Application Form for Appointment of Financial Adviser's Representative

Under Financial Services Act 2013 and Islamic Financial Services Act 2013

PERSONAL PARTICULARS OF APPOINTEE (NEW & EXISTING FINANCIAL ADVISER REPRESENTATIVE)
Qualification Year Obtained
1 RFP
2 Syariah RFP
3 CFP
4 IFP
Academic Qualification Awarded By Country Year Obtained
Institution Position Country Duration
to
to
to
to
to

Has the applicant ever been REGISTERED as an agent with the Life Insurance Association of Malaysia, General Insurance Association of Malaysia or any Investment company?


Has the applicant ever been TERMINATED as an agent with any companies?

For purposes of commission, fees or allowances payment
Name of Bank Account Nos Name of Account holder
Name IC Nos / Passport Nos Contact Nos
Relationship Address
Tick
1 I understand that I will need to pay RM200 monthly as business fees that covers personal portal usage, all office related costs and professional indemnity fees. This will however be refunded if I achieve RM15,000 monthly on my total annualised production for all classes of business.
2 Failure to pay the monthly business fees will result in auto suspension of above and will only be reinstated when all outstanding monthly business fees have been paid in full.
3 Failure to close above RM5,000 ANP within three months upon joining will result in auto termination.
  1. Please prepare the following :- a copy of Identity Card (front and back) marked "For Bank Negara Malaysia use",passport photo, RFP/CFP, Syariah RFP. IFP, highest education certificate, CTOS report, Bankruptcy search report, 1 passport size photo
  2. Bank in slip for the following :- RM200 first month business fees, RM60 - (name card 3 boxes), RM53 - Mitraland card access (KL only, refundable). Please transfer to
    Company Name
    : Capspring Temasik Financial Group Sdn Bhd
    Bank Account No
    : 5642-7650-8950 (Maybank)
  3. Upon approval, a copy of the associate agreement will be emailed to you. Kindly print out, sign off and send back to us.
File size should not exceed 8MB.
STATUTORY DECLARATIONS BY FAR
  1. I am not disqualified under section 59(1) of the Financial Services Act 2013 (FSA) and/or section 68(1) of the Islamic Financial Services Act 2013 (IFSA) whereby:
    • I am not an undischarged bankrupt, I do not have any suspended payments and I have not compounded with my creditors, whether within or outside Malaysia. To my knowledge, there is no bankruptcy proceeding being initiated against me at present;
    • I do not have any charge proven against me for a criminal offence relating to dishonesty or fraud under any written law or the law of any country, territory or place outside Malaysia;
    • I am not prohibited from being a director of a company or in any way, whether directly or indirectly, be concerned or take part in the management of a company in Malaysia pursuant to a court order made under section 130A of the Companies Act 1965 and have not obtained any leave of the court under the same section; and
    • Under any law relating to prevention of crime, drug trafficking or immigration:-
      • There has not been any order of detention, supervision, or deportation made against me; and
      • There has not been any form of restriction or supervision by bond or otherwise, imposed on.
    (Tick whichever applicable. If (ii) is selected, please provide details, i.e. name of supervisory authority, reasons and amount of penalty, in a separate attachment)
  3. I understand that in my tenor as the FAR of Capspring Temasik Financial Group Sdn Bhd     I shall not:
    • engage in any activities or practices that would result in conflict of interest and will disclose any conflicts which may impair the objectivity and integrity of Capspring Temasik Financial Group Sdn Bhd
    • hold any directorship in an insurer or a takaful operator or registered as an insurance or takaful agent; and
    • hold any shares in an insurer or a takaful operator or own an insurance or a takaful agency.
  4. All the information submitted in this form and in any attached annexure (if any) is true, correct and complete;

AND I MAKE THIS SOLEMN DECLARATION CONSCIENTIOUSLY BELIEVING THE SAME TO BE TRUE, AND BY VIRTUE OF THE PROVISIONS OF THE STATUTORY DECLARATIONS ACT 1960.


Additional Information Business Readiness
Year 1 Year 2 Year 3
Growing your team
Total numbers to recruit*
Nos of active advisers in your team*
Growing your sales
Gross Premium (RM)*
Year 1 Year 2 Year 3
Life*
Takaful*
General Insurance*
Employee Benefits*
Investment - Offshore*
Investment - Local Unit Trust*
Bereavement*
Housing Loan*
Total
Financial Readiness
Monthly financial commitment of Understand (Pls tick)
Associate RM100 (to be waived upon achieving RM7,500 ANP monthly)
Adviser RM200 (to be waived upon achieving RM15,000 ANP monthly)
Operational Readiness
Adoption of the following social media in conducting their business Do you have (pls tick)
Facebook
Instagram
TikTok
Whatsapps
Regulatory Readiness
Pass the exam within 24 months of joining Pls tick one
Certified Financial Planning (CFP)
Islamic Financial Planning (IFP)
Registered Financial Planning (RFP)
Syariah Registered Financial Planning (ShrRFP)
Emotional Readiness
You are doing this to Agree (Y/N)?
have a better life for your family
grow your career & income
offer better solutions to your clients
You will face initial challenge arising from Understand (Y/N)?
unfamiliar practises by different insurers
explosion of information from different channels and insurers
rejection from friends from present insurer