CUSTOMER INFORMATION FORM
PHOTO
PERSONAL DETAILS
Full Name [As per NRIC] : ……………………………………………………………………………………………………………
NRIC No. :
Correspondence Address : ……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
Post Code : …………………….. Town : ………….. State:………………….……………
Telephone : [HOME]………………………….[OFFICE]……………………………….[HP]…………………….....
Race Malay Chinese India Others :……………………
Nationality Malaysian Others: ....................................Status: Bumi Non Bumi
No of family members.: ………… Any relatives/friends in SME Bank? Yes: …………………...
No
EMPLOYERS / CURRENT BUSINESS
Name : ………………………………………………….. Company No. : ………………………............
Address : ………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………
Post Code : ………………………………… Town: …………………………… State:………………….……..
Telephone : [1] ……………………… Fax: ……………………… E-mail Address:…………………………….….
Position : …………………………………………………. Years of services : ……………………
Working Status Permanent Contract. Previous Employment:………………………………………................
Details of Spouse
Full name [As per NRIC] : …………………………………………………………………………………………………………
NRIC No. : …………………………………………………………………………………………………………
Correspondence Address : …………………………………………………………………………………………………………
…………………………………………………………………………………………………………
Post Code : …………………….. Town : …………………….…. State:………………….………
Telephone : [Home] ………………………….[Office]………………………………. [HP]…………………………….……….
Race Malays Chinese India Others:……………………
Nationality Malaysian Others:……………… Status: Bumi Non Bumi
No. of family members : ………… Any relatives/friends in SME Bank? Yes: …………………...
No
Small Medium Enterprise Development Bank Malaysia Berhad (SME BANK) | Customer Information Form 1
Version 2.0 - 08/23
CUSTOMER INFORMATION FORM
EMPLOYERS / CURRENT BUSINESS FOR SPOUSE
Name : ………………………………………………….. Company No. : ………………………...……
Address : ………………………………………………………………………………………..........................................................
………………………………………………………………………………………..........................................................
Post Code : …………………………. Town: …………………….. State:………………………
Telephone : [1] ……………………… Fax: ……………………… E-mail Address: ………………………………………
Position : …………………………………………………. Years of services : …………………………….
Working Status Permanent Contract. Previous Employment:………………………………………..……
CONTACT PERSON (Family Members/Guardian)*:
Full Name NRIC No. Correspondence Address Occupation Telephone No.
*please state at least 2 family members / guardian
APPLICANT FORMAL EDUCATION
Highest Qualification SPM Diploma Degree Master Others: ………………….
Course : …………………………………………………………………………………….………..
University: ………………………………………………………………………………………………
Year : ……………………………
CURRENT INCOME AND EXPENSES
A] MONTHLY INCOME Personal [RM] Husband/Wife [RM] Total [RM]
• Salary & Allowances
• …………………………………
• …………………………………
GROSS INCOME
B] MONTHLY EXPENSES
• Living Cost
• Housing Financing
• Vehicle Financing
• Income tax
• EPF
• …………………………………
• …………………………………
C] NET INCOME
Small Medium Enterprise Development Bank Malaysia Berhad (SME BANK) | Customer Information Form 2
Version 2.0 - 08/23
CUSTOMER INFORMATION FORM
PERSONAL FINANCING INFORMATION
Property Current Value Financiers Total financing Period Balance
DECLARATION
I/We hereby authorize the Small Medium Enterprise Development Bank Malaysia Berhad (Now known as SME
Bank) to obtain from any party any information that SME Bank need. I/We are independent from any action for
bankruptcy or legal action and declare that all the information recorded above is correct and complete. I/We agree
to accept any decision of the SME Bank to reject the application without giving any reason or excuse.
For financing that requires a guarantor, I/We agree to:
a) Disclose in writing to the guarantor the sourced of the financing facility are from any of the financial
institutions and the assurances given by me/us to the other parties. A copy of the letter will be given to SME
Bank.
b) Authorize given to the SME Bank to disclose information relating to the financing of correspondence
between Me/Us and the SME Bank to the guarantor during the financing.
I/We given authorize to the SME Bank to disclose my/our information to the following parties:
i. Malaysian Government, Donors, Ministries or other authorities, agencies or bodies which have jurisdiction
over the SME Bank;
ii. Auditors, Lawyer or Professional advisors appointed by the SME Bank:
iii. Security provider under a financing facility;
iv. Companies in the Bank Group;
v. According to any subpoena or other legal provisions or in connection with any legal action, suit or
proceeding related to financing facilities;
vi. Pursuant to any law; and
vii. As required by Bank Negara Malaysia.
Bank Reserve to share my/our information (excluding information relating to the business or account) with third
parties for strategic alliances, marketing and promotion needs to obtain my/our authorization.
Exposure to the companies in the Bank group is to simplify operation, business, cross-selling and other Bank
purposes and/or companies to provide within Bank Group the exposure for cross selling purpose is not possible
if such disclosure is objected by me/we. If any enquires please contact the bank at the phone number or address
(which can be changed by the Bank from time to time by notice) Level 10 Menara SME Bank, Jalan Sultan Ismail,
PO Box 12352, 50774 Kuala Lumpur, Tel: 03-26037700
I/We have read the Personal Data Protection Notice before completing this form. I/We signing this form by
submitting personal data, hereby I/We are giving authorize and agree the terms of the Notice that are available in
the Bank’s website at www.smebank.com.my and Enterprise Centres.
Opt-Out Clause
If you/your company do not want to receive any marketing materials about the products and/or special
offers from the Bank, please mark √ here.
Small Medium Enterprise Development Bank Malaysia Berhad (SME BANK) | Customer Information Form 3
Version 2.0 - 08/23
CUSTOMER INFORMATION FORM
I hereby declare that I have estimated net worth/assets as below:
More than RM3 million
Less than RM3 million
Note:
Net worth/assets – land, houses, motor vehicles, shares, cash at Bank etc.
I/We hereby declare that we/our vendor have no business relationship or any dealings with North Korea
(Democratic People’s Republic of Korea (DPRK)), Iran or Myanmar.
I/We declare that there is no director, manager; agent or company guarantor has family relationship such as
spouse, child or parents with any of the director or executive in the SME Bank at this time.
I/We also undertake to inform SME Bank if there arise any contact as mentioned above at any time.
…………………………………………………..
[ ]
Date:
Attachment:
Copy of Identity
Card BE Form [Income Tax]
Small Medium Enterprise Development Bank Malaysia Berhad (SME BANK) | Customer Information Form 4
Version 2.0 - 08/23
