Broker Case Submission

Broker Application Form

For case submissions by Brokers
Is this your first time filling up this form?*

YesNo
Broker Name*

First NameLast Name
Brokerage Firm*
Website*
Broker Email*
example@example.com
Contact Number*

Phone Number
Case Information

Details of the client you would like to refer to Choco Up for funding assessment
Company Director Name*

First NameLast Name
Company Name*
Website
Contact Email*
example@example.com
Where is {companyName} incorporated in?*

SingaporeHong KongAustraliaMalaysiaOther
Kindly provide a business overview of {companyName}*
Currency*
How much funding is {companyName} seeking?*
We typically fund 1.0x monthly revenue, minimum SGD 10k
What type of financing is {companyName} looking for?*

Term LoanInvoice FinancingRevolving Credit FacilityMerchant Cash AdvanceOther
Kindly explain the purpose of the funding or use of funds*
e.g. the primary purpose for seeking funds, such as growth or expansion, working capital, equipment purchase, or any other specific purpose
Kindly provide the ACRA for {companyName} and its subsidiaries (if any).

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Please provide details of all bank accounts held by the company. (Insert more bank accounts if needed)*
Kindly provide the last 6 months bank statements for all operating bank accounts of {companyName}

If the business has been operating less than 12 months, please upload all the bank statements you have to date.
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What other non-funding assistance does {companyName} require?*

FX RequirementsCorporate Credit Card (with up to 1.5% Cashback)Employee BenefitsNo assistance requiredOther
Kindly provide the latest CBS report of {companydirectorname}.

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Kindly provide the last 2 years NOA of {companydirectorname}.

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Kindly provide the IC or Passport of {companydirectorname}.

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Kindly upload a copy of {companyName} business card (if any)

Please skip if not applicable.
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Does the Director or the business have any type of loan or credit facilities that are outstanding as at the date of declaration?*

YesNo
If Yes to any of the above, please state the details:*
Kindly provide any other relevant documents for our review (if applicable)

Financials, etc
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I, {brokerEmail}, affirm that I have read and understood the contents of this “Declaration Form” and that I am authorized to provide this information on behalf of {companyName}, and I hereby confirm all information provided in this form is true, accurate, and complete to the best of my knowledge and belief. I understand that any misrepresentation, discrepancy, misstatement, dishonesty or deliberate omission of information may constitute fraud.

I further acknowledge that by submitting this declaration, I am providing consent to Choco Up SG Pte Ltd and its affiliates to verify the information provided and conduct necessary due diligence, including but not limited to any applicable kinds of background checks and verification of legal proceedings.
I/We hereby agree and grant consent to Happy CP MY Sdn Bhd. the (“Company”), and its authorized officers to

conduct any credit, property, litigation, trade, CCRIS, identity, background, compliance risk and/or any other checks and verifications which are relevant to my/our business relationship/credit facility with the Company on me/our company, its directors/ shareholders/ owners/ partners/ guarantors/ individuals/ party/ providing securities with Credit Bureau Malaysia and/or any registered credit reporting agencies under Credit Reporting Agencies (CRA) Act 2010 at any time, for as long as such business relationship/credit facility continues to exist and/or where any dues owed to the Company remain unpaid and outstanding;
disclose my/our information including trade/account conduct to Credit Bureau Malaysia and/or any registered credit reporting agencies.
I/we also hereby grant consent to Credit Bureau Malaysia & any other relevant registered credit reporting agencies under the CRA Act 2010 to:

procure my/our CCRIS and any other credit information from relevant data sources;
assess, use and disclose credit information relating to me/our company (including its directors/its shareholders/owners/ partners/ guarantors/ individuals/ party providing securities to the Company) to Credit Bureau Malaysia, to the Company, other subscribers of Credit Bureau Malaysia and other persons/parties as and when the services of the credit reporting agency/ies is/are used for purposes mentioned above and for other purposes to the extent permitted by the applicable laws, regulations and/or regulatory requirements;
share any of trade information/ account conduct as mentioned in clause (b) above to other subscribers of their services;
transfer and disclose any credit information relating to me/our company, its directors/ its shareholders/ owners/ partners/ guarantors/ individuals/ party/ providing securities to relevant third parties and/or data processor either located within or places outside Malaysia when required.
I/We agree that:

consent wherever mentioned in this letter is irrevocable and shall continue to be valid to the extent it remains consistent with any changes in law and for as long as there is an existing business relationship/ credit facility/ any due remain outstanding with the Company;
the database of Credit Bureau Malaysia & the relevant registered credit reporting agency/ies may retain credit and trade information relating to me/us as long as it is consistent with applicable laws, regulations, regulatory requirements and any changes thereto;
Credit Bureau Malaysia & the relevant credit reporting agency/ies, its respective directors, officers, members, servants or agents are absolved and held harmless from all liability however arising from the abovementioned consent, the exercise of any/all activity stated above by Credit Bureau Malaysia & the relevant credit reporting agency/ies and the subsequent disclosure of any information relating to me/us for the purposes mentioned above.
Should be Empty:

Broker Application Form

Case Information