SULIT & PERSENDIRIAN

PRIVATE & CONFIDENTIAL

Borang Soal-Jawab (Untuk diisi oleh Peserta)

Questionnaire (To be completed by Participant)

SOALAN KAJI SELIDIK WARGA ASING

Foreigners Questionnaire
IK Sila berikan maklumat yang diperlukan bagi membantu kami memproses permohonan tuan/puan. Setiap maklumat akan dilayan
secara sulit.
Kindly provide the information requested in order to assist us to process your proposal. All details provided shall be treated as highly
confidential.

Nama :
Name __________________________________
1.

No Cadangan :
Proposal No. ______________________________

Apakah warganegara anda / What is your nationality?

__________________________________________________________________________________

2.

Di negara manakah pernah anda menetap sebelum ini / In what countries have you previously resided?
__________________________________________________________________________________

3.

i.

Sudah berapa lama anda berada di Malaysia / How long have you been in Malaysia ?

__________________________________________________________________________________
ii. Adakah anda mempunyai Status Penduduk tetap Malaysia? Jika ya, sila nyatakan nombor kad
pengenalan dan sertakan salinan kad pengenalan. Do you hold a Permanent Residence Status of
Malaysia? If yes, please provide your identity card (IC) number and a copy of your IC.
__________________________________________________________________________________

4.

Adakah anda mempunyai permit pekerjaan ? Jika ada, sila berikan nombor permit tersebut.
Do you have work permit? If so, please give the number.
__________________________________________________________________________________

5.

Berapa lama lagikah anda bercadang untuk tinggal di Malaysia / How much longer do you intend to stay
in Malaysia?
__________________________________________________________________________________

6.

Adakah anda memiliki perniagaan atau harta tanah di Malaysia? Jika ada, sila berikan butiran lanjut.
Do you own a business or property in Malaysia? If so, please give details.

FNB/GL001/FRM008/00

__________________________________________________________________________________

7.

Terangkan pekerjaan anda sekarang dan juga apa-apa pekerjaan yang pernah anda lakukan di Malaysia.
Describe your current occupation and any previous occupation you been doing in Malaysia.
__________________________________________________________________________________

8.

Apakah pekerjaan anda di negara anda sebelum anda datang ke Malaysia / What occupation were you
doing in your own country before you came to Malaysia?
__________________________________________________________________________________

9.

Adakah pasangan anda tinggal bersama sama anda / Does your spouse reside with you?
__________________________________________________________________________________

10. Adakah pasangan anda warganegara Malaysia / Is your spouse a Malaysian Nationality?
__________________________________________________________________________________

11. Adakah anda atau pasangan anda pernah atau masih memegang jawatan seperti Ketua Negara atau
Kerajaan, Ahli Politik Kanan, Pegawai Kanan Kerajaan, Pegawai Perundangan, Pegawai Angkatan
Bersenjata atau Pegawai Kanan di Jabatan Awam/Have you or your spouse have been entrusted with
prominent public functions, such as Heads of State or Government, Senior Politicians, Senior
Government Officials, Judicial or Military Officials and Senior Executives of Public Organisations

__________________________________________________________________________________
Dengan ini saya mengakui bahawa jawapan-jawapan yang saya berikan adalah, sepanjang pengetahuan saya,
benar dan saya tidak menyembunyikan apa-apa maklumat yang boleh mempengaruhi penilaian atau
penerimaan cadangan ini.
I declare that the answers I have given are, to the best of my knowledge, true and that I have not withheld any
material information that may influence the assessment or acceptance of the proposal.
Saya bersetuju yang borang ini akan menjadi sebahagian dari cadangan Takaful Keluarga saya dan
kegagalana untuk mengemukakan apa-apa maklumat yang saya ketahui boleh menyebabkan perjanjian ini
terbatal.
I agree that this form will constitute part of my proposal for Family Takaful and that failure to disclose any
material fact known to me may invalidate the contract.

Tandatangan
Signed

: .

FNB/GL001/FRM008/00

Tarikh :
Date