SHARE APPLICATION FORMCLASS ‘B’ SHAREFull Golf Membership

CLASS ‘C’ SHARESocial Membership

Individual : RM12,500.00

Corporate : RM3,500.00(1 Nominee Only)

Individual : RM3,500.00

NILAI SPRINGS BHD.( Incorporated in Malaysia under the Companies Act, 2016

A member of NILAI RESOURCES GROUP SDN BHD )

NILAI RESOURCES GROUP SDN BHD( 17654-P )

( Co.No. 312270-P )

Corporate : RM40,00.00(2 Nominees Only)

FULL NAME OF APPLICANT :

NRIC/PASSPORT NUMBER :

DATE OF BIRTH RACE :

OCCUPATION NATIONALITY :

HOME ADDRESS

MAILING ADDRESS

H/P NO MARITAL STATUS : * SINGLE / MARRIED

RESIDENCE PHONE NO EMAIL ADD : …………………………………..

VEHICLE OWNED 1)2)

NAME OF BUSINESS / :EMPLOYER

NATURE OF BUSINESS :

OFFICE ADDRESS :

OFFICE TEL NO : FAX NO

TYPE OF SECTOR : GOVT. PRIVATE OWN BSNE OTHERS……………………..

NAME OF SPOUSE :*MR/MRS/MS/MDM

NRIC/PASSPORT NO :

DATE OF BIRTH :

NUMBER OF CHILDREN : OCCUPATION OF SPOUSE :

OFFICE / H/P NO :

SEX(M/F)

1)2)3)4)5)* DELETE WHERE NOT APPLICABLE

M YDNAME

FAMILY PARTICULARS

BUSINESS / EMPLOYMENT PARTICULARS

PERSONAL PARTICULARS

DATE OF BIRTH NRIC / PASSPORT NO

MODEL REG.NO

CHILDREN PARTICULARS

D M Y

D M Y

( AS IN NRIC/PASSPORT, UNDERLINE SURNAME) *MR/MRS/MS/MDM.

:

:

:

:

:

:

:

OTHER CLUB MEMBERSHIP ( S )

1)2)3)4)

Please write within the boxes provided the name as it should appear SPECIMEN SIGNATURE OF CARDHOLDERon the Membership Card

YOUR NAME :

SPOUSE'S NAME :

This part to be filled by Corporate Applicant only.

NAME OF COMPANY :

ADDRESS OF COMPANY :

NATURE OF BUSINESS : TEL NO :

PLACE OF INCORPORATION :

DATE OF :REGISTER NO : INCORPORATION

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

1) NAME OF NOMINEE :

DESIGNATION :

2) NAME OF NOMINEE :

DESIGNATION :

1) Please complete all section on PERSONAL PARTICULARS .2) Please attach photocopy NRIC ( both sides ) of applicant only.3) Please submit four ( 4 ) passport size photograph of applicant, spouse and children below the age of 18 years old.4) For corporate nominees , please provide family particulars on separate sheet.

YM

MISCELLANEOUS PARTICULARS

CURRENT H/CAP

CORPORATE PARTICULARS

SINCE WHENNAME OF CLUBD M Y

D

NOTES

1)

2)

3)

4)

5)

6)

7)

APPLICATION RECEIVED : REMARKS :PAYMENT :CHEQUE NO :AMOUNT :DATE :

REMARKS : APPROVED / NOT APPROVED

Applicant attended by : Membership No :

Please return completed form to :

Nilai Springs Bhd ( Co.No. 312270-P )

PT 4770, Nilai Springs, 71800 Putra Nilai, N.S.D.K

REMITTANCE

NOTE : Please make cheque payable to NILAI SPRINGS BHD.

DECLARATION

SIGNATURE OF APPLICANT

I/We the undersigned, hereby declare that the particulars given are true to my / our knowledge and belief.

DATE

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 prospectus on procedure and payment terms bysigning 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 thedate 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 contrue as an essential part of membershipissued 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/Weunderstand and agreed that NILAI SPRINGS BHD may conduct reference checks on me / us with any business entity / ies for bona fidetrade 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.

FOR OFFICE ONLY

MEMBERSHIP SECTION

MANAGERDate

Tel : 06-8508888. Fax : 06-8503388.Mobile : 013-524 5007 / 013-524 5670Website : www.nilaisprings.com.myE-mail : membership@nilaisprings.com.my

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 4pcs / 3pcsSPOUSE 4pcs / 3pcsCHILDREN BELOW 18 YEARS OLD 4pcs / 3pcsCHILDREN BELOW 12 YEARS OLD 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 1pcsSPOUSE 1pcsCHILDREN

NOTE : TO EXPEDITE THE APPROVAL OF APLLICANT(s) KINDLY SUBMIT ALL DOCUMENTS REQUIRED IN SECTION A

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 4pcs / 3pcsSPOUSE 4pcs / 3pcsCHILDREN BELOW 18 YEARS OLD 4pcs / 3pcsCHILDREN BELOW 12 YEARS OLD 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 1pcsSPOUSE 1pcsCHILDREN

NOTE : TO EXPEDITE THE APPROVAL OF APLLICANT(s) KINDLY SUBMIT ALL DOCUMENTS REQUIRED IN SECTION A

MUTUAL AGREEMENT (SOCIAL MEMBERSHIP)

This is a Mutual Agreement made between Mr./ Mdm/ Ms …………………………….. NRIC No…………………………(Applicant for NSGCC’s Social Membership (Class C) of RM3,500.00 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 C shares are as follows:-

(i) an applicant desiring to subscribe for a unit of Class C share is required to

fill up the requisite application form and submit the same together with a remittance of RM1000.00 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 RM2,500.00 shall be payable to the Company by way of ten (10) monthly installments (the installment) of the RM 250.00 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 RM 3,500.00 Amount payable by Applicant upon application RM 1000.00 Proposed monthly installment RM 250.00 per month Number of monthly installments 10 installments

……………………………….. …..……………………………..… APPLICANT’S SIGNATURE SALES & MARKETING DEPT. Name : Date :