Project/Property Name*
—Please choose an option—Kampar PutraTanjung MalimSeri BembanOther

Developer Name*

Plot Number / Unit Lot*

Land Area / Housing Size

Property Type*

Property State*

Phase

Land Status
—Please choose an option—Lease holdFree hold

Development Progress
—Please choose an option—Under constructionComplete

Type of Loan
—Please choose an option—LPPSABANKCASH

Type of Bank (LPPSA/Which Bank)

Debt Settlement Agreement
YesNo

SPA Price

Loan Amount

Date of Purchase*

Purchaser Name*

NRIC*

Others ID

Date of Birth*

Race*
—Please choose an option—MalayChineseIndianOther

Marital Status
—Please choose an option—SingleMarriedOther

Mobile Phone

Home Phone

Email Address

Mailing Address

Occupation

Position

Office Number

Date of Work/Establish

Company Address