CGC DISCLOSURE FORM VERSION 1.

CGC DISCLOSURE FORM

Company Name
Business Registration Number
Business Address /
Correspondence Address
Contact Number / Fax Number

I / We agree and confirm that I / we as sole-proprietor / partners / directors / shareholders / hereby irrevocably and
unconditionally give my / our consent to and authorize AFFIN BANK GROUP to:

1. Disclose any information and / or data relating to the Company / Business / sole-proprietor / partners / directors /
shareholders as may deem fit and necessary to CREDIT GUARANTEE CORPORATION (M) BERHAD, and

2. For CREDIT GUARANTEE CORPORATION (M) BERHAD to disclose to BANK NEGARA MALAYSIA of the same, and

3. For BANK NEGARA MALAYSIA or / and CREDIT GUARANTEE CORPORATION (M) BERHAD to disclose to any
participating Financial Institutions of the CGC Scheme at any time without notice and liability of any information relating
to customer’s affairs, banking account or conduct of account thereof (including the customer credit standing) pertaining
to the all matters in regards to the CGC Scheme.

4. For AFFIN BANK GROUP and CREDIT GUARANTEE CORPORATION (M) BERHAD to obtain and verify any
information about the Company / Business / sole-proprietor / partners / directors / shareholders at its absolute discretion
and as it deems fit pertaining to the all matters relating to the CGC Scheme at any time and without notice and liability.

5. This consent is on continuing basis and shall be effective at any time and from time to time.

Authorized Signatories as per Directors’ Resolution

Name Signature Company stamp
Designation
NRIC No.
Date
Name Signature
Designation
NRIC No.
Date
Name Signature
Designation
NRIC No.
Date
Name Signature
Designation
NRIC No.
Date
Name Signature
Designation
NRIC No.
Date
Name Signature
Designation
NRIC No.
Date

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