Dealer Recruitment Form

Application Criteria:

Personal Particulars

Please upload recent passport-sized photograph of yourself here:

Name:

Address:

Postcode:

City:

State:

Mobile No:

Email:

Gender:

Race:

NRIC:

Date of Birth:

Current Age:

Place of Birth:

Marital Status:

No of Children:

Spouse Details

Spouse Full Name:

NRIC:

Occupation:

Monthly Income:

Business Location Area
(preferred state location)

Location 1:

Location 2:

Location 3:

Are you willing to relocate?:
YesNo

Working / Business Experience

Experience 1

Name & Address of Current Employer / Business:

Position / Title:

Monthly Income:

Year of Experience:

Experience 2

Name & Address of Current Employer / Business:

Position / Title:

Monthly Income:

Year of Experience:

Experience 3

Name & Address of Current Employer / Business:

Position / Title:

Monthly Income:

Year of Experience:

1. Experience in service station operation?
YesNo

2. Experience in automotive service?
YesNo

3. Have you applied for any petrol station dealership before? BHPetrol / Others:
YesNo

4. Do you or your family members own, manage, or operate any petrol station business?
YesNo

If Yes, please state which petrol station business?

Qualification

Education
DegreeMasterOthers

If others, please specify:

Language

Bahasa Malaysia:
FairGoodExcellent

English:
FairGoodExcellent

Financial Standing

A. Saving Account

Value (in RM & Cents):

Bank / Financial Company:

B. Current Account

Value (in RM & Cents):

Bank / Financial Company:

C. Fixed Deposit Account

Value (in RM & Cents):

Bank / Financial Company:

D. ASN / ASB / ASM

Value (in RM & Cents):

Bank / Financial Company:

E. Sale of House & Car

Value (in RM & Cents):

F. Shares

G. Other Financial Sources

Real Estate

A. Land - (if any)

In Name of:

Address:

Assessed Value (RM):

Year Purchased:

Encumbrances Charges (RM):

Amount Owing (RM):

B. Residential Real Estate - (if any)

In Name of:

Address:

Assessed Value (RM):

Year Purchased:

Encumbrances Charges (RM):

Amount Owing (RM):

C. Commercial Real Estate - (if any)

In Name of:

Address:

Assessed Value (RM):

Year Purchased:

Encumbrances Charges (RM):

Amount Owing (RM):

Finance

1. How much working capital do you plan to invest in this business? (RM):

2. How do you propose to raise the above funds (Please submit documentary evidence)?

a. Fixed Deposit (RM):

b. Current Account (RM):

c. Saving Account (RM):

d. Stocks & Shares (RM):

e. Bank Loan (RM):

f. Overdraft Facilities (RM):

Business Structure

Do you agree to run the service station on a sole proprietorship basis?:
YesNo

Please specify the business name and business structure under which you will operate the station:

Station Operation

1. Why do you choose to be in the petrol station business?:

2. How much time would you spend at the station daily?:

3. How will you manage the station when you are not at the station? Who will stand in for you?:

4. Aside from a competitive salary, what else would you do to ensure that your staff committed and motivated to do the job?:

5. How will your spouse / family be assisting you in the business?:

6. What training do you need to run the station effectively?:

7. What other services do you wish to offer at the station?:

Convenience Retailing

1. What do you know about convenience store operations?:

2. How would you plan to manage the store efficiently and profitability?:

3. What is your expectation on sales and profit from the convenience store business?:

4. What would you personally do to promote sales from your convenience store?:

Cards and E-Payment

1. What role does credit card and e-payment play in the station business?:

2. How would increasing credit card and e – payment usage affects your business?:

3. How do you plan to control cash, cards and e-payment acceptance at your station to minimize losses?:

Profit

1. How much do you think would be a fair monthly net return for this business venture? (RM):

2. What would you do if your actual income from the business does not meet your expectations?:

3. What percentage of your profit from this business venture do you intend to reinvest back into this business?:

Declaration

I understand that the operation of a BHPetrol service station must be in compliance with laws, regulations and the Company’s prescribed standards, policies & guidelines;I am not an employee of BHPetrol, neither are any of my family members employees of BHPetrol;I have never been declared a bankrupt;I have never been convicted of any criminal offense;I shall abide by all standards requirements related to this application as specified in the Company’s retailer recruitment processI have not offered any inducement to any BHPetrol employee for favorable consideration of my application or future appointmentI declare that I am a Government Official

“Government Officials” means any official or employee of any government, or any agency, ministry, department of a government (at any level), person acting in an official capacity for a government regardless of rank or position, official or employee of a company wholly or partially controlled by a government, political party and any official of a political party; candidate for political office.

Supporting Document

I attach herewith the supporting documents as required by the Company;
Evidence of previous two years’ income returns, e.g Form J or equivalent

Proof of financial standing: bank statements / share certificates / property titles / ASB-ASN certificate, etc

Medical history report (if there has been a major illness)

I confirm that the information I rendered above is true, complete, and accurate to the best of my knowledge. I understand and accept that should any information herewith declared be false or untrue, the Company shall have the right to cancel or terminate any license, products supply etc, if any, made to me.

Consent of PDPA 2010

To:
BOUSTEAD PETROLEUM MARKETING SDN BHD (5783-T)
Level 15, Surian Tower, No. 1,
Jalan PJU 7/3, Mutiara Damansara,
47810 Petaling Jaya,
Selangor Darul Ehsan

Re: PERSONAL DATA PROTECTION ACT 2010 – LETTER OF CONSENT

I acknowledge that:-

during the course of business, specifically (but not limited to) in relation to the Service Station Supply and Licence Agreement and the dealership granted pursuant thereto you will be required to request from or provide to other parties my personal data/information relating to me and my property(ies) whether or not to assess my credit worthiness and or my general back ground for purposes stated in your Privacy Notice which we note can be viewed at www.bhpetrol.com.my/private.html. Such information is collected, used and processed for purposes of this matter and accordingly, you are authorised to provide to or request from other parties my personal data/information relating to me and or my property(ies);
you may disclose or use any information and documents in the ordinary course of business.
unless I notify you to the contrary in writing, you may disclose and use information and documents about me in the ordinary course of business; and
by signing this letter, I consent to your use of my personal data as envisaged pursuant to the Personal Data Protection Act 2010.

Dealer Recruitment Form