Financial Hardship Assistance Application

Financial Hardship Assistance Application

CrediBill is committed to supporting clients facing genuine financial difficulty. Please complete this form to apply for financial hardship assistance. We will acknowledge your application in writing no later than the next business day, and communicate our decision within 30 calendar days of that acknowledgement.
SECTION A – Applicant Details
Registered Company Name
e.g., ABC Sdn Bhd
Trading Name (if any)
e.g., ABC Coffee
Company Registration No. (Old)
e.g., 0383123D
Company Registration No. (New)
e.g., 199701010123
SECTION B – Nature of Financial Hardship
For critical illness, critical injury or non-voluntary loss of income, these must personally affect the individual(s) responsible for the business's repayment.
Date the hardship circumstance arose

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Nature of Financial Hardship
If Other reasonable cause, please specify
How does this hardship affect your ability to repay?
Supporting documents for your hardship

Upload official documents that support the hardship you selected, such as a medical report, death certificate or termination letter.
Cancelof
Bank statements from the past three (3) months

Cancelof
SECTION C – Requested Assistance
Type of relief requested

Other
If Other, please specify
Proposed affordable repayment amount (RM)
Additional supporting information
SECTION E – Declaration & Consent
Declaration
E-signature
Signer's Full Name
Signer's NRIC No.
Signer's Designation
Signer's Email Address
example@example.com
Signer's Mobile No.
Date of submission

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Signer's Residential/Office Address

Street Address

Street Address Line 2

CityState

PostcodeCountry
Should be Empty:

Financial Hardship Assistance Application

SECTION A – Applicant Details

SECTION B – Nature of Financial Hardship

SECTION C – Requested Assistance

SECTION E – Declaration & Consent