NILAI SPRINGS BHD.

SHARE APPLICATION FORM
CLASS ‘C’ SHARE
Social Membership
CLASS ‘B’ SHARE
Full Golf Membership
Individual : RM12,500.00
Individual : RM3,500.00
Corporate : RM40,000.00
NILAI SPRINGS BHD.
( Incorporated in Malaysia under the Companies Act, 1965
A member of NILAI RESOURCES GROUP SDN BHD )
NILAI RESOURCES GROUP SDN BHD
( 17654-P )
PERSONAL PARTICULARS
FULL NAME OF APPLICANT :
( AS IN NRIC/PASSPORT, UNDERLINE
SURNAME) *MR/MRS/MS/MDM.
NRIC/PASSPORT NUMBER :
DATE OF BIRTH
:
RACE :
OCCUPATION
:
HOME ADDRESS
:
MAILING ADDRESS
:
D
H/P NO
M
Y
NATIONALITY :
:
RESIDENCE NO
VEHICLE OWNED
MARITAL STATUS : * SINGLE / MARRIED
EMAIL ADD : …………………………………..
:
:
MODEL
1)
2)
REG.NO
BUSINESS / EMPLOYMENT PARTICULARS
NAME OF BUSINESS /
EMPLOYER
:
NATURE OF BUSINESS
:
OFFICE ADDRESS
:
OFFICE TEL NO
:
TYPE OF SECTOR
:
FAX NO
GOVT.
PRIVATE
OWN BSNE
OTHERS……………………..
FAMILY PARTICULARS
NAME OF SPOUSE
:
*MR/MRS/MS/MDM
NRIC/PASSPORT NO
:
DATE OF BIRTH
:
NUMBER OF CHILDREN
:
D
M
Y
OCCUPATION OF SPOUSE :
H/P NO
CHILDREN PARTICULARS
SEX
NAME
(M/F)
1)
2)
3)
4)
5)
* DELETE WHERE NOT APPLICABLE
DATE OF BIRTH
D
M
:
NRIC / PASSPORT NO
Y
MISCELLANEOUS PARTICULARS
OTHER CLUB MEMBERSHIP ( S )
NAME OF CLUB
D
SINCE WHEN
M
CURRENT H/CAP
Y
1)
2)
3)
4)
Please write within the boxes provided the name as it should appear
SPECIMEN SIGNATURE OF CARDHOLDER
on the Membership Card
YOUR NAME :
SPOUSE'S NAME :
CORPORATE PARTICULARS
This part to be filled by Corporate Applicant only.
NAME OF COMPANY
:
ADDRESS OF COMPANY
:
NATURE OF BUSINESS
:
PLACE OF INCORPORATION
:
TEL NO :
DATE OF
INCORPORATION
REGISTER NO :
:
D
M
Designated Executive(s) authorised to hold the Corporate Nomination are as follows :
1) NAME OF NOMINEE :
DESIGNATION
:
2) NAME OF NOMINEE :
DESIGNATION
:
NOTES
1)
2)
3)
4)
5)
Please complete all section on PERSONAL PARTICULARS .
Please attach photocopy NRIC ( both sides ) of applicant only.
Please submit four ( 4 ) passport size photograph of applicant, spouse and children below the age of 18 years old.
For corporate nominees , please provide family particulars on separate sheet.
Please submit marriage certificate and Birth certificate of your immediate family members.
Y
REMITTANCE
NOTE : Please make cheque payable to NILAI SPRINGS BHD.
DECLARATION
1) I/We the undersigned, hereby declare that the particulars given are true to my / our knowledge and belief.
2) I/We agree that if my / our application is successful, NILAI SPRINGS BHD, will within thirty ( 30 ) days from the date of applicant inform me
/ us of the acceptance.
3) I/We agree that in any event my / our application in unsuccessful, any monies paid by me / us shall be refundable to me without interest.
4) I/We agree to pay by installment scheme of the allotment price as stipulated in the prospectus on procedure and payment terms by
signing the Mutual Agreement as acceptance.
5) I/We also agree to pay in addition to the respective Subscription Price, the monthly subscription and refundable security deposit at the
date to be determined by NILAI SPRINGS BHD to activate my/our operating account with the Club Rules, Regulations and By-Laws.
6) I/We hereby declare and agree that the declaration set out herein shall be taken, read and contrue as an essential part of membership
issued to me / us, on the event that my / our application is approved by NILAI SPRINGS BHD.
7) I/We the undersigned, hereby give my / our consent to NILAI SPRINGS BHD to process my / our personal data. By this consent, I/We
understand and agreed that NILAI SPRINGS BHD may conduct reference checks on me / us with any business entity / ies for bona fide
trade checking now or any future time for the purposes of opening new member account, credit / account evaluation, review, monitoring,
debt recovering purpose and / or legal documentation.
SIGNATURE OF APPLICANT
DATE
Please return completed form to :
Nilai Springs Bhd ( Co.No. 312270-P )
Tel : 06-8508888.
PT 4770, Nilai Springs, 71800 Putra Nilai, N.S.D.K
Fax : 06-8503388.
E-mail : [email protected]
Website : www.nilaisprings.com.my
FOR OFFICE ONLY
MEMBERSHIP SECTION
APPLICATION RECEIVED
PAYMENT
CHEQUE NO
AMOUNT
DATE
REMARKS :
:
:
:
:
:
REMARKS : APPROVED / NOT APPROVED
Date
Applicant attended by :
Membership No :
MANAGER
A.
NEW APPLICANT TO SUBMIT THE FOLLOWING
APPLICANT FORM DULY SIGNED
A PHOTOCOPY OF NRIC BOTH SIDED OF APPLICANT ONLY
APPLICANT MONEY ( RM12,500 / RM3,500 / RM4,500 / RM 1000 )
REFUNDABLE SECURITY DEPOSIT OF RM500.00
PHOTOCOPY OF MARRIAGE CERTIFICATE
BIRTH CERTIFICATE OF CHILDREN
PHOTOGRAPHS (NRIC SIZE)
APLLICANT
SPOUSE
CHILDREN BELOW 18 YEARS OLD
CHILDREN BELOW 12 YEARS OLD
4pcs / 3pcs
4pcs / 3pcs
4pcs / 3pcs
2pcs
GOLF BAG TAG RM15.90 EACH
ADDITIONAL CAR STICKERS RM21.20 PER STICKER
B.
NEW APPLICANT TO BE GIVEN THE FOLLOWING
RULES AND REGULATION
FLYER
2 CAR STICKER (FREE)
TEMPORARY CARD
MEMBER
SPOUSE
CHILDREN
1pcs
1pcs
NOTE : TO EXPEDITE THE APPROVAL OF APLLICANT(s) KINDLY SUBMIT ALL DOCUMENTS REQUIRED IN SECTION A
MUTUAL AGREEMENT
(GOLF MEMBERSHIP)
This is a Mutual Agreement made between Mr./ Mdm/ Ms ……………………………..
NRIC No…………………………(Applicant for NSGCC’s Golf Membership (Class B) of
RM12,500.00 and Nilai Springs Golf and Country Club ( NSGCC) on…………………
That I, the applicant shall follow the procedure and payment terms as stated below.
The procedure and payment terms on this installment scheme for class B shares are
as follows:(i)
an applicant desiring to subscribe for a unit of  Class B  share is required to
fill up the requisite application form and submit the same together with a
remittance of RM4,500.00 of the issue price of the share in favor of the
Company.
(ii)
if the application is accepted the Company will inform the applicant of the
acceptance and the balance of RM8,000.00 shall be payable to the Company
by way of ten (10) monthly installments (the installment) of the RM 800.00
each the first of which installment shall be paid within thirty days after
notification to the applicant of the acceptance of his application by the
Company and the subsequent installments shall be payable to the Company at
monthly intervals thereafter.
(iii)
the Company will upon its receipt of each installment forward the same to the
appointed Solicitor to hold as stakeholders and the Solicitor shall only be
authorized to release all the installments to the Company within seven (7)
days of receipt of the final installment from the Company ;
(iv)
in the event that the applicant defaults in payment for more than three (3)
consecutive installments to the Company, the Company’s acceptance shall
automatically lapse and the total amount paid by the applicant to the
Company shall be absolutely forfeited by the Company and the appointed
Solicitor as the stakeholders, shall be authorized to refund to the Company all
installments which are held by the Solicitor.
The main terms of the Installment Scheme are as follows:Issue Price per share
Amount payable by Applicant upon application
Proposed monthly installment
Number of monthly installments
………………………………..
APPLICANT’S SIGNATURE
Name :
Date :
RM 12,500.00
RM 4,500.00
RM
800.00 per month
10 installments
…..……………………………..…
SALES & MARKETING DEPT.
Accounts Department,
Nilai Springs Bhd
PT4770, Putra Nilai
Negeri Sembilan
Direct Bank In Form
Name :
…………………………………
Membership No :
…………………………………
Date of Banked In :
…………………………………
Amount :
…………………………………
Type :
Machine / Counter / Internet
Mark (X)
Bank Name :
CIMB Bank Berhad
Bank Address :
Lot 5717-5719, Jalan TS 2/1D
Taman Semarak, Bandar Baru Nilai,
71800 Nilai, Negeri Sembilan,
Malaysia.
Account No :
8004518031
Swift Code :
CIBBMYKL
Payee :
Nilai Springs Bhd
OR
Bank Name :
Malayan Banking Berhad
Bank Address :
PT 7443, Jalan BBN 1/2F
Bandar Baru Nilai,
71800 Nilai, Negeri Sembilan,
Malaysia.
Account No :
505103401754
Swift Code :
MBBEMYKL
Payee :
Nilai Springs Bhd
Yours sincerely,
……………………….
Name :
Date :
Important Note
Please fax back this form duly filled and signed together with your bank in slip at
06-850 3005 / 3388.