Application form – Golf & Country Club at Nilai Springs Resort Hotel

CLASS ‘B’ SHARE FULL GOLF MEMBERSHIP *

Individual: RM 14,375+
Corporate: RM 40,000 + (2 Nominees only)

CLASS ‘C’ SHARE SPORTS MEMBERSHIP *

Individual: RM 3,500+

TERM FULL GOLF MEMBERSHIP *

Individual: RM 3,625+

TERM SPORTS MEMBERSHIP *

Individual: RM 1,979.60+

Personal Particulars

Full Name Of Applicant *

( As in NRIC/Passport, underline surname ) *MR/MRS/MS/MDM.

NRIC / Passport Number *

Date Of Birth *

Race *

Occupation *

Nationality *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Club Your of

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mobile Phone No *

Residence Phone No *

Maritial Status *

Email *

Model *

Reg No *

Business / Employment Particulars

Name Of Business / Employer *

Nature of Business *

Office Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Office Tel No *

Fax No *

Type of Sector *

Govt
Private
Own BSNE
Other

Family Particulars

Name of Spouse *

NRIC / Passport Number *

Date of Birth *

Occupation of Spouse *

Office Mobile No *

Children Particulars

Name *

Gender ( M / F ) *

Date of Birth (DD/MM/YY) *

NRIC / Passport No *

Miscellaneous Particulars

Name Of Club *

Since When (DD/MM/YY) *

Current H/CAP *

Your Name *

Please write within the boxes provided the name as it should appear on the memberships card

Spouse's Name *

Miscellaneous Particulars. Please write within the boxes provided the name as it should appear on the memberships card

Corporate Particulars

*This part to be filled by Corporate Applicant only

Name of Company *

Address of Company *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Nature of Business *

Place of Incorporation *

Tel No *

Date of Incorporation *

Designated Executive(s) authorised to hold the Corporate Nomination are as follows:

Designation Executive Information

Name of Nominee *

Designation *

Document to Submit

1) Please complete all section on PERSONAL PARTICULARS.
2) For corporate nominees , please provide all particulars on separate sheet for second nominee.
3) Please attach photocopy/images of NRIC ( both sides ) of applicant only. (Maximum 2MB)*

Click or drag a file to this area to upload.

4) Please submit passport size photograph of applicant, spouse and children below the age of 18 years old.
5) Please submit photocopy/images of marriage certificate and Birth certificate of your immediate family members. (Maximum 2MB)

Remittance

NOTE : Please make cheque payable to NILAI SPRINGS BHD.

DECLARATION

1) I/We the undersigned, hereby declare that the particulars given are true to my / our knowledge and belief.
2) I/We agree that if my /our application is successful, NILAI SPRINGS BHD, will within thirty ( 30 ) days from the date of applicant inform me / us of the acceptance.
3) I/We agree that in any event my / our application in unsuccessful, any monies paid by me / us shall be refundable to me without interest.
4) I/We agree to pay by installment scheme of the allotment price as stipulated in the prospect us on procedure and payment term by signing the Mutual Agreement as acceptance.
5) I/We also agree to pay in addition to the respective Subscription Price, the monthly subscription and refundable security deposit at the date to be determined by NILAI SPRINGS BHD to activate my/our operating account with the Club Rules, Regulations and By-Laws.
6) I/We hereby declare and agree that the declaration set out herein shall be taken, read and construed as an essential part of membership issued to me / us, on the event that my / our application is approved by NILAI SPRINGS BHD.
7) I/We the undersigned, hereby give my / our consent to NILAI SPRINGS BHD to process my / our personal data. By this consent, I/We understand and agreed that NILAI SPRINGS BHD may conduct reference checks on me / us with any business entity / ies for bona fide trade checking now or any future time for the purposes of opening new member account, credit / account evaluation,review, monitoring debt recovering purpose and / or legal documentation

Consent *

I have read the Declaration and agreed to it

Captcha *

What is 13+4?

NILAI SPRINGS GOLF & COUNTRY CLUB OFFERS GOLF & SPORTS MEMBERSHIP FOR INDIVIDUAL & CORPORATE COMPANIES. WE OFFER LIFETIME MEMBERSHIP WHICH IS TRANSFERABLE AND TERM MEMBERSHIP WHICH IS RENEWABLE ON A YEARLY BASIS

Personal Particulars

Business / Employment Particulars

Family Particulars

Children Particulars

Miscellaneous Particulars

Corporate Particulars

Designation Executive Information

Document to Submit

Remittance

DECLARATION