APPLICATION FORM

CROSS BORDER FINANCING FACILITIES

Please Tick () where appropriate:

Bank Guarantee Facility Bank Guarantee - i

Buyer Credit Facility Buyer Financing- i
Export of Services Facility Export of Services Financing- i
Overseas Contract Facility Overseas Contract Financing- i
Overseas Project Facility Overseas Project Financing- i
Overseas Investment Financing Overseas Investment Financing- i
Term Financing Term Financing- i
IDB- CO Financing

Loan Amount Applied

For Bank’s Use Only: Applicant For Bank’s Use Only :

ITEM DATE

Received
NAME OF APPLICANT
Acknowledgement

Assigned to:

FACILITY Reviewed by:

PURPOSE Documents complete Yes No

PROJECT
DESCRIPTION
 Cross Border Financing Facilities
APPLICANT:

1.0 INFORMATION ON APPLICANT AND / OR SPONSOR

Company Name

Correspondence Address

Registered/Office Address

Principal Activities Purpose of Facility

Date of Incorporation Authorized Capital

Date of Commencement of Business Paid-Up Capital

Contact Person

Telephone No. Mobile No.

Fax No. Email

No. of Employee Local Foreign Percentage of Last Year’s Worth of Contracts/Turnover:

Full Time Local Overseas

Part Time

1.1 INFORMATION ON APPLICANT AND/OR SPONSOR

Company Name

Correspondence Address

Registered/Office Address

Principal Activities Purpose of Facility

Date of Incorporation Authorized Capital

Date of Commencement of Business Paid-Up Capital

Contact Person

Telephone No. Mobile No.

Fax No. Email

No. of Employee Local Foreign Percentage of Last Year’s Worth of Contracts/Turnover Were:

Full Time Local Overseas

Part Time

2.0 SECURITY OFFERED

Please Tick () Where Applicable Amount (RM) Please Tick () Where Applicable Amount (RM)

Fixed Deposit/ Cash Margin/General Investment

i. Assignment of Contract Proceeds vi.
Account

ii. SBLC/ Bank Guarantee vii. Landed Property

iii. Assignment of Insurance/Takaful viii. Assignment of payment

iv. Directors Personal Guarantee viii. Others (please specify):

v. Corporate Guarantee

PQM/CBFF/12/15-03C11-11 Page 1 of 6
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APPLICANT:

3.0 SUBSIDIARIES AND ASSOCIATE COMPANY(IES)*

Name % Shareholding Activities

i.

ii.

iii.

*Please provide the group organization chart.

4.0 DIRECTORS

Profile/Working Experience
I.C. No./ Other
Name Nationality Position Qualification (kindly use separate sheet for
Passport Directorship
details)

i.

ii.

iii.

5.0 SHAREHOLDERS*

Shareholding
Name Nationality
Amount %

i.

ii.

iii.

*If a public listed company, please provide a list of ten (10) major shareholders.

6.0 MANAGEMENT TEAM*

Profile/Working Experience
Name I.C. No./Passport Nationality Qualification Position (kindly use separate sheet for
details)
i.

ii.

iii.

*Please provide detailed resume.

7.0 CREDIT FACILITIES WITH OTHER FINANCIAL INSTITUTIONS (including Hire Purchase and Leasing Facilities)*

Name of Financial Institution and Type of Facility and Date of Facility

Outstanding Balance (RM) Interest Rate Security
Location Approved Limit (RM) Granted

i.

ii.

iii.

*To attach copies of relevant Letter of Offer.

8.0 CORPORATE GUARANTOR (if applicable)

Please Tick () Where Applicable Listed Non-Listed Company Registration No.

Company Name

Correspondence Address

Registered/Office Address

Principle Activities

Date of Incorporation Date of Commencement of Business

Authorized Capital Paid-Up Capital

Contact Person

Telephone No. Mobile No.

Fax No. Email

/0 PQM/CBFF/12/15-032/11-11 Page 2 of 6
 Cross Border Financing Facilities
APPLICANT:

9.0 FOREIGN EXCHANGE ADMINISTRATION

Notice 2, Part. E – Guarantee, Clause 14 (Sub-paragraph 1-6) Pursuant To Section 214 of FSA 2013 & Section 225 of IFSA 2013*

Yes No Not Applicable Remarks

Financial Guarantee/collateral obtained from Non-Resident

1.
(Approval from FEA)

Approval is required only for the obtaining of financial

guarantees/collateral from other non-residents exceeding RM100.00
million equivalent in aggregate.

Financial Guarantee/collateral issued to Non-Resident (Approval

2.
from FEA)

Approval is required for financial guarantees/collateral exceeding RM50

million equivalent in aggregate issued by a resident to secure
borrowing obtained by a non-resident entity from a non resident entity
which is not within its group of entities.

3. Registration to FEA

Financial Guarantee/collateral exceeding RM50.0 million equivalents in

aggregate which do not require approval shall be registered not later
than seven (7) business days after issuing or obtaining the financial
guarantee/collateral.

*For more information on this requirement, please visit www.bnm.gov.my. The rules and notices can be downloaded from the Foreign Exchange Administration section of
www.bnm.gov.my.

10.0 POLITICALLY EXPOSED PERSONS (PEPS) AND/OR HIGH NET WORTH INDIVIDUALS

Please indicate whether beneficial owner, shareholders, directors and/or management in the applicant’s company is a politically exposed person and/or a high
net worth individual

Yes No Not Applicable Remarks

1. Foreign PEPs

Refers to individuals who are or who have been entrusted with

prominent public functions by a foreign country. For example, Heads of
State or Government, senior politicians, senior government, judicial or
military officials, senior executives of state owned corporations and
important political party officials.

2. Domestic PEPs

Domestic PEPs refers individuals who are or have been entrusted

domestically with prominent public functions. For example, Heads of
State or Government, senior politicians, senior government, judiciary or
military officials, senior executives of state owned corporations and
important political party officials.

Person entrusted with a prominent function by an international

3.
organisation

Refers to members of senior management for example, directors,

deputy directors and members of the board or equivalent functions.

International organisation refers to entities established by formal

political agreements between their member States that have the status
of international treaties; their existence is recognised by law in their
member countries; and they are not treated as residential institutional
units of the countries in which they are located.
Examples of international organisations include the following:
i) United Nations and its affiliated international organisations;
ii) regional international organisations such as the Association of
Southeast Asian Nations, the Council of Europe, institutions of
the European Union, the Organisation for Security and Co-
operation in Europe and the Organization of American States;
iii) military international organisations such as the North Atlantic
Treaty Organization; and
iv) economic organisations such as the World Trade Organization.

4. High net worth individual

Refers to individuals with net worth of not less than RM10,000,000.00.

Notes:
 The requirements for PEPs are applicable to family members or close associates of all types of PEPs.
 Family members refers to are individuals who are related to a PEP either directly (consanguinity) or through marriage or similar (civil) forms of partnership. A family
member will include PEP’s direct family members including spouses, children, parents and siblings.
 Close associates are individuals who are closely connected to the PEP, either socially or professionally. Close associates will include a PEP’s widely-and publicly-
known close business colleagues and/or personal advisors, in particular financial advisors or persons acting in a financial fiduciary capacity.
 The definition of PEPs does not cover middle ranking or more junior individuals.

/0 PQM/CBFF/12/15-032/11-11 Page 3 of 6
 Cross Border Financing Facilities
APPLICANT:

11.0 EXISTING CREDIT FACILITIES OF CORPORATE GUARANTOR WITH EXIM BANK (if applicable)*

Type of Facility and Approved Limit Amount Outstanding (RM) Date Approved Security

i.

ii.

iii.

*To attach copies of relevant Letter of Offer.

12.0 COMPLETED AND ONGOING CONTRACTS*

Description of Contract Contract Amount Year Amount

Tenor Contract Awarder
(Please indicate, L for Local and O for Overseas) (RM) Commenced Outstanding (RM)

i.

ii.

iii.

*For the last three (3) years.

13.0 ORDER BOOK

Commencement/ Contract Awarder/ Stage of

Description of Contract Contract Amount (RM)
Completion Main Contractor Completion

i.

ii.

iii.

14.0 LIST OF MAJOR SUPPLIERS/SUB-CONTRACTORS

Amount Payment Length of

Type of Raw
Name of Supplier/Sub-Contractor Location Purchased Credit Terms Mode Business
Materials
Per Year (LC/DA/DP) Relationship

i.

ii.

iii.

/0 PQM/CBFF/12/15-032/11-11 Page 4 of 6
 Cross Border Financing Facilities
APPLICANT:

15.0 DETAILS OF SECURED PROJECT/CONTRACT IN RELATION TO THIS APPLICATION

Contract Name

Name of Awarder

Contract Type Commencement Date

Contract Value RM Completion Date

Main Contractor (if applicable) Contract Period

Retention Sum by the Awarder (if

RM Defect Liability Period (if applicable)
applicable)

Country Where Project/Contract is

Awarder’s Country
Undertaken

16.0 RAW MATERIAL INFORMATION

Composition % / Total Raw Average Price Two (2) Average Price One (1) Current Average
Major Raw Material Used
Material Cost Years Ago Year Ago Price

i.

ii.

iii.

17.0 TO FACILITATE OUR PROCESSING, PLEASE SEND US “CERTIFIED TRUE COPY” OF THE FOLLOWINGS:
IMPORTANT: Kindly ensure that all documents in foreign language are to be translated into either Bahasa Malaysia or English language.

1. Corporate Profile of Applicant and/or sponsor (s) (Business Registration, M&A, Forms 24, 44 and 49);

2. kllklkJJHSHFDJSFH
Organisation Chart, Subsidiary and/or Associate Company ;Profile of Directors/Shareholders, Senior Management (together with a copy of their NRIC/Passport);

3. kllklkJJHSHFDJSFH
Copies of the last six (6) months statement of Current Account;

4. kllklkJJHSHFDJSFH
Details of Applicant’s existing borrowing (including Hire Purchase and Leasing facilities);

5. kllklkJJHSHFDJSFH
Business Plan (for newly set-up business) or Expansion Plan (for ongoing business) (where applicable);

6. kllklkJJHSHFDJSFH
Information on the Project i.e. location, description of the project, GDC, GDV, Project timeline, consultants, contractors, subcontractors, operators, etc.

7. kllklkJJHSHFDJSFH
Copy of Concession Agreement Operating Agreement, Joint Venture Agreement and Shareholders Agreement

8. kllklkJJHSHFDJSFH
Valuation Report

9. kllklkJJHSHFDJSFH
Contact Information (in details);

10. kllklkJJHSHFDJSFH
Copy of relevant Letter of Award/ Letter of Intent/ Contract Agreement/ Summary of Tender Document/ Purchase Order, etc.;

11. kllklkJJHSHFDJSFH
Cash Flow of the Project and detailed/basis of assumptions in both hard and soft copy form;

12. kllklkJJHSHFDJSFH
Proforma P&L of the Project in both hard and soft copy form;

13. kllklkJJHSHFDJSFH
Projected P&L for the next two (2) years (commencing from the date of last Audited Account/New Financial Year);

14. kllklkJJHSHFDJSFH
Project Schedule/ Technical Plan/ Technical Drawing/ Plant Layout;

15. kllklkJJHSHFDJSFH
Bill of Quantities, List of Suppliers and Credit Term, Confirmation on Price Locking for Raw Material, etc.;

16. kllklkJJHSHFDJSFH
Profile of Contract Awarder;

17. kllklkJJHSHFDJSFH
Contract Awarder’s latest Audited Account/ supporting documents to substantiate that the Contract Awarder has obtained financing to finance the Contract (if

applicable);

18. kllklkJJHSHFDJSFH
Profile of Key Technical Personnel inclusive of qualifications and experience;

19. kllklkJJHSHFDJSFH
Profile of Contractor inclusive of its track record and its last three (3) years Audited Account;

20. kllklkJJHSHFDJSFH
Copies of relevant documents pertaining to approvals/permits/license issued by local authorities;

21. kllklkJJHSHFDJSFH
Copy of Guarantee Format (if applicable);

22. kllklkJJHSHFDJSFH
Profile of Corporate Guarantor (Business Registration, M&A, Forms 24, 44 and 49);

kllklkJJHSHFDJSFH

/02 PQM/CBFF/12/15-03/11-11 Page 5 of 6

 Cross Border Financing Facilities
APPLICANT:

23. Corporate Guarantor Organisation Chart, Subsidiary and/or Associate Company; Profile of Directors /Shareholders, Senior Management together with a copy of

their NRIC/Passport (if applicable);

24. kllklkJJHSHFDJSFH
Corporate Guarantor’s Audited Financial Statements for the last three (3) years and the latest Management Account (if applicable);

25. kllklkJJHSHFDJSFH
Details of Corporate Guarantor’s existing borrowing (including Hire Purchase and Leasing facilities) (if applicable);

26. kllklkJJHSHFDJSFH
Profile of Personal Guarantors together with a copy of their NRIC and/or Passport and Net Worth Declaration Form (if applicable);

27. kllklkJJHSHFDJSFH
Authorization Letter (Appendix A);

28. kllklkJJHSHFDJSFH
Other Documents (if any):

We hereby declare that all the details given are true to the best of our knowledge and hereby give our consent to EXIM Bank to conduct the necessary credit
checking with the relevant agencies.

Authorized Signatory Company Stamp

Name

Designation Date

HOW DID YOU GET TO KNOW EXIM BANK? CONTACT PERSON

Please tick () Where Applicable Name Direct Line Email

Seminar/Talk/Exhibition Business Associates/Friends Farizah Hashim (603) 2601 2064 [email protected]

Media (TV, Billboard, etc.) Azrin Azizuddin (603) 2601 2089 [email protected]

Others (please specify): Dailami Aiman Bolkim (603) 2601 2036 [email protected]

Other Conditions:

1. The Applicant/Customer shall not under any circumstances offer, promise or make any gift, payment, loan, reward, inducement, benefit or other
advantage to any of the Bank’s employees, members of the Boards of Directors, representatives and/or agents in relation to this
application/facility/agreement. Such acts are criminal offences under the Malaysian laws and shall entitle the Bank and without prejudice to the Bank’s
other rights and remedies, to terminate the application/facility/agreement forthwith, and the applicant/borrower shall be liable for all consequential losses
incurred by the Bank as a result of such termination, and shall indemnify and render the Bank harmless from all such costs. The Bank is also entitled to
report the same to the relevant authorities including but not limited to the Malaysian Anti-Corruption Commission and/or the Royal Malaysian Police.

2. All traveling expenses, charges and any whatsoever out-of-pocket expenses incurred under, in respect of or in connection with the processing of this
financing application including but not limited to the cost of inspections and visits of the project(s) to be financed under the Facility by EXIM Bank, its
employees, agents, or other consultants at such intervals and in such manner as may be determined by EXIM Bank in its absolute discretion shall be
borne by the Customer.

Please send your application with your supporting documents to :

Export-Import Bank of Malaysia Berhad
Level 1, EXIM Bank
Jalan Sultan Ismail
50250 Kuala Lumpur

Tel: (603) 2601 2000 Fax: (603) 2601 2453

Website Address : www.exim.com.my

/02 PQM/CBFF/12/15-03/11-11 Page 6 of 6

 Appendix A

(On Company’s Letterhead)

(Participating Financial Institutions Address)

Dear Sir/Madam

REF: ACCOUNT NO.

We hereby give our authorisation for you to provide information requested by

Export-Import Bank of Malaysia Berhad pertaining to our account (s) with your
financial institution.

Your cooperation is highly appreciated.

Yours faithfully,

……………………………………

(Authorized Signatory (ies))

Name :

Position:

Date: