Please complete the following to authorize for Gold Gram transfer to a third party's GAP account.
| Applicant Name : |
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File: /var/www/pajak_gadai/application/views/pajakgadai/cust_agreement_01.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/index.php |
| PG Code : |
A PHP Error was encounteredSeverity: Notice Message: Undefined variable: customer Filename: pajakgadai/cust_agreement_01.php Line Number: 29 Backtrace:
File: /var/www/pajak_gadai/application/views/pajakgadai/cust_agreement_01.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/index.php |
| NRIC / Police / Army / Passport / Company No : |
A PHP Error was encounteredSeverity: Notice Message: Undefined variable: customer Filename: pajakgadai/cust_agreement_01.php Line Number: 33 Backtrace:
File: /var/www/pajak_gadai/application/views/pajakgadai/cust_agreement_01.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/index.php |
| Mobile No : |
A PHP Error was encounteredSeverity: Notice Message: Undefined variable: customer Filename: pajakgadai/cust_agreement_01.php Line Number: 37 Backtrace:
File: /var/www/pajak_gadai/application/views/pajakgadai/cust_agreement_01.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/index.php |
| Email Address : |
A PHP Error was encounteredSeverity: Notice Message: Undefined variable: customer Filename: pajakgadai/cust_agreement_01.php Line Number: 41 Backtrace:
File: /var/www/pajak_gadai/application/views/pajakgadai/cust_agreement_01.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/index.php |
| Quantity (Gram) : |
A PHP Error was encounteredSeverity: Notice Message: Undefined variable: customer Filename: pajakgadai/cust_agreement_01.php Line Number: 45 Backtrace:
File: /var/www/pajak_gadai/application/views/pajakgadai/cust_agreement_01.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/index.php |
| Recipient Name : | AR RAHNU @ KOPERASI DAGANG EMAS PULAU PINANG BERHAD |
| Recipient PG Code : | PG00352206 |
By signing this GAP Gold Gram Transfer Authorization, you authorize the disclosure of your account information on a statement and the transfer of Gold Gram from your GAP accounts at Public Gold Marketing Sdn Bhd to the third party account listed above. Public Gold Marketing Sdn Bhd reserves the right in its sole discretion to refuse the application. Public Gold Marketing Sdn Bhd will not be liable for any damages or losses of whatsoever nature arising out of due to this instruction and you hereby expressly indemnify Public Gold Marketing Sdn Bhd and hold Public Gold Marketing Sdn Bhd harmless against any claim of whatsoever nature arising out of or in connection with the transfer.
| Signature of the applicant |
|
| Date (DD/MM/YY) |
A PHP Error was encounteredSeverity: Notice Message: Undefined variable: customer Filename: pajakgadai/cust_agreement_01.php Line Number: 85 Backtrace:
File: /var/www/pajak_gadai/application/views/pajakgadai/cust_agreement_01.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/index.php |
For Office Use Only :
| Service Branch |
A PHP Error was encounteredSeverity: Notice Message: Undefined variable: customer Filename: pajakgadai/cust_agreement_01.php Line Number: 97 Backtrace:
File: /var/www/pajak_gadai/application/views/pajakgadai/cust_agreement_01.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/index.php |
| Person in charge | |
| Status | Approved / Rejected |
| Date (DD/MM/YY) |
A PHP Error was encounteredSeverity: Notice Message: Undefined variable: customer Filename: pajakgadai/cust_agreement_01.php Line Number: 109 Backtrace:
File: /var/www/pajak_gadai/application/views/pajakgadai/cust_agreement_01.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/application/controllers/Pajakgadai.php
File: /var/www/pajak_gadai/index.php |
| Manager Approval |