Application for HLB / HLISB Payment Relief Assistance Plan

 

Please complete this form to apply.

* Full Name (as per NRIC / IC):
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* NRIC / IC Number:
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* Mobile Number (e.g.01x12345678):
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* Email:
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* Loan / Financing Account No (1) e.g. 00xxxxxxxxx:
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Loan / Financing Account No (2):
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If you have more than 1 account

Loan / Financing Account No (3):
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If you have more than 1 account

Loan / Financing Account No (4):
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If you have more than 1 account



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* Monthly income in MYR: (e.g. 5000.00)
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IMPORTANT- Your selection of the preferred plan may not be the final as it will be reviewed by HLB/HLISB. Our offer will be catered to your loan/financing type, your situation and the severity of your loss of income.


By submitting this form, I hereby confirm that I have read and agreed to the contents of the Privacy Notice. I further acknowledge and agree that all personal data provided by me and/or acquired by Hong Leong Bank Berhad (“HLBB”) and Hong Leong Islamic Bank (“HLISB”) from the public domain, as well as personal data that arises as a result of the provision of services to me will be subject to the Privacy Notice.

I confirm that the mobile/fixed phone number provided herein is accurate and shall be used by you to contact me. I further agree and understand that any statements, notices and/or communication to be given by you to me pursuant to my Loan/Financing-I facility, where permissible by law, may, be sent to the e-mail address provided herein. I confirm that this e-mail address will replace my existing e-mail address in your record, if any.