Application Form

Applicant Information

Full Name: Salesperson name/Agency name:

Residential address:

NRIC: Email: Mobile No:

Financing Information

Amount: RM Tenure: months Promo code:

Purpose of Financing: Working Capital Business Expansion Project Financing

Business Information

Business Name: Registration Number:

Business Address:
Business
Type of Company: Sole Prop Partnership Sdn. Bhd. Not SSM registered registered date:

Business Industry: Annual Sales: RM

Bank account number: Bank Name: e-Banking facility: Yes / No

Is your business (i.e. services & products offered) Shariah compliant: Yes / No
Director/ Partner Details (if applicable)

Partner 1
(Full name): Email: Mobile No:

Partner 2
(Full name): Email: Mobile No:

Partner 3
(Full name): Email: Mobile No:

Emergency Contact (Family Member)

Name: Contact Number: Relationship:

Disclaimer and Signature

I hereby acknowledge and certify that the information above are true and complete to the best of my knowledge and I
hereby consent to the collection, use and disclosure of my personal data for the purposes set in our privacy notice as
can be found on Funding Societies’ website (www.fundingsocieties.com.my) as required by the Personal Data
Protection Act 2010.

I agree to be contacted via WhatsApp for verification and communication needs with Funding Societies.

Signature: Date:
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 Statement of Consent – Authorization
Date:

To: Modalku Ventures Sdn Bhd [201601019329 (1190266-X)](“MV”)

Unit 15.01 & 15.02, Level 15, Mercu 3, KL Eco City,
Jalan Bangsar, 59200 Kuala Lumpur

Dear Sir(s),

This Statement of Consent on Authorization (“SoC”) of the undersigned as director(s), commissioner(s), shareholder(s), guarantor(s),
partner(s) and/or in his/her capacity as the authorized representative ( “Authorizer”), or as related or associated parties or
stakeholders in the following company (as the context requires in the sole discretion of MV) (collectively the “Parties”):

Company Name (the “Company”) :

Company Registration No :
Company Registered Address :

The Company and Parties’ Unconditional Consent to MV, which, to the extent permissible by law and Personal Data Protection
Act 2012 (“PDPA”) in particular, shall function as the sole and acceptable proof of irrevocable consent to grant MV the following
unconditional authority to:

a. process, verify and review or assess the application for the obtaining of loan and/or its associated documents (including other
requirements as mandated by and in the sole discretion of MV) (“Assessment”) as submitted by the Parties to MV or similar
transaction in the ordinary course of its business with due observance of and with reference to the Terms and Conditions, Terms
of Service, and Privacy Notice available on www.fundingsocieties.com.my including the amendments thereof from time to time;

b. carry out required actions in accordance with MV’s internal policy and procedure for the purpose of implementing or completing
the aforesaid Assessment, including but not limited to:

i. conducting due diligence on each document submitted by the Parties and/or as required by MV from time to time in
relation to the Assessment;
ii. procuring the Company and Parties’ personal credit records or history through any registered credit reporting agencies
under the CRA Act (Credit Bureau Malaysia Sdn Bhd (820050-T), CTOS Data Systems Sdn Bhd (247651-H) and
Experian Information Services (Malaysia)Sdn Bhd (532271-T)), including CCRIS, DCHEQS and any other credit or
trade information from relevant data sources, and;
iii. granting consent to the registered credit reporting agencies to disclose credit, trade or any information pursuant to
checks, review, monitoring and verifications mentioned in b.ii relating to the Company and/or Parties providing
securities to the Company, relevant third parties and/or data processor either located within or places outside Malaysia
when required, and share this information to other subscribers of the credit reporting agency/ies’ services;

c. refrain from undertaking or being involved in any action(s) aimed to revoke or terminate the authority or consent granted
hereunder or annul this SoC by any means or under any circumstance whatsoever until full completion of the Assessment as
notified by MV in its sole discretion, unless otherwise decided by MV.

The Company and Parties undertake and covenant that this SoC shall:

1) be governed under and construed in accordance with Malaysia laws;

2) be effective and binding to the Company, Parties and MV from the date of this SoC where it is signed by, sent to and
accepted by MV (and therefore is implemented by MV as proof of its receipt and acceptance), unless otherwise agreed in
writing by them (“Effective Date”);
3) allow the database of MV and the relevant registered credit reporting agency/ies to retain credit and trade information
relating to the Company and Parties as long as it is in compliance with the applicable laws & any changes thereto (including
PDPA), and therefore the Company and Parties to indemnify, keep harmless, release and discharge MV, the relevant
registered credit reporting agency/ies, their respective directors, officers, members, servants or agents from all liability and
detrimental consequences however arising from or in connection with the abovementioned consent and the exercise of
any/all stated activity including the subsequent disclosure of any information relating to the Company and Parties;
4) be signed without and under no duress or coercion, undue influence and unconscionable bargains whatsoever which may
cause this SoC to be invalid, unenforceable, void or voidable; and
5) not be in contravention of all agreements, arrangements or commitments to which the Company and/or any of the Parties
is a party and therefore no further or subsequent approval is required to effectuate it.

(This page must be initiated by Authorizer)

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In witness whereof, this SoC has been executed on the date and year first above written and shall constitute a valid and absolute
proof of consent of the Parties to the matters set out herein. This SoC shall be irrevocable and continue to be valid as long as
existing business relationship/credit facility/transaction/potential engagement continues to exist and/or any dues owed by the
Company and Parties remain outstanding.

Signed by the Parties Company stamp (if any)

Authorized Signatory & Director

Authorizer Name:
(Full name as per NRIC)

Authorizer NRIC/Passport Number:

Date:

Full Name: Full Name:

NRIC/Passport Number: NRIC/Passport Number:

Position: Director / Shareholder Position: Director / Shareholder
Date: Date:

Full Name: Full Name:

NRIC/Passport Number: NRIC/Passport Number:

Position: Director / Shareholder Position: Director / Shareholder
Date: Date:

Full Name: Full Name:

NRIC/Passport Number: NRIC/Passport Number:

Position: Director / Shareholder Position: Director / Shareholder

Date: Date: