B40 Confirmation Form

Confirmation Assistance Required Form for Individual under
Category B40 & Micro SME Customers with Financing Value up to

RM150,000 (V2revised Feb2021)
Branch / HPC / HPH / CAC:

Date: 08.06.2021
Expanded Targeted Repayment Assistance for All Individuals Under B40 Category
(Registered in the Bantuan Sara Hidup / Bantuan Prihatin Rakyat's Database) &
Micro Enterprise / Micro SME Customers with Financing Value up to RM150,000.00
Please Select: √ Individual B40
Tick √ where applicable Micro Enterprise / Micro SME
For Multiple HP / AITAB HP-i Accounts. To fill in account details in Page 2
►Personal Particulars
Vehicle Registration No. VEU 249 Account No. 869055570590010 Note No.
Hirer’s Name DESMOND A/L AUGUSTUS Vehicle Year Made 2020

NRIC / Passport No. 851218145321
Business Registration No. -
Telephone No./ Handphone No. 0169715172
E-mail Address* [email protected]
Guarantor's Name JOANNE RENU ALEXANDER
Guarantor's NRIC/ Passport No. 891124085678 Relationship with hirer WIFE
For Individual B40

C-42-18 SENTUL POINT, JALAN SENTUL PASAR, 51000 KUALA LUMPUR
Residential Address
Office / Business -
Address
For Micro Enterprise / Micro SME
Nature of Business Year in Business: yrs
Entity [ ] Sole Proprietor [ ] Partnership [ ] Company [ ] Others:
Office / Business
Address
►Hirer's Declaration
For Individual B40 Tick (√) where applicable
[√ ] I hereby declared that I am categorised as B40 group and registered in the Bantuan Sara Hidup (BSH) / Bantuan Prihatin
Rakyat (BPR) database.
For Micro Enterprise / Micro SME
[ ] I hereby declared that my / our firm / company is under Micro SME category as define below:-
■ Sales turnover of less than RM300,000.00, or
■ Less than 5 full-time employees
[ ] Total financing value is NOT more than RM150,000.00.
*Disclaimer:
Please ensure the email furnished belongs to you as it will be used for communication with you and any attachment transmitted with
it may contain information that is privileged and/or confidential.
►I would like to confirm / apply for the following ETRA option :

Tick 1 only (√ )
[√ ] Option 1 : 3-Month Deferment Repayment / Payment of Instalments
[ ] Option 2 : 50% Reduction in Monthly Instalment for 6 months
[ ] Option 3 : Rescheduling with First 3-Month Deferment of Instalments and Reduction of Existing Monthly Instalments
Note: Please refer to Page 3 on the descriptions of each option

Page 1 of 3
Account No. / Note No:

869055570590010
I/We hebeby would like to revise / reschedule the following accounts with the same ETRA option :-
Vehicle Registration
Account No. Note No. Vehicle Model Branch /HPC/ HPH/ CAC
Number
1.VEU 249 869055570590010 MYVI 1.5 H
2.
3.
4.
5.
►Terms and Conditions of ETRA

1. Acceptance to the Letter of Offer together with the terms and conditions.
2. Supplemental Agreement to be signed by the hirer and guarantor (if any).
3. A stamp duty of RM10.00 and additional RM10.00 stamp duty per guarantor (if any) will be collected upon signing of the
above documents.
Note: Due to COVID-19 pandemic, execution of Supplemental Agreement and other documents may be done via electronic
means including e-Acceptance as allowed by the Ministry of Domestic Trade and Consumer Affairs pursuant to the
Electronic Commerce Act 2006.
►Hirer’s Declaration:
I/We hereby declare that:
i) I am not an undischarged bankrupt / My company is not wound up.
ii) The information given in this confirmation is true, complete and accurate. I understand that any false or incorrect information
declared may result in my confirmation be declined or approval be recalled at the Bank’s sole discretion.
iii) The email address furnished belongs to me and I hereby authorise PBB/PIBB to use the said email address as a channel
of correspondence with me. I shall indemnify PBB / PIBB against any losses, damages, claims whatsoever which may
arise as a consequence of the Bank using the email address given by me in the confirmation form.
iv)I/We have obtained consent from the guarantor (if any) for my confirmation to revise payment of / reschedule the above HP
account and the guarantor will continue the guarantee and legally bind by the terms and conditions of the Hire Purchase
Agreement.
v) I / We am/are the appointed and authorised person of the company / business to provide the above information.
(For Business Hirer)
[√ ] I/We hereby confirm that I/We required the repayment assistance and have read and accept the above terms and
conditions.
Hirer's Signature
Name : DESMOND A/L AUGUSTUS

Date : 08.06.2021
Page 2 of 3
Account No. / Note No:

869055570590010
►Descriptions on ETRA Options:
Option 1: 3-Months Deferment Repayment/Payment of Instalments

a. Loan/financing tenure will be consequentially extended for 3 months with interest / profit charged / accrued on the deferred
instalment amount at the prevailing Annual Percentage Rate (APR) as stated in the existing HP/AITAB HP-i Agreement until it
is fully settled. (Only applicable for fixed rate HP/AITAB HP-i account).
Option 2: 50% Reduction in Monthly Instalment for 6 months

a. 50% reduction of monthly instalment for 6 months.
b. Loan/financing tenure will be consequentially extended for 3 months with interest / profit charged / accrued on the deferred
instalment amount at the prevailing Annual Percentage Rate (APR) as stated in the existing HP/AITAB HP-i Agreement until it
is fully settled. (Only applicable for fixed rate HP/AITAB HP-i account).
Option 3: Rescheduling with First 3-Month Deferment of Instalments and Reduction of Existing Monthly Instalments
a. Rescheduling with reduction in monthly instalments including 3 month deferment of instalments.
b. Loan/financing tenure will be extended for maximum of 2 years. However, customer may request for longer extension tenure
exceeding 2 years to suit their financial situations.
[√ ] I/We have read and understand the ETRA option selected.

[√ ] I/We am/are aware and acknowledged that this repayment assistance shall result in higher overall borrowing/financing
cost due to the extended loan/financing tenure. I/We have the option to review the repayment schedule to reduce the
borrowing/financing costs such as to increase monthly instalment amount and/or shortening the loan/financing tenure
that is affordable should my/our financial circumstances improves.
[√ ] I/We am/are aware and acknowledged that the documentation process may be completed cross month-end. My/Our BNM
CCRIS status will reflect the actual arrear(s) as at end of the month,if any.
Hirer's Signature
Name : DESMOND A/L AUGUSTUS

Date : 08.06.2021
Page 3 of 3

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Confirmation Assistance Required Form for Individual under

Category B40 & Micro SME Customers with Financing Value up to

Branch / HPC / HPH / CAC:

Hirer’s Name DESMOND A/L AUGUSTUS Vehicle Year Made 2020

For Individual B40

►I would like to confirm / apply for the following ETRA option :

Note: Please refer to Page 3 on the descriptions of each option

Branch / HPC / HPH / CAC:

Account No. / Note No:

►Terms and Conditions of ETRA

Name : DESMOND A/L AUGUSTUS

Branch / HPC / HPH / CAC:

Account No. / Note No:

►Descriptions on ETRA Options:

Option 1: 3-Months Deferment Repayment/Payment of Instalments

Option 2: 50% Reduction in Monthly Instalment for 6 months

[√ ] I/We have read and understand the ETRA option selected.

Name : DESMOND A/L AUGUSTUS

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