PARTICULARS FORM

DATE :
I. PERSONAL PARTICULARS 02 Apr
2022

Full name as in IC / Passport: 1) SABRINA BINTI MOHAMED KASSIM

2)

3)

4)

How do you know about this project:

No NRIC / Passport Date of Birth Nationality Race Marital Status

1 850915-75-5016 1985-09-15 1985-09-15 Malay Single

Mailing Address

1. B904 ALIRAN DAMAI APARTMENT , JALAN DAMAI PERDANA 5/2 , 56000 KUALA LUMPUR, Wilayah Persekutuan Kuala Lumpur,
Malaysia

2.

3.

4.

Telephone E-mail

(H) (O) (H/P) +60127537317 sabrina_mkassim@yahoo.com

II. PARTICULAR PROPERTY

Project Name Ritma Perdana (Terrace), LBS Alam Perdana

Phase 4C

Property Type Double Storey Terrace House

Unit No. RT-2081

Purchase Price (RM) 619,287.00

III. CAREER OR BUSINESS DETAILS

Buyer Co-Buyer 1 Co-Buyer 2

Employer’s Name /
Own Business

Position /
Nature Of Business

GST Registration No.

Employer’s
Address /
Business Address

Telephone

Ritma Perdana (Terrace),

Unit No : RT-2081 7. Particulars Form
LBS Alam Perdana
Page 1/2
IV. FINANCIAL STATUS

Buyer Co-Buyer 1 Co-Buyer 2

Gross Monthly Income RM 0.00

Other Income / Allowance

TOTAL INCOME (A) RM 0.00

EPF / SOCSO / Income Tax

Loan Repayment

Other Deduction

TOTAL DEDUCTION (B)

Monthly Nett income (A) – (B)

V. MODE OF PAYMENT

Mode of Payment [] Cash [] EPF Withdrawal [/] Housing Loan

Maximum Loan Eligible

RM 0.00
(Approximately)

Tenure of Loan
(Approximately)

Monthly Repayment
RM 0.00
(Approximately)

VI. INFORMATION REQUIRED BY TENAGA NASIONAL BERHAD (TNB) FOR MOVE IN APPLICATION (COMPULSORY)

Name Of Applicant (Buyer) SABRINA BINTI MOHAMED KASSIM

NRIC No 850915755016

Date Of Birth (DOB) 1985-09-15

Mother’s Name VISA UMMAL

GST Number (If any)

Email sabrina_mkassim@yahoo.com Fax

Telephone

(H) (O) (H/P) +60127537317

NEXT TO KIN CONTACT

Name MYLEN KUMAR A/L RAMASAMY

NRIC No 840628075537

Email Address mylenkumar@gmail.com (H/P) 0164112204

VII. DECLARATION ON RELATED PARTY / STAFF OF LBGB:-

1) I am / we are not related party of LBGB Group.

2) I am / we are related party of LBGB Group.
3) I am staff of LBGB.
Please specify :

VIII. DECLARATION:-

I/We hereby declare that the information given above is true and correct.

Signature of Buyer Signature of Co-Buyer 1 Signature of Co-Buyer 2

Ritma Perdana (Terrace),

Unit No : RT-2081 7. Particulars Form
LBS Alam Perdana
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