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Online Financing Application (Pre-Screening and Customer Segmentation Questionnaire)
Kindly fill up the form with much detail as possible, including your contact information for subsequent correspondence. Thank you.
 
  Name*
  MyKad No. / Passport No. without ' - '
  Contact Number without ' - '
  Email Address*
  Classification*
  Business Unit
  Your Comments*
  Company Name*
  Company / Business Registration No.*
  Products / Services*
  Nature of Business*
  No. of Years in Business*
  Latest Audited Annual Sales Turnover (RM)* Year*
  No. of Full Times Employees*
  Paid-Up Capital (RM)*
  Retained Profit / (Accumulated Losses) (RM)*
  Business Address*
  Postcode*
  State*
  Type of Financing Required*
  Cost of Item to be Financed*
 
 

Verification Code*
(Please re-type the following letters)

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How did you get to know about MIDF?  
   
From seminar/talk/exhibition From business associates/friends
From MIDF Promotional Letter Call from MIDF Officer
From printed advertisement
(Please state the media) :
Others
(Please indicate,
example : MIDF Website,
MIDF Facebook pages) :
   
 
 
 

Check the status of an existing ticket*
Ticket tracking ID: Email Address :