Test Form page Nilai Springs Resort Hotel

Hotel in Nilai
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Membership Form

  • Personal Particulars

  • ( As in NRIC/Passport, underline surname ) *MR/MRS/MS/MDM.
  • Date Format: DD slash MM slash YYYY
  • Leave it empty if same as home address
  • ModelReg No. 
  • Business / Employment Particulars

  • Family Particulars

  • *MR / MRS / MS / MDM
  • Date Format: DD slash MM slash YYYY
  • NameGender ( M / F )Date of Birth (DD/MM/YY)NRIC / Passport No. 
  • Miscellaneous Particulars

  • Name Of ClubSince When (DD/MM/YY)Current H/CAP 
  • Please write within the boxes provided the name as it should appear on the memberships card
  • 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.
  • Date Format: DD slash MM slash YYYY
  • Designated Executive(s) authorised to hold the Corporate Nomination are as follows:
  • Name of NomineeDesignation 
  • 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.
  • Drop files here or
    Accepted file types: jpg, gif, png.
  • 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.

    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 prospect us on procedure and payment term 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 construed 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
  • This field is for validation purposes and should be left unchanged.