SuppCd Bk - Maybank

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information to Bank Negara Malaysia regarding my/our credit facilities ... Office / Pejabat. Residential Address / Alamat Kediaman. NRIC No. / Passport No.

Please complete this form in BLOCK LETTERS / Sila isikan borang ini dengan menggunakan HURUF BESAR FOR BANK STAFF USE / UNTUK KEGUNAAN BANK Branch : Date Received : A / A No. : CIF No. : Campaign Code :

Supplementary Card Application Form / Borang Permohonan Kad Tambahan ü For additional supplementary credit card applications, you can make photocopies of the form or get more forms from your nearest Maybank branch. ü6XSSOHPHQWDU\&DUGDSSOLFDQWPXVWEHƇƎ\HDUVRIDJHDQGDERYH ü3OHDVHHQFORVHDFRS\RIVXSSOHPHQWDU\DSSOLFDQWõV15,& ERWKVLGHV  or passport. ü$SSURYDOLVVXEMHFWWRWKH%DQNõVFUHGLWDVVHVVPHQWDQGWKH%DQNLVQRW obligated to disclose reasons for rejecting an application. ü 8QWXN SHUPRKRQDQ WDPEDKDQ DQGD EROHK PHPEXDW VDOLQDQ IRWRNRSL DWDXGDSDWNDQERUDQJERUDQJGLFDZDQJDQ0D\EDQN\DQJEHUKDPSLUDQ ü 3HPRKRQ.DG7DPEDKDQPHVWLODKEHUXPXUƇƎWDKXQNHDWDV ü 6LOD VHUWDNDQ VDOLQDQ .DG 3HQJHQDODQ SHPRKRQ .DG 7DPEDKDQ GHSDQ GDQEHODNDQJ DWDXSDVSRUW ü .HOXOXVDQ DGDODK WHUWDNOXN NHSDGD SHPHULNVDDQ NUHGLW %DQN GDQ %DQN EHUKDNXQWXNWLGDNPHQJHPXNDNDQDODVDQXQWXNSHQRODNDQ

Supplementary Card / Kad Tambahan 6XSSOHPHQWDU\&DUGPHPEHUPXVWEHƇƎ\HDUVROGDQGDERYHƅ $KOL.DG7DPEDKDQPHVWLODKEHUXVLDƇƎWDKXQNHDWDV Salutation / Gelaran Mr / Encik Mrs / Puan Ms / Cik Others / Lain-lain (Please specify / Sila nyatakan) Gender / Jantina Male / Lelaki Female / 3HUHPSXDQ Name to appear on card / 1DPDXQWXNGLFHWDNSDGDNDG 0D[LPXPƇƏFKDUDFWHUVƅ7LGDNPHOHELKLƇƏKXUXI

Note: Delivery of cards by courier is currently applicable to Penisular Malaysia, Sabah and Sarawak, except to P.O.Box addresses / 1RWD 3HQJKDQWDUDQ .DG PHODOXL NXULHU EROHK GLODNXNDQ XQWXN 6HPHQDQMXQJ 0DOD\VLD6DEDKGDQ6DUDZDNPHODLQNDQDODPDWSHWLVXUDW

Annual Income / 3HQGDSDWDQ7DKXQDQ50 Designation / -DZDWDQ

-

Date of Birth / 7DULNK/DKLU

Monthly Bill /Bil Bulanan

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Residential Address / Alamat Kediaman

City / Bandar

State / Negeri

House Tel. No. / 1R7HO5XPDK HP No. / 1R7HO%LPELW Email / E-Mel

HP No. / 1R7HO%LPELW

Separate statement - Supplementary Cardmember will be sent a personal statement. / 3HQ\DWDEHUDVLQJDQ$KOL.DG7DPEDKDQDNDQ PHQHULPDSHQ\DWDQ\DVHQGLUL Duplicate statement - Supplementary Cardmember will be sent a personal statement with a copy sent to Principal Cardmember. / Penyata 6DOLQDQ$KOL.DG7DPEDKDQDNDQPHQHULPDSHQ\DWDVHQGLULGDQ VDOLQDQGLKDQWDUNHSDGD$KOL.DG8WDPD Joint statement - Principal and Supplementary Card activities are combined and sent to Principal Cardmember. / Penyata bersama $NWLYLWL.DG8WDPDGDQ.DG7DPEDKDQGLJDEXQJNDQGDODPVDWX SHQ\DWDGDQGLKDQWDUNHSDGD$KOL.DG8WDPD

I/We have read and understood the terms and conditions of the Malayan Banking Berhad Credit Card Agreement and agree to be bound by them and agree that the Principal Cardmember shall be responsible for all liabilities and obligations of the Principal &DUGPHPEHUDVZHOODVWKRVHRIWKH6XSSOHPHQWDU\&DUGPHPEHU V  The Supplementary Cardmember however, shall only be responsible for his/her own liabilities and obligations. / Saya/Kami bersetuju dan membenarkan Bank untuk melaksanakan rujukan kredit yang relavan GHQJDQSLKDNOXDUWHUPDVXNWHWDSLWLGDNWHUKDGNHSDGD&&5,6),6&726 GDQVHEDUDQJDJHQVLUXMXNDQNUHGLWODLQGDQVHPDVDXVDKDUXMXNDQNUHGLW %DQN EHUKDN PHQGHGDKNDQ PDNOXPDW \DQJ ZDMDU XQWXN PHPEROHKNDQ SLKDN OXDU PHPEHUL %DQN UXMXNDQƅNHSXWXVDQ \DQJ GLFDUL %DQN PHPSXQ\DL KDN PXWODN XQWXN PHOXOXVNDQ DWDX PHQRODN SHUPRKRQDQ VD\DƅNDPL VHZDMDUQ\D WDQSD PHPEHULNDQ DSDDSD VHEDE 6D\Dƅ.DPL GHQJDQ LQL PHPEHUL NHEHQDUDQ NHSDGD 0DOD\DQ %DQNLQJ %HUKDG XQWXN PHQGHGDKNDQ PDNOXPDW EHUKXEXQJ NHPXGDKDQ NUHGLW DWDX DNDXQ VD\DƅNDPLNHSDGD%DQN1HJDUD0DOD\VLDVHSHUWLPDQD\DQJGLWHWDSNDQ ROHK XQGDQJXQGDQJ DWDX VHEDOLNQ\D 0DOD\DQ %DQNLQJ %HUKDG WLGDN DNDQEHUWDQJJXQJMDZDEWHUKDGDSVHEDUDQJOLDELOLWLVHFDUDODQJVXQJDWDX WLGDNODQJVXQJ\DQJGLDNLEDWNDQROHKSHQGHGDKDQEHUNHQDDQVDPDDGD NHSDGD VD\DƅNDPL DWDXSXQ PDQDPDQD SLKDN ODLQ 6D\Dƅ.DPL WHODK PHPEDFDGDQPHPDKDPLVHPXDV\DUDWGDQSHUDWXUDQGDODP3HUMDQMLDQ .DG.UHGLW0DOD\DQ%DQNLQJ%HUKDGGDQGHQJDQLQLDNDQWHUWDNOXNNHSDGD VHJDOD\DQJWHUNDQGXQJGDODP3HUMDQMLDQWHUVHEXWGDQEHUVHWXMXEDKDZD 3HPHJDQJ .DG 8WDPD KHQGDNODK EHUWDQJJXQJMDZDE WHUKDGDS VHPXD liabiliti dan obligasi Pemegang Kad Utama serta Pemegang SHPHJDQJSHPHJDQJ .DG7DPEDKDQ:DODXEDJDLPDQDSXQ3HPHJDQJ .DG 7DPEDKDQ DNDQ KDQ\D EHUWDQJJXQJMDZDE WHUKDGDS OLDELOLWL GDQ REOLJDVLQ\DVHQGLUL Please tick where applicable in relation to the above provision. / Sila WDQGDSDGD\DQJEHUNHQDDQEHUKXEXQJWHUPD\DQJGLQ\DWDNDQGLDWDV Yes / Ya Noƅ7LGDN

3ULQFLSDO&DUGPHPEHUõV6LJQDWXUHƅ 7DQGDWDQJDQ3HPRKRQ.DG8WDPD Name / Nama Dateƅ7DULNK

Declaration: Postcode / Poskod

House Tel. No. / 1R7HO5XPDK

Office / Pejabat

6WDWHWKHEUDQFK1DPDNDQFDZDQJDQ

Race / Bangsa

NRIC No. / Passport No. / 1R.31R3DVSRUW

Contact Details / %XWLUEXWLU3HUKXEXQJDQ

Home / 5XPDK

Please courier to my billing address / 6LODKDQWDUNHDODPDW surat-menyurat saya &ROOHFWDW0D\EDQN&DUG&HQWUH./0DLQƇVW)ORRU0HQDUD0D\EDQNƅ 3HQJDPELODQGL3XVDW.DG0D\EDQN./0DLQ7LQJNDWƇ0HQDUD0D\EDQN Collect at Maybank branch / 3HQJDPELODQGLFDZDQJDQ0D\EDQN

Religion / Agama

Salutation / Gelaran Mr / Encik Ms / Cik

Name as in NRIC or Passport / 1DPDVHSHUWLGLGDODP.DG3HQJHQDODQDWDX3DVSRUW

Billing Address And Collecting Branch /Alamat Surat-menyurat Dan Cawangan Pengambilan Kad Bill To / Bil Ke

Nationality / Warganegara

Name as in NRIC or Passport / 1DPDVHSHUWLGLGDODP.DG3HQJHQDODQDWDX3DVSRUW

Principal Maybank Credit Card Account No. / Pemegang Kad Utama Nombor Akaun Kad Kredit Maybank

My Supplementary Cardmember will share my credit limit. / $KOL.DG7DPEDKDQVD\DDNDQPHQJRQJVLKDGNUHGLWVD\D

&ROOHFWLRQRI&DUG V Pengambilan Kad

Relationship to Principal Cardmember / +XEXQJDQGHQJDQ$KOL.DG8WDPD

Details Of Principal Cardmember / Maklumat Peribadi Pemohon Mrs / Puan Others / Lain-lain (Please specify / Sila nyatakan) Nationality / Warganegara Malaysia Others / Lain-lain

1RWH0LQLPXPFUHGLWOLPLWDVVLJQHGVKRXOGQRWEHOHVVWKDQ50ƇƆƆƆ 7RWDOFRPELQHGFUHGLWOLPLWFDQQRWH[FHHGWKH3ULQFLSDO&DUGPHPEHUõV approved credit limit. / 1RWD+DGNUHGLWPLQLPD\DQJGLWHWDSNDQWLGDN EROHKNXUDQJGDULSDGD50ƇƆƆƆ-XPODKJDEXQJDQKDGNUHGLWWLGDNEROHK PHOHELKLKDGNUHGLW\DQJGLOXOXVNDQXQWXN$KOL.DG8WDPD

Credit Limit / Had Kredit I would like to assign % or RM of my credit limit to my Supplementary Cardmember. 6D\DLQJLQPHQHWDSNDQ % atau RM GDULSDGDKDGNUHGLWVD\DXQWXN$KOL.DG7DPEDKDQVD\D

I/We further agree and authorise the Bank to make relevant credit references with external parties including but not limited to CCRIS, FIS, CTOS, and any other credit reference agencies and that in doing so the Bank shall be entitled to disclose such information as may be necessary in order for the external parties to provide the Bank with the references/confirmation sought. I/We declare that the information given by me/us is true and complete. The Bank shall reserve the absolute right to approve or reject my/our application as the Bank deems fit without assigning any reason. I/We hereby agree to you disclosing information to Bank Negara Malaysia regarding my/our credit facilities and my/our account to you as may be required, whether pursuant by law or otherwise. Malayan Banking Berhad shall not be liable whether directly or indirectly to me/us or any other persons for such disclosure.

6XSSOHPHQWDU\$SSOLFDQWõV6LJQDWXUHƅ 7DQGDWDQJDQ3HPRKRQ.DG7DPEDKDQ Name / Nama Dateƅ7DULNK Fax to / Faks ke ƆƉƈƈƎƉƌƈƊƋ

or call / DWDXKXEXQJL ƇƉƆƆƎƎƌƌƎƎ

or e-mail to / DWDXHPHONHSDGD [email protected]