We will contact you immediately upon receiving your application form
Full name as in NRIC :
NRIC no. (new) :
NRIC no. (old) :
Residential Address :
Postcode :
State :
House Telephone No. :
Handphone No. :
Property :
No. of Occupants :
Years of Stay :
Months of Stay :
Application Date :
Date Of Birth :
Licence :
Sex :
Race :
Marital Stutus :
Email Address :
Name of Company :
Office Address :
Postcode :
State :
Office Telephone No.
Position
Department
Nature of Business
Net Monthly Salary
RM
Salary Date
DD
DD
Mid Month (If Any)
Length of Service
Years
Months
Emergency Contact Person (Individual not staying with you)
Name :
Residential Address :
Postcode :
State :
Relationship With Applicant :
House Telephone No. :
Handphone No. :
Office Telephone No. :
Motorcycles Order Information
Motorcycles Model :
Installment Period :
Installment Plan :
Agreed
*** I agree to accept by the "Terms & Conditions" of the agreement.
* We reserves the right to reject this application without giving any explanation and documents submited for this application will not be returned.
* Terms and conditions apply.
We are the authorised dealer for Naza, Modenas, Honda & Yamaha Motorcycles in Sabah and Labuan.
