Test Form page Nilai Hotel - Nilai Springs Resort Hotel

CLASS ‘B’ SHARE FULL GOLF MEMBERSHIP

Individual : RM 12,5000+
Corporate : RM 40,000+ (2 Nominees only)

CLASS ‘C’ SHARE SPORTS MEMBERSHIP

Individual : RM 3,500+

TERM FULL GOLF MEMBERSHIP

Individual : RM 3,300+

TERM SPORTS MEMBERSHIP

Individual : RM 1,650+

Personal Particulars

Full Name Of Applicant*

( As in NRIC/Passport, underline surname ) *MR/MRS/MS/MDM.

NRIC / Passport Number*

Date Of Birth*

Race*

Occupation*

Nationality*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address

Leave it empty if same as home address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Phone No.*

Residence Phone No.

Maritial Status*

Email*

Enter Email Confirm Email

Vehicle Owned

Model	Reg No.

Business / Employment Particulars

Name Of Business / Employer

Nature of Business

Office Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Office Tel No.

Fax No.

Type of Sector

Govt.
Private
Own BSNE

Family Particulars

Name of Spouse

*MR / MRS / MS / MDM

NRIC / Passport Number*

Date of Birth

Number of Children

Occupation of Spouse

Office Mobile No.

Children Particulars

Name	Gender ( M / F )	Date of Birth (DD/MM/YY)	NRIC / Passport No.

Miscellaneous Particulars

Other Club Membership (s)

Name Of Club	Since When (DD/MM/YY)	Current H/CAP

Your Name*

Please write within the boxes provided the name as it should appear on the memberships card

Spouse's Name*

Please write within the boxes provided the name as it should appear on the memberships card

Corporate Particulars

*This part to be filled by Corporate Applicant only.

Name of Company

Address of Company

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nature of Business

Place of Incorporation

Tel No.

Register No

Date of Incorporation

Designated Executive(s) authorised to hold the Corporate Nomination are as follows:

Designation Executive Information

Name of Nominee	Designation

Document to Submit

1) Please complete all section on PERSONAL PARTICULARS.
2) For corporate nominees , please provide all particulars on separate sheet for second nominee.

3) Please attach photocopy/images of NRIC ( both sides ) of applicant only. (Maximum 2MB)*

Drop files here or

4) Please submit passport size photograph of applicant, spouse and children below the age of 18 years old.
5) Please submit photocopy/images of marriage certificate and Birth certificate of your immediate family members. (Maximum 2MB)

Remittance

NOTE : Please make cheque payable to NILAI SPRINGS BHD.

DECLARATION

I/We the undersigned, hereby declare that the particulars given are true to my / our knowledge and belief.
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.
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.
I/We agree to pay by installment scheme of the allotment price as stipulated in the prospect us on procedure and payment term by signing the Mutual Agreement as acceptance.
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.
I/We hereby declare and agree that the declaration set out herein shall be taken, read and construed as an essential part of membership issued to me / us, on the event that my / our application is approved by NILAI SPRINGS BHD.
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

Consent*

I have read the Declaration and agreed to it

Name

This field is for validation purposes and should be left unchanged.

Test Form page Nilai Springs Resort Hotel

Test test

Membership Form

Personal Particulars

Business / Employment Particulars

Family Particulars

Miscellaneous Particulars

Corporate Particulars

Document to Submit

Remittance

DECLARATION