leader Remarks Request Detail :

Name:_________________________ Name:___________________________
_______________________________________
_______________________________________
Signature_______________________ Signature:________________________
_______________________________________

Date: ___/___/________ Date ___/___/________

:

Note:
1. MBSB will respond to this request within 5 working days
2. All information that will appear on the letter will be as at the date of this application
3. Any full uplifting of blacklist is subject to full payment of arrears amount