Co Registration No.

XXXXXXXX
201301006084

COMPANIES ACT 2016

Sections 352(1), 354 & 356(1)
STATEMENT OF PARTICULARS TO BE LODGED WITH CHARGE

[COMPANY’S NAME]

1. Charge is created by : [COMPANY’S NAME]

(Co. Reg No: )

2. *Charge was created on (1) :

*Property which is subject to a charge
was acquired on (1)

3. The charge is *fixed/*floating/*fixed : Fixed

and floating

4. The description of the instrument(s) : (i) Memorandum of Deposit of Fixed

creating or evidencing the charge
Deposit Certificate and/or Mudharabah
Investment Account Certificate and/or
negotiable Certificate of Deposit (First
Party); and
(ii) Letter of Set Off

5. Describe briefly the nature of liability : Additional Bank Guarantee-i Facility of

(present or prospective) secured by Ringgit Malaysia Two Million
the charge (RM2,000,000.00) only
Co Registration No.

XXXXXXX
201301006084

6. The liability secured is for the benefit : [COMPANY’S NAME]

of the company or for another party (Co. Reg No: ), a company
(name and address of another party) incorporated in Malaysia and having its
registered address at [ ], and
business address at [ ]

7. The creation of subsequent charges : is restricted and prohibited

*is/* is not restricted or prohibited

8. A short description of the property : Marginal Islamic Fixed Deposit (“IFD”) to

Affected be placed as and when BG-i issued with the
following manner:-

BG-i (Financial) 30% IFD

BG-i (Non- Financial) 10% IFD

9. The name and address of the XXXXXXXXXXXXXXXXXXXXXX

: MAYBANK ISLAMIC BERHAD (Company
Charge XXXXXXXXXXXX
No. 200701029411), a company
incorporated in Malaysia and having its
registered office at 15th Floor, Tower A,
Dataran Maybank, 1, Jalan Maarof, 59000
Kuala Lumpur (“the Bank”).
10. Important covenants or terms and : Please refer to the Memorandum of Deposit
conditions of the instrument of of Fixed Deposit Certificate and/or
charge Mudharabah Investment Account
Certificate and/or negotiable Certificate of
Deposit (First Party) and Letter of Set-Off
dated
Which covenants are of equal importance.

11. The instrument of charge or a copy thereof is kept at the registered office of the company
and is open to the inspection of any creditor or member of the company without fee or
of any other person on the payment of a fee of RM2.00.

Dated this __________day of _____________2021

____________________________________________________
[COMPANY’S NAME]
(Co. Reg No: )
Name: [Insert Director’s Name]
NRIC No.: [Insert NRIC No.]
Designation: Director
Co Registration No.

XXXXXXX
201301006084

Attention:

It is an offence under section 591 of the Companies Act 2016 to make or authorize the making of
a statement that a person knows is false or misleading and that person may be liable, upon
conviction, to imprisonment for a term not exceeding ten years or to a fine not exceeding
RM3million or to both.

Name : XXXXXXXXXXXXXXXX
Juniza Binti Mohd Jabbarullah
NRIC No : XXXXXXXXX
940212-07-5312
Address : Nik Saghir & Ismail
Level G2 & Mezzanine, Plaza Permata,
No. 6, Jalan Kampar, 50400 Kuala Lumpur,

Phone No : 603-4043 2888

Email : nsikl@nsi.com.my

XXXXXXXXXXXXXXXXXXXXXXXXX
[Ref No. BNK/007/0921/MIB VS INGRESS (HH/JJ/ak)