This document is a cheque cancellation requisition form used to request cancellation of a cheque. It collects information about the cheque such as the cheque number, payee, date, and amount. It also requires the participant or agent requesting cancellation to provide a reason by ticking applicable options such as claims, refunds, or contribution applications. Finally, it provides notes that no official receipt will be issued for cancelled cheques and that any related forms must be attached when returning the cheque.

1. CHEQUE CANCELLATION REQUISITION FORM/ BORANG PERMINTAAN PEMBATALAN CEK
Form ID 61501011
Cheque Details/ Butir-butir Cek
Transaction Details/ Butir-butir Urusan
TOTAL/ JUMLAH PENUH
Amount/ Jumlah (RM)
Certificate Number/ Nombor Sijil : __________________________ Cheque No./ Nombor Cek : _____________________
Payee/ Penerima Bayaran : __________________________ Cheque Date/ Tarikh Cek : _____________________
Branch/ Cawangan : __________________________ Amount/ Jumlah : _____________________
Reason : Please tick () where apply. / Sebab : Sila tandakan () dimana terpakai.
Claims/ Tuntutan
Please utilise for/ Sila gunakan untuk:
Contribution Application/ Permohonan Caruman
Endorsement (Suspense A/C)/ Endorsan (Akaun Tangguh)
Revival (Suspense A/C)/ Pemulihan (Akaun Tangguh)
1st
Modal Contribution (Suspense A/C)/ Caruman Modal Pertama (Akaun Tangguh)
Others (Please Specify)/ Lain-lain (Sila Nyatakan)
Note:
Signature / Tandatangan :
(Participant/ Peserta)
Agent/ Ejen :
Code/ Kod :
Office/ Pejabat :
Name/ Nama :
Date/ Tarikh) :
Certificate/ Proposal No./ Nombor Sijil/ Cadangan: _______________ Certificate Status/ Taraf Sijil: ___________________
Participant/ Peserta: _______________________________________ Contact No./ Nombor Hubungan: _________________
Refunds/ Pulangan
Others/ Lain-lain _________________________________
.......................................................................................................................................................................................................
No official receipt will be issued./ Resit rasmi tidak akan dikeluarkan.
Balance of payment must be paid together with the returned cheque./ Baki bayaran mestilah dibayar bersama-sama dengan cek yang dikembalikan.
Endorsement/Revival forms should be attached together with the returned cheque./ Borang Endorsan /Pemulihan sepatutnya dilampirkan
bersama-sama dengan cek yang dipulangkan.
Branches Use Only/ Kegunaan Cawangan Sahaja:
Date/ Tarikh:
Branch/ Cawangan:
Office Use Only/ Kegunaan Pejabat Sahaja:
Authorised Signature/ Company Stamp
Tandatangan yang Ditauliahkan/ Cap Syarikat: