MPIS Partner - Company Form | Alliance Bank Malaysia

Details Of Partner

Name of Company/Business*

Email Address*

Business Registration Number*

Company Office Number*

Nature of Business*

Company Establishment Date* (In DD/MM/YYYY format e.g. 01/01/2001)

Office Address*

Company’s Directors Details

Name(s) of Directors(As per NRIC)*

ID Type*

NRIC of Directors/Partners/Proprietor*

Contact Number*

Company Shareholder’s Details

Key Contact Personnel

Primary Contact Personnel*

Primary Contact Personnel Designation*

Primary Contact Number (HP)*

Secondary Contact Personnel*

Secondary Contact Personnel Designation*

Secondary Contact Number (HP)*

Bank Name* (For referral fee payment purpose)

Company Saving Account/Current Account No.*(For referral fee payment purpose)

Expected number of referrals/volume of referrals per month*
(Minimum Commitment Of 5 Successful Referrals Per Month)

Are you currently referring any Mortgage Loan leads to other banks?*
(If Yes, Please State The Name Of The Bank(s) Separated with Commas)

Yes

No

Required Document

Company's profile*
(Please Upload PDF File)

Upload

Company Registration Form/Form 24,49 and M&*
(Please Upload PDF File)

Upload

Director’s IC (Front)*
(Please Upload Image File)

Upload

Director’s Business card (Front)*
(Please Upload Image File)

Upload

Director’s IC (Back)*
(Please Upload Image File)

Upload

Director’s Business card (Back)*
(Please Upload Image File)

Upload

Who referred you to this MPIS referral program?

(Please select Alliance Bank staff who refer you MPIS program from drop down list below)

Preferred Sales staff*

Do your shareholders/directors/proprietor have relationship with any of the Bank's director/shareholder/employee or their close relatives? If yes, kindly fill in the details of the Bank's director/shareholder/emplyoee or their close relatives as below.

(Close relatives is referred to spouse and dependents of the spouse, child (including step children and adopted children) and spouse of the child,parent; brother or sister and their spouses and financial dependents of the individual/spouse - this refers to any person who is financially dependent on the individual or his spouse for his livelihood, e.g a person who receives financial assistance on a regular basis from the individual/spouse)

Name (as per NRIC)

NRIC

Relationship

Do you have relationship with any of the Bank's director/shareholder/emplyee or their close relatives? If yes, kindly fill in the detials of the Bank's director/shareholder/employee or their close relatives as below.

(Close relatives is referred to spouse and dependents of the spuse, child (including step children and adopted children) and spouse of the child, parent; brother or sister and their spouses and financial dependents of the indivisual/spouse - this refers to any person who is financially dependent on the individual or his spouse for his livelihood, e.g. a person who receives financial assistance on a regular basis from the individual/spouse)

Name (as per NRIC)

NRIC

Relationship

Terms and Conditions

I/We hereby declare that:

The information given is true and correct and I/we have not withheld any particulars which might prejudice my application;
I/We am/are not bankrupt nor wound-up at present;
I/We hereby give permission to the Bank to conduct CTOS checks on the company/business and personnel involved. If any adverse is revealed, the Bank has the right to exclude the company/business or the relevant personnel involved from this scheme. I/We hereby consent to and authorise Alliance Bank Malaysia Berhad (88103-W) (hereinafter called “the Bank”) to verify with and/or disclose to any party the Bank deems fit including but not limited to the Central Credit Unit of Bank Negara Malaysia, the Central Credit Reference Information System of Bank Negara Malaysia and/or any authority or body established by Bank Negara Malaysia, any other financial institution granting or intending to grant any credit facilities to me/us, any agency established by the Association of Banks Malaysia and/or any other party whatsoever, any information concerning or relating to me/us whether financial or otherwise, my/our account and/or the conduct thereof for any purpose which the Bank deems fit without notice of the same to me/us.
I/We hereby declare and agree that any data/information (including personal data) relating to or arising from or in connection with my/our application hereunder and also information pertaining to my/our affairs whether hereunder or otherwise on this application may be held, used and disclosed by the Bank for the purpose of processing this application and providing subsequent services for this and other products and services and/or direct marketing to communicate with me/us for such purpose.
The Bank reserves the right to reject this application without stating any reason(s). If my/our application is approved and the information above is found to be untrue, the Bank has the right to terminate the agreement

Registration Form (Company)

Details Of Partner

Company’s Directors Details

Company Shareholder’s Details

Key Contact Personnel

Required Document

Who referred you to this MPIS referral program?

Do your shareholders/directors/proprietor have relationship with any of the Bank's director/shareholder/employee or their close relatives? If yes, kindly fill in the details of the Bank's director/shareholder/emplyoee or their close relatives as below.

Do you have relationship with any of the Bank's director/shareholder/emplyee or their close relatives? If yes, kindly fill in the detials of the Bank's director/shareholder/employee or their close relatives as below.

Terms and Conditions

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