Application Form for Appointment of Associate

Under Financial Services Act 2013 and Islamic Financial Services Act 2013

PERSONAL PARTICULARS OF APPOINTEE
Qualification Year Obtained
1 PCE Either / Or
2 CEILLI Either / Or
3 TBE Either / Or
4 RFP
5 Syariah RFP
6 CFP
7 IFP
8 Diploma
9 Degree
10 Others
11 Others
12 Others
Institution Position Country Duration
to
to
to
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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?

Has the applicant ever been TERMINATED as an associate in Capspring Temasik before?

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 RM100 monthly as business fees that covers email, IT portal usage, all office related costs and RM500k professional indemnity fees. This will however be refunded if I achieve RM7,500 monthly on my total annualised production across all classes of business.
2 Failure to pay the monthly business fees will result in AUTO TERMINATION 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, PCE, CEILLI, TBE,RFP/CFP, highest education certificate and prove of previous year personal production if above RM100k.
  2. Bank in slip for the following :- RM100 first month business fees, RM60 - (name card 3 boxes), RM53 - Mitraland card access (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.
DECLARATIONS BY APPOINTEE
  1. I am not disqualified under the Financial Services Act 2013/ Islamic Financial Services Act 2013. In addition, to the best of my knowledge and belief there are no bankruptcy proceedings being initiated against me at present and I have never been declared a bankrupt by any competent authority to do so within or outside Malaysia;
  2. I have complied with the minimum criteria of 'A Fit and Proper Person' prescribed under the the Financial Services Act 2013/ Islamic Financial Services Act 2013 for my appointment as an Associate of a licensed institution or regulated entity under the Financial Services Act 2013/ Islamic Financial Services Act 2013; I have complied with the minimum criteria of 'A Fit and Proper Person' prescribed under the the Financial Services Act 2013/ Islamic Financial Services Act 2013 for my appointment as an Associate of a licensed institution or regulated entity under the Financial Services Act 2013/ Islamic Financial Services Act 2013;
  3. To the best of my knowledge and belief, I am not aware of any actions taken by me that may result in myself becoming disqualified or not complying with the 'Fit and Proper' criteria under the Financial Services Act 2013/ Islamic Financial Services Act 2013.
  4. I have :
  5. All the information submitted in this form is true 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