Muamalat Kawasaki & Modenas Lead Generator Program

Customer Name

Name as per MyKad

Customer MyKad Number

without (-)

Customer Mobile Number

Customer Email Address

Financing Amount

Customer Preferred Branch

Dealer Name

Dealer ID

Dealer Mobile Number

Dealer Email Address

Vehicle Sales Order (VSO)

Please attached VSO

Declaration

I hereby declared that I have secured the necessary authorization to disclose his/ her information to Bank Muamalat Malaysia Berhad under the Collaboration With Modenas & Kawasaki Dealers on Lead Generator Program