I/We Applicant's First Name Last Name, Visit Type of/or registered office, acknowledge myself/ourselves bound to pay the Government the sum of Type money amount Type currency.
Whereas it is a condition of the issue of a Visit Type to me/ Applicant's First Name Last Name of Adress in overseas that there be furnished by me/on behalf of written applicant. Security Bond in the sum RM Rate of Personel Bond as a guarantee that I/the will comply regulations made thereunder and with any conditions imposed in respect of instructions approved on such pass.
Here and now I/we, Supporter's Name, NRIC No Sponsor's NRIC do hereby bind myself that I/said Applicant's First Name Last Name will comply with arrangements imposed in respect of/or instruction approved on such Visit Type Pass and in case of my/the said Applicant's First Name Last Name make default therein. I herewith bind myself to forfeit to the Government the sum of RM Rate of Personal Bond from date this Date atAddress.
Signature and executed by the abovenamed First Name Last Name in Witness's First Name Last Name presence.