CS376WS (ENG)(R1.

1/2018)
SECOND SCHEDULE
[Regulation4]
WRITTEN STATEMENT
[Subsection 24N(1)]
SUMMARY OF FINANCIAL OBLIGATIONS OF PROSPECTIVE PURCHASER UNDER THE PROPOSED CREDIT SALE AGREEMENT
This document contains a short description of the goods specified in the proposed credit sales agreement (hereinafter referred as “Agreement”)
and a summary of financial obligations of the prospective purchaser under the Agreement.

1. Particulars of goods:
a) Short description of goods : ____________________________________________________________
b) If motor vehicle, state registration number : ____________________________________________________________
c) State whether new or second-hand goods : NEW SECOND-HAND
d) Address where goods will be kept : ____________________________________________________________
______________________________________________________________________________________________________
2. Particulars relating to financial obligations:
a) Cash price of goods (inclusive of any tax imposed by Government) RM ______________
b) Booking fee, if any RM ______________
c) Deposit, including booking fee, if any RM ______________
d) Cash price less deposit RM ______________
e) Freight charges, if any RM ______________
f) Vehicle registration fee, if any RM ______________
3. Insurance:
a) For motor vehicles, the amount of Insurance for first year only RM ______________
b) For goods other than motor vehicles, amount of insurance for the period of the Agreement RM ______________
c) For any other risk on the credit facility, if necessary RM ______________
4. Term charges (fixed rate):
a) Rate per annum ___________%
b) Total amount of term charges RM ______________
5. Balance originally payable under this agreement RM ______________
6. Annual percentage rate __________ % RM ______________
7. Total amount payable under the Agreement (in accordance with subparagraph 24P(1)(b)(x) of the Act) RM ______________
8. Difference between cash price of goods and the total amount payable under this agreement RM ______________
9. Particulars relating to payment:
Period of payment of instalments in -
a) Number of months __________________
b) Number of instalments __________________
c) Amount of each instalment RM _______________
d) Amount of final instalment (if any) RM _______________
10. Any Ancillary charges which may be imposed (if any) shall be separately paid and shall not be included in the total amount payable
under the Agreement:
a) Processing Fee RM _______________
b) Installation Charges RM _______________
c) Delivery & Commissioning Charges RM _______________
d) Collection/Convenience Fee RM _______________
e) Storage Fee RM _______________
11. Date / Period for delivery of goods : ____________________

This document is issued by or on behalf of ____________________________________________________ at ___________________

_________________________________________________________ on this _____ day of ______________ pursuant to subsection 24N(1)

of the Consumer Protection Act (Amendment) 2017. This document is given free of charge without any obligation to enter into a credit sale
agreement.

I/We ___________________________________________________ NRIC No _______________________ of

____________________________________________________ hereby acknowledge receipt of this document.

_____________________________ ___________________
Signature Date

NOTE :
No credit sale agreement shall be entered into within the period of ten working days after the service of this written statement. However, the
prospective purchaser may elect to enter into a credit sale agreement after three working days from the date of service of this written
statement. This provision are in accordance with subsections 24N(8) and (9) of the Consumer Protection Act (Amendment) 2017.

1st copy – Credit Sales Agreement (attachment) 2nd copy – Branch Prospective Purchaser
3rd copy - Customer