1593423757 s:23194:"

GREAT CASA REALTY SDN BHDE(1)1688

CLAIM FORM

Date:

LOR/LOS:

Property Address:

Selling Price/Rental:

RM

Payment Received:

1)

RM

Ref. No:

TOTAL RECEIVED:

RM

(-) Payment to Owner:

RM

Name:

NRIC:

(-) Bal. to Purchaser:

RM

Name:

NRIC:

(-) External Co-Broke:

RM

Name:

Co.Reg:

GROSS RECEIVED:

RM

(-) Referral Fees:

RM

Name:

NRIC:

(-) G.S.T(6%):

RM

Owner Agent Cobroke

NET COMMISSION:

RM

Total Negotiator Comm.:

RM

Negotiator Comm:

%

RM

Name:

Negotiator Bonus:

%

RM

Name:

Premier Leader O/R:

%

RM

Name:

Ex Premier Leader O/R:

%

RM

Name:

Ex Premier Leader O/R:

%

RM

Name:

Type of claim

CHECK LIST:

Undertaking Letter

Letter of Consent

Termination Letter

Others :

Name

Date

Initial

Prepared & Checked by Branch Account

Approved by Branch Head

Remark:

";