Personal Information
Applicant's Name (required)
Correspondence (required)
NRIC No. (required)
Address (required)
City (required)
State (required)
Postal Code (required)
Country (required)
Phone No. (required)
Mobile No. (required)
Marital Status (required)
Spouse Name (required)
Spouse Occupation (required)
Total No. Of Dependants (required)
Employment/Business Experience
Position(required)
Company (required)
Address(required)
Postcode (required)
Annual Income (required)
Location Preferences
Independent Shop Lot/ Shopping Mall (Name the Shopping Mall) 1 (required)
Independent Shop Lot/ Shopping Mall (Name the Shopping Mall) 2 (required)
Independent Shop Lot/ Shopping Mall (Name the Shopping Mall) 3 (required)
Do you plan to have equity partners? (required) YesNo
If YES, complete the following:
Name of Partner
Relationship
Address
City
State
Postal Code
Country
Phone No.
Mobile No.
Schedule A - Financial (Cash On Hand And In Bank) *Kindly attached the documents
Name Of Bank/ Financial Institute (required)
Amount (required)
Name Of Bank/ Financial Institute
Amount
Schedule B - Cash Value of Life Insurance
Name of Insurance Company (required)
Face Amount (required)
Cash Value (required)
Name of Insurance Company
Face Amount
Cash Value
Schedule C - Real Estate Owned
Description of Property (required)
Name on Title (required)
Cost (required)
Market Value (required)
Balance Owed (required)
Mortgage Holder (required)
Description of Property
Name on Title
Cost
Market Value
Balance Owed
Mortgage Holder
Schedule D - Liabilities
Description of Liabilities (required)
Total Amount (required)
Years Left to Service (required)
Monthly Amount to Service (required)
Joint Guarantee with Others? (Yes/No) (required)
Description of Liabilities
Total Amount
Years Left to Service
Monthly Amount to Service
Joint Guarantee with Others? (Yes/No)
References
List three (3) Professional References you have known at least 5 years (Do not include relatives).
Name (required)
Relationship (required)
Contact No. (required)
I understand that the granting of franchise is at the sole discretion of Crab Factory (Paca Consulting Sdn Bhd).
I understand that I and/or representatives will have to be successfully complete Crab Factory's training program and competent to operate prior to the start of business operations.
I have read this application and everything I have stated in it is true. I understand that Crab Factory, in granting me as a licensee, will rely upon the information provided by me.
Authorised Signature (required)
Please fill up your Identification Number (I.C) No. for the Authorised Signature Portion
Print Name (required)
Your Email (required)
Date (required)
I hereby authorise Crab Factory, its agent and all credit agencies, educational institutions, corporations, current and former employers, law enforcement and government agencies, city state, country and federal courts, military services and persons to release any information they may have about me to the company with which this has been field, or their agent.
I release Crab Factory and/or its agents and any person or entity which provided information pursuant to this information, from any and all liabilities, claims or lawsuits in regards to the information obtained from any and all referenced sources used.
Applicant Signature (required)
Please fill up your Identification Number (I.C) No. for the Applicant Signature Portion
