Section 1: Personal Details
For Ease of future reference please provide as much information as possible (All info provided will be strictly confidential)

Normal Corporate
(Company/Sole Proprietorship/Partnership or Society/Association/Clubs etc - Pse attach Form 9 & 49 or other relevant Forms & Board/Committee Resolution)

 Tan Sri  Puan Sri  Datuk  Datin
 Dr.  Ir.  Mr.  Mrs.
 Ms.  Mdm.



male female







Residential Address






Billing Address






Office Address






Payment Details

 Credit Card  Cheque  Cash
Clients are advised to pay using cross cheques or Bankers Drafts made payable to:

HSJ Dhaliwal Sdn Bhd
Hong Leong Bank Account No 06300072505

Alternatively clients who would like to pay by Credit Card may drop by at our office.
Optional

 Below 10K  10K - 30K  31K - 50K
 51K - 80K  80K Above
 
Section 2: Next of kin's contact details
Next of kin, in case of emergency


male female









 
Section 3: Choose Your Box
Box Sizes Available. Please Tick Your Preferred Choice (You may make more than one choice)
 Royal 1 5" x 5" x 23"  Royal 1A 3" x 5" x 23"
 Royal 2 3" x 10" x 23"  Royal 3 5" x 10" x 23"
 Royal 4 10" x 10" x 23"

If you have not chosen your favourite box number, view the layout of our vault here >
 
Section 4: For Our Reference
For our record purposes - How did you come to know about us:
 Friend  Internet  Own  Brochure
 Informed by another bank  Advertisement




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