(518026-P)

Lot 3.6, Level 3

PNB Perdana Commercial Centre
No. 10, Jalan Binjai
50450 Kuala Lumpur
Tel: 03-21802888 Fax: 03-21802828
www.pnbcommercial.my

SECTION 1 (To be filled in by Applicant)

A. APPLICANT/ COMPANY

1. PROPERTY INTERESTED

Kawasan MIEL : ………………….……..……….. Phase : ……… Lot No : ………………………..

Mode of Acquisition :

Cash Tenancy Scheme

2. Name of Applicant/ Company & Company No :

………………………………………………………………………………………………………….
………………………………………………………………………………………………………….
………………………………………………………………………………………………………….

3. Registered Address :

………………………………………………………………………………………………………….
………………………………………………………………………………………………………….
………………………………………………………………………………………………………….

4. Postal Address :

………………………………………………………………………………………………………….
………………………………………………………………………………………………………….
………………………………………………………………………………………………………….

5. Contact Person : ……………………………………….… Designation : …………………………..

6. Telephone No : ………………………………………….. Fax No : ……………………………....

Email : ……………………………………………………

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7. Date of Registration/ Incorporation : …………………………………………………………………

8. Items Manufactured : ……………………………………………………………………………

Local Market : …………………… % Export Market : ………………………. %

9. No. of Workers Required : ………………………………………………………………………

10. Purpose of Acquisition :

Relocation Expansion New Venture

11. Projected Investment :

RM

Building : ……………………………………………
Renovation : ……………………………………………
Plant and Machinery : ……………………………………………
Others : ……………………………………………
TOTAL : ……………………………………………

12. Source of Finance :

RM
Equity/ Proprietorship/ Partner Capital
: ……………………………………………
Bank Loans : ……………………………………………
Others : ……………………………………………
TOTAL : ……………………………………………

13. Name of Bankers : ………………………………………………………………………………

B. PRESENT CAPITAL STRUCTURE

1. Type of Organisation :

Private Limited
Sole Proprietorship Partnership
Company

2. Authorised Capital : ………………………………... Paid-up Capital : ………………………

Proprietorship/ Partner Capital : …………………………………………………………………

3. Percentage of Shareholdings :

% Malaysians (Bumiputra)

% Malaysians (Non-Bumiputra)

% Foreign

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4. Information on Shareholders/ Directors/ Proprietorship/ Partner

% of
Name and Address I.C. No. Sex Shareholding

a)

b)

c)

d)

e)

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DECLARATION

 I/We confirm that the information given above is true and correct and authorise you or your
representative to obtain and confirm the information from any source regarding this application.

 I/We understand that MIDF Property Bhd reserves the right to reject the application at MIDF
Property Bhd sole discretion without stating any reason whatsoever. This application will remain
the property of MIDF Property Bhd irrespective of whether the application is approved or
rejected.

………………………………………………………… Date : …………………………………

Applicant’s Signature

Name : ………………………………………………………………………………………………

Designation : ………………………………………………………………………………………..

Please tick to indicate documents enclosed

A copy of the Memorandum and Articles of Association, Partnership Agreement or Business

Registration Certificate, where applicable.

Copies of Form 24, Form 44 and Form 49, where applicable.

Copies of Directors I/C (minimum 2 person)

Latest three (3) months Bank Statement (for Tenancy Scheme only)

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