CIMB Affinity Partnership Form

Transkripsi

1 CIMB Affinity Partnership Form FOR BANK USE ONLY Branch Code Employee No. Logo Professional Body / Badan Profesional Fellow / Associate / Gradate / Affiliate Member / Felo / Madya / Gradan / Ahli Bersekt Please / Sila (3) SMSA Association Membership No. / No. Keahlian Persatan Membership to appear on card (2nd line) / Keahlian ntk dicetak pada kad (garis ke-2) Institte of Chartered Accontants in England & Wales (Malaysia City Grop) (ICAEW MCG) 8937 ICAEW MEMBER Malaysian Institte of Accontants (MIA) Malaysian Institte of Accontants (MIA) 8932 MIA MEMBER Malaysian Medical Association (MMA) Malaysian Medical Association (MMA) 8900 MMA MEMBER The Incorporated Society of Planters (ISP) The Incorporated Society of Planters (ISP) 8972 ISP MEMBER The Instittion of Engineers, Malaysia (IEM) The Instittion of Engineers, Malaysia (IEM) 8921 IEM MEMBER The Malaysian BAR Concil (Malaysian BAR) 8999 MALAYSIAN BAR The Malaysian Dental Association (MDA) The Malaysian Dental Association (MDA) 8901 MDA MEMBER The Malaysian Institte of Certified Pblic Accontants (MICPA) The Malaysian Institte of Certified Pblic Accontants (MICPA) MICPA MEMBER The Malaysian Institte of Chartered Secretaries & Administrators (MAICSA) 8931 MAICSA MEMBER

2 CIMB Affinity Partnership Form / Borang CIMB Affinity Partnership REQUIREMENTS / KELAYAKAN Age / Umr Principal Card / Kad Utama : 21 years old / 21 tahn Spplementary Card / Kad Tambahan : 18 years old / 18 tahn Minimm Income Per Annm / Pendapatan Tahnan Minima Visa INFINITE World MasterCard Platinm RM150,000 RM100,000 RM24,000 1 I WISH TO APPLY FOR THE FOLLOWING CARD (PLEASE 3) / SAYA INGIN MEMOHON KAD BERIKUT (SILA 3) : CIMB WORLD MasterCard CIMB Visa INFINITE CIMB Platinm MasterCard CIMB Visa Platinm Notes / Nota : 1. Additional credit cards will share a combined credit limit. / Kad kredit tambahan akan berkongsi had kredit. 2. All fields are mandatory to be filled-in. / Sema bidang adalah wajib dilengkapi. Please retrn the completed application form (together with non-retrnable docments) to any nearest CIMB MSF centre (Mobile Sales Force), contact or CIMB MSF Relationship Manager or scan-copy to icimb Operations at Address: ops.cco@cimb.com / Sila kembalikan borang permohonan yang lengkap (bersama dengan dokmen yang tidak akan dikembalikan) ke mana-mana psat CIMB MSF yang terdekat (Paskan Jalan Bergerak), hbngi Pengrs Perhbngan MSF CIMB kami ata salinan imbas ke icimb Operasi di Alamat E-mel : ops.cco@cimb.com 2 MY PERSONAL DETAILS / BUTIR-BUTIR PERIBADI SAYA Mr / Encik Miss / Cik Madam / Pan Dr / Dr Others / Lain-lain New I/C No. / No. K/P Bar : MyKad MyTentera MyPolis Passport/Pasport Fll Name As In NRIC / Nama Penh Mengikt Kad Pengenalan : Association Membership Nmber / No. Keahlian Persatan : Name To Appear On Card (Not More Than 19 Letters) Nama Untk Dicetak Pada Kad (Tidak Melebihi 19 Hrf) : Date Of Birth (DD/MM/YYYY) / Tarikh Lahir (HR/BLN/THN) : / / Marital Stats / Stats Perkahwinan : Single / Bjang Married / Berkahwin Widowed / Bal Divorced / Bercerai Sex / Jantina : Male / Lelaki Female / Perempan Highest Edcation Level / Tahap Pendidikan Tertinggi : Primary / Rendah Secondary / Menengah College / Kolej University / Universiti Others / Lain-lain Mother s Maiden Name (For Verification Prposes) / Nama Ib (Untk Tjan Pengesahan) : Old I/C No. / No. K/P Lama : Nationality / Kewarganegaraan : M A L A Y S I A N 3 MY HOME ADDRESS / ALAMAT RUMAH SAYA Residential Address / Alamat Kediaman : Postcode / Poskod : Residence Is / Kediaman Adalah : Owned - No Loan / Milik Sendiri - Tanpa Pinjaman Owned - With Loan / Milik Sendiri - Dengan Pinjaman Rented / Sewa Employer s / Milik Majikan Parents / Relatives / Milik Ibbapa / Sadara-Mara Years There / Tempoh Menetap : Mobile Tel / Tel Bimbit : (Mandatory for Transaction Alert Services / Diwajibkan ntk Perkhidmatan Amaran Transaksi) Version 2016.Affinity.01 [1/6]

3 4 MY EMPLOYMENT / BUSINESS DETAILS / BUTIRAN PEKERJAAN / PERNIAGAAN SAYA Name Of Company / Nama Syarikat : Address / Alamat : Natre Of Bsiness / Jenis Perniagaan : Retail / Perncitan Edcation / Pendidikan Manfactring / Perkilangan Financial Instittions / Institsi Kewangan Professional Services / Perkhidmatan Professional Real Estate Constrction / Hartanah Pembinaan Wholesale (exclding Constrction) / Pemborong (kecali Pembinaan) Information Technology & Telecommnication / Informasi Teknologi & Telekomnikasi Land Transport, Logistic & Warehosing / Pengangktan Darat, Logistik & Stor Government & Qasi-Government / Kerajaan & Semi Kerajaan F&B, Restarant, Hotel & Torism / Restoran, Hotel & Pelancongan Others / Lain-lain Salaried Employee / Pekerja Bergaji Self-Employed / Perniagaan Milik Sendiri Postcode / Poskod : Years There / Tempoh Dalam Perkhidmatan / Perniagaan : Occpation / Pekerjaan : Office Tel / Tel Pejabat : 5 DEBT OBLIGATION WITH NON-BANKS / HUTANG OBLIGASI DENGAN BUKAN BANK My total monthly instalments with non-banks (if any) / Jmlah ansran blanan saya selain dengan bank (jika ada) R M 6 MAILING PREFERENCE / ARAHAN KIRIMAN SAYA 6.1 / E-mel : Cstomers with address will be enrolled for e-statement atomatically. / Pendaftaran ntk e-penyata adalah secara atomatik bagi pelanggan yang mempnyai alamat e-mel. Paper Statement / Penyata Bercetak : No, I prefer paper statement to be sent to my mailing address / Tidak, saya memilih ntk menerima salinan bercetak dihantar ke alamat srat-menyrat CIMB CLICKS Internet Banking / Perbankan Internet CIMB CLICKS : No, I prefer to receive my statement via CIMB Clicks Internet Banking / Tidak, saya memilih ntk menerima penyata melali Perbankan Internet CIMB Clicks 6.2 Mailing address / Alamat srat-menyrat : Home Address / Alamat Rmah Office Address / Alamat Pejabat 7 MY EMERGENCY CONTACT / HUBUNGAN KECEMASAN SAYA Name / Nama : Relationship To Principal Cardmember / Applicant / Pertalian Dengan Pemegang / Pemohon Kad Utama : Contact No. / Talian ntk Dihbngi : 8 MY SUPPLEMENTARY CARD DETAILS / BUTIR-BUTIR KAD TAMBAHAN SAYA Mr / Encik Miss / Cik Madam / Pan Dr / Dr / E-mel : Others / Lain-lain Fll Name As In NRIC / Nama Penh Mengikt Kad Pengenalan : Name To Appear On Card (Not More Than 19 Letters) Nama Untk Dicetak Pada Kad (Tidak Melebihi 19 Hrf) : Date Of Birth (DD/MM/YYYY) / Tarikh Lahir (HR/BLN/THN) : / / Old I/C No. / No. K/P Lama : New I/C No. / No. K/P Bar : MyKad MyTentera MyPolis Passport/Pasport Nationality / Kewarganegaraan : MALAYSIAN Non-MALAYSIAN / Bkan-MALAYSIA, please state / sila nyatakan Sex / Jantina : Male / Lelaki Mobile Tel / Tel Bimbit : Female / Perempan (To Enable Transaction Alert Services / Untk Membolehkan Perkhidmatan Amaran Transaksi) Relationship To Principal Cardmember / Applicant / Pertalian Dengan Pemegang / Pemohon Kad Utama : Mother s Maiden Name (For Verification Prposes) / Nama Ib (Untk Tjan Pengesahan) : Yes, I wold like to nominate a credit limit for this spplementary application of / Ya, saya ingin menetapkan had kredit ntk permohonan tambahan ini pada : R M Note / Nota : The total combined credit limits cannot exceed the principal cardmember s crrent approved credit limit. If no nomination is made specifically, the spplementary card will share the principal credit limit. / Jmlah gabngan had kredit tidak boleh melebihi had kredit yang ditetapkan ntk pemegang kad tama. Jika had kredit tidak ditetapkan, kad tambahan tersebt akan berkongsi had kredit pemegang kad tama. [2/6]

4 9 CIMB Toch n Go Zing AUTOMATIC RELOAD AMOUNT / JUMLAH TAMBAH NILAI AUTOMATIK CIMB Toch n Go Zing CIMB Toch n Go Zing Card / Kad CIMB Toch n Go Zing (Toch n Go card linked to CIMB Bank Credit Card / Kad Toch n Go yang dihbngkan dengan Kad Kredit CIMB Bank) I wold like to apply for CIMB Toch n Go Zing Card with the following atomatic reload amont / Saya ingin memohon ntk Kad CIMB Toch n Go Zing dengan jmlah tambah nilai atomatik berikt : Principal Card / Kad Utama : RM100 RM200 RM300 Spplementary Card / Kad Tambahan : RM100 RM200 RM300 Note / Nota : If the ato reload amont is not specified, CIMB Bank will atomatically set the defalt reload amont to RM100. / Sekiranya tambah nilai atomatik tidak ditetapkan, CIMB Bank akan menetapkan RM100 sebagai nilai tambah asas secara atomatik. 10 CIMB Toch n Go Zing CARD DECLARATION SECTION / BAHAGIAN AKUAN KAD CIMB Toch n Go Zing I agree to abide by the terms and conditions of the CIMB Toch n Go Zing Card ( the Card ) and any other terms and conditions imposed by Toch n Go Sdn. Bhd. (hereinafter referred to as TNGSB ) and/or the Bank from time to time pon giving twenty one (21) calendar days prior notice in respect of the se of the Toch n Go featres of the Card. I am aware the Card has an atomatic reload amont of RM100, RM200 or RM300 and that the atomatic reload fee of RM1.59 is payable. I confirm and irrevocably athorize the Bank to debit my Credit Card accont, linked to the Card for each reload and atomatic reload fee (where chargeable) whenever the accont balance drops to RM50 and below. In the event that I cancel my Card and my Card has an accont balance at the point of cancellation, sch balance will be refnded, pon reqest, to my Credit Card accont after dedcting the processing fee of RM5.30 from the accont balance of the Card. In the event that my Card does not have any accont balance when I cancel my Card, no processing fee will be charged. A RM10.00 fee is also chargeable for new Card replacements. By signing and/or sing the Card I agree to be bond by the terms and conditions imposed on the Card and other variations or amendments thereof. I nderstand that the Card remains the property of TNGSB and mst be retrned to TNGSB pon reqest. Saya bersetj ntk memathi terma-terma dan syarat-syarat Kad CIMB Toch n Go Zing ( Kad ) dan mana-mana terma dan syarat lain yang dikenakan oleh Toch n Go Sdn. Bhd. (selepas ini dirjk sebagai TNGSB ) dan/ata Bank dari masa ke semasa apabila diberikan da plh sat (21) hari kalendar notis terlebih dahl berkenaan dengan penggnaan ciri kad Toch n Go. Saya menyedari bahawa Kad ini mempnyai penambahan atomatik bernilai RM100, RM200 ata RM300 dan yran nilai tambahan atomatik adalah sebanyak RM1.59 kena dibayar ntk setiap penambahan. Saya mengesahkan dan memberi kasa mtlak kepada Bank ntk mendebitkan Akan Kad Kredit Bank saya ntk setiap penambahan dan yran penambahan atomatik (dimana dicajkan) apabila baki akan menrn sehingga RM50 dan di bawah RM50. Sekiranya saya membatalkan Kad saya dan Kad saya mempnyai baki akan semasa pembatalan, baki akan tersebt akan dibayar balik, atas permintaan, kepada akan Kad Kredit Bank saya selepas menolak yran pemprosesan sebanyak RM5.30 dari baki akan Kad. Sekiranya Kad saya tidak mempnyai apa-apa baki akan semasa pembatalan, tiada yran pemprosesan akan dikenakan. Yran RM10.00 jga akan dikenakan ntk mendapatkan Kad gantian bar. Dengan menandatangani dan/ata menggnakan Kad ini, saya bersetj ntk tertaklk kepada terma-terma dan syarat-syarat Kad ini termask apa-apa variasi ata pindaan kepada terma-terma dan syarat-syarat tersebt. Saya faham bahawa Kad adalah milik TNGSB dan mesti dikembalikan kepada TNGSB apabila dikehendak. 11 DECLARATION (BY PRINCIPAL CARDMEMBER) IN CONNECTION WITH BANK NEGARA GUIDELINES ON CREDIT TRANSACTIONS AND EXPOSURES WITH CONNECTED PARTIES / PERAKUAN (OLEH AHLI KAD UTAMA) BERHUBUNG DENGAN GARIS PANDUAN BANK NEGARA BAGI URUS NIAGA DAN PENDEDAHAN KREDIT DENGAN PIHAK BERKAITAN Please complete this declaration section if any of the below is applicable to yo. (No declaration from yo denotes that it is not applicable) / Sila lengkapkan perakan di bawah sekiranya berkaitan. (Sekiranya tiada perakan, bermakna ianya tidak berkaitan dengan anda) 1. I am a staff of the CIMB Grop¹ / Saya seorang kakitangan Kmplan CIMB¹ 2. To the best of my knowledge, I have close relative(s)² employed nder the CIMB Grop or has acted as my garantor / Pada pengetahan saya, saya mempnyai sadara mara terdekat yang merpakan kakitangan Kmplan CIMB ata merpakan penjamin saya² Particlars of my close relative(s) in CIMB Grop / Maklmat sadara mara terdekat yang merpakan kakitangan Kmplan CIMB : Name / Nama I/C / Passport No. / No. K/P / Paspot Relationship / Pertalian Acted As Garantor (Indicate Yes or No) / Penjamin (Sila nyatakan Ya ata Tidak) Yes / Ya No / Tidak 1 CIMB Grop means CIMB Bank Berhad or CIMB Islamic Bank Berhad or CIMB Investment Bank Berhad or other sbsidiaries or companies controlled by the aforesaid respective banking instittions / Kmplan CIMB bermaksd CIMB Bank Berhad ata CIMB Islamic Bank Berhad ata CIMB Investment Bank Berhad ata lain-lain anak syarikat ata syarikat yang dikasai oleh institsi-institsi perbankan yang tersebt. 2 Close relative(s) inclde parents / spose of staff inclding the spose s dependents / children / spose of the children / brother and sister / spose of brother / sister and any other dependents and persons who may inflence / be inflenced by the staff / Sadara-mara terdekat termask ib bapa / sami / isteri kakitangan termask tanggngan / anak / sami ata isteri anak / adik-beradik dan sami ata isteri adik-beradik dan orang lain di bawah tanggngan dan orang yang mngkin mempengarhi ata dipengarhi oleh kakitangan. [3/6]

5 12 DECLARATION SECTION FOR STATEMENT DELIVERY / BAHAGIAN PENGAKUAN UNTUK PENGHANTARAN PENYATA I/We agree to be bond by CIMB Bank/CIMB Islamic Bank Terms & Conditions for Statement Delivery available at CIMB Bank/CIMB Islamic Bank website - in respect of all my/or credit card statements reqested to be sent to me/s by . / Saya/Kami bersetj ntk terikat dengan Terma-terma & Syarat-syarat CIMB Bank/CIMB Islamic bagi Penghantaran Penyata E-mel yang boleh didapati di laman web CIMB Bank/CIMB Islamic Bank - ntk sema Penyata kad kredit yang telah dipohon ntk dihantar kepada saya/kami secara e-mel. 13 DECLARATION SECTION TO VIEW/RECEIVE STATEMENTS BY CIMB CLICKS INTERNET BANKING / BAHAGIAN PENGAKUAN UNTUK MENERIMA / MELIHAT PENYATA OLEH PERBANKAN INTERNET CIMB CLICKS Where I/we have a CIMB Clicks Internet Banking accont ( CLICKS ) and have reqested to view all my/or CIMB Bank/CIMB Islamic Bank credit card Statement(s) via CLICKS. I/We agree to be sbject to the Terms and Conditions for Credit Card e-statement accessed via CIMB Clicks pblished on CIMB Bank s/cimb Islamic Bank s website. I/We agree that I/we will not receive hardcopy Statements nor will I/we receive Statement(s) via . / Di mana saya/kami mempnyai akan Perbankan Internet CIMB Clicks ( CLICKS ) dan telah memohon ntk melihat sema Penyata saya/kami melali CLICKS. Saya/Kami bersetj ntk tertaklk kepada Terma-terma dan Syarat-syarat ntk Kad Kredit Penyata-e diakses melali CIMB Clicks di laman web CIMB Bank/CIMB Islamic Bank. Saya/Kami bersetj bahawa saya/kami tidak akan menerima Penyata bercetak dan saya/kami jga tidak akan menerima Penyata saya/kami melali E-mel. 14 DECLARATION SECTION / BAHAGIAN AKUAN I/We hereby declare and certify that all the information given by me/s in this application is tre, accrate and complete. Notwithstanding the generality of the foregoing, I/We confirm that CIMB Bank Berhad (the Bank ) is athorised to verify and/or make any checks and/or obtain any information and/or confirmation at any time and from time to time now and/or in the ftre, with or from any credit reference/reporting agencies, inclding bt not limited to CCRIS, FIS and/or any other agencies and/or from any financial instittion and to provide to sch aforesaid party(s) with the reqired information reqested to enable the Bank to ascertain my/or stats and/or any other person, individal and/or entity related to and/or associated with me/s as may be reqired by the Bank for the prpose of the consideration of this application and thereafter if this application is approved for the prposes of the issance of the credit card(s) and/or grant and/or contined maintenance of the credit card facility/accont; and/or recovery of debts owing nder the credit card facility/ accont; and/or any prpose related to or in connection with the credit card facility/accont applied for; and/or for any other prpose that is reqired or permitted by any law, reglations, gidelines and/or relevant reglatory athorities. I/We hereby reqest the Bank to isse, pon approval of this application, the credit card(s) which I/we have indicated. I/We acknowledge that the se of the credit card(s) issed to me/s shall be sbject to the Bank s Cardholder Terms and Conditions ( Cardmember Agreement ) which is available in CIMB Bank s website at and which will be sent to me/s with the credit card(s) pon the approval of this application, and I/we frther agree to be bond by the terms and conditions set forth in the Cardmember Agreement pon issance or se of the credit card(s). I, the Principal Applicant frther agree to accept joint and several liability for all amonts incrred arising from the se of the principal and/or spplementary credit card(s) issed prsant to this application or at any time thereafter at my and/or the Spplementary Applicant s reqest. I/We frther nderstand that the Bank shall not hold the Spplementary Applicant jointly and severally liable for the debts or amonts incrred by the Principal Applicant or other Spplementary Applicant(s). I/We, acknowledge that the Bank reserves the sole and absolte right to decline or reject my/or application(s) withot assigning any reasons therefore. I/We also acknowledge that it is a reqirement by Bank Negara Malaysia ( BNM ) that all information relating to this application, whether sccessfl or otherwise, mst be pdated and/or transmitted to the Central Credit Reference Information System ( CCRIS ), a database maintained by BNM. Sbject to the provisions below which (i) prohibit disclosre of information to companies within the grop of the Bank as well as companies within the grop of CIMB Grop Holdings Berhad, the Bank s ltimate holding company (collectively Grop Companies ) if objected to by me/s; and (ii) reqire my/or express consent for disclosre of information to third parties for the stated prposes. I/We hereby agree and athorise the Bank to disclose to any of its agents, service providers, aditors, legal consel, professional advisors, secrity providers and garantors in or otside Malaysia and to Grop Companies, whether sch Grop Companies are residing, sitated, carrying on bsiness, incorporated or constitted within or otside Malaysia, any information relating to me/s, my/ or affairs and/or any acconts maintained by me/s with the Bank for facilitating the bsiness, operations, facilities and services of or granted or provided by the Bank and/or the Grop Companies to their cstomers as the Bank deems fit or appropriate. Disclosre to Grop Companies shall be for facilitating the operations, bsinesses, cross-selling and other prposes of the Bank and/or the Grop Companies provided always that disclosre for cross selling prposes shall not be affected if sch disclosre is objected by me/s by contacting the Bank at the following telephone nmber or address (which may be changed by the Bank from time to time by notice to me/s): 19th Floor, Menara Bmiptra Commerce, 11 Jalan Raja Lat, Kala Lmpr, Tel No: I/We nderstand that the credit card(s) when issed shall at all times remain the property of the Bank and mst be dly retrned pon reqest by the Bank. I/We frther agree to accept liability for all amont incrred arising from the se of my/or credit card(s) issed prsant to this application or at any time thereafter at my/or reqest. I hereby consent to the release of my information herein contained to Malaysian Airline System Berhad [10601-W] ( Malaysia Airlines ) or any of its related corporations to enable Malaysia Airlines to enroll me as an Enrich Member nder their Enrich Freqent Flyer Programme. I hereby acknowledge that CIMB Bank Berhad reserves the right not to isse me with the CIMB Enrich MasterCard for any reason whatsoever (inclding bt not limited to Malaysia Airlines s refsal or inability to enroll me as an Enrich member). I/We hereby confirm having read, nderstood and retained a copy of the prodct disclosre sheet containing key information relating to my application for the credit card(s). [4/6]

6 14 DECLARATION SECTION / BAHAGIAN AKUAN... CONTINUED / SAMBUNGAN Saya/Kami dengan ini mengaki dan mengesahkan bahawa sema maklmat yang diberikan oleh saya/kami dalam permohonan ini adalah benar, tepat dan lengkap. Saya/Kami mengesahkan bahawa CIMB Bank Berhad ( Bank ) diberikasa ntk menentsahkan dan/ata membat sebarang semakan dan/ata mendapatkan apa-apa maklmat dan/ata pengesahan pada bila-bila masa dan dari semasa ke semasa sekarang dan/ata pada masa depan, dengan ata daripada mana-mana agensi rjkan/laporan kredit, termask tetapi tidak terhad kepada CCRIS, FIS dan/ata mana-mana agensi lain dan/ata daripada manamana institsi kewangan dan memberikan kepada pihak yang tersebt di atas maklmat diperlkan yang diminta ntk membolehkan Bank ntk memastikan stats saya/kami dan/ata mana-mana orang, individ dan/ata entiti lain yang berkaitan dengan dan/ata berhbng dengan saya/kami sebagaimana yang dikehendaki oleh Bank ntk tjan pertimbangan permohonan ini dan selepas it jika permohonan ini dillskan ntk tjan pemberian dan/ata pengekalan kemdahan kad kredit/akan yang bertersan; dan/ata mendapatkan semla htang yang terhtang di bawah kemdahan kad kredit/akan; dan/ata apa-apa tjan yang berkaitan dengan ata berhbng dengan kemdahan kad kredit/akan yang dipohon; dan/ata ntk sebarang tjan lain yang dikehendaki ata dibenarkan oleh mana-mana ndang-ndang, peratran-peratran, garis pandan dan/ata pihak berkasa yang berkenaan. Selepas permohonan ini dillskan, saya/kami dengan ini meminta pihak Bank mengelarkan kad (kad-kad) kredit yang telah saya/kami nyatakan. Saya/ Kami mengaki bahawa penggnaan kad (kad-kad) kredit yang dikelarkan kepada saya/kami adalah tertaklk kepada terma-terma dan syarat-syarat Bank ( Perjanjian Ahli Kad ), yang boleh didapati dalam web CIMB Bank di dan akan dihantar kepada saya/kami bersama kad (kad-kad) kredit selepas permohonan ini dillskan, dan saya/kami selanjtnya bersetj ntk memathi terma-terma dan syarat-syarat yang ditetapkan dalam Perjanjian Ahli Kad selepas kad (kad-kad) kredit dikelarkan ata dignakan. Saya, Pemohon Utama selanjtnya bersetj ntk menanggng liabiliti secara bersesama dan berasingan ntk sema jmlah yang ditanggng yang timbl daripada penggnaan kad (kad-kad) kredit tama ata tambahan yang dikelarkan di bawah permohonan ini ata pada bila-bila masa selepas it atas permintaan saya dan/ata Pemohon (Pemohon-Pemohon) Tambahan. Saya/Kami, selanjtnya difahamkan bahawa pihak Bank tidak akan mempertanggngjawabkan Pemohon Tambahan secara bersesama dan berasingan bagi htang ata jmlah yang ditanggng oleh Pemohon Utama ata Pemohon (Pemohon-Pemohon) Tambahan lain. Saya/Kami mengaki bahawa pihak Bank mempnyai hak tnggal dan mtlak ntk tidak menerima ata menolak permohonan saya/kami tanpa memberikan sebarang sebab ntknya. Saya jga mengaki bahawa adalah menjadi syarat Bank Negara Malaysia ( BNM ) bahawa sema maklmat yang berkaitan dengan permohonan ini, sama ada berjaya ata tidak, mesti dikemaskinikan dan dihantar dan/ata dikemkakan kepada Sistem Maklmat Rjkan Kredit Psat ( CCRIS ), sebah pangkalan data yang dikendalikan oleh BNM. Tertaklk kepada perntkan di bawah yang (i) melarang pendedahan maklmat kepada syarikat-syarikat dalam kmplan Bank serta syarikat-syarikat dalam kmplan CIMB Grop Holdings Berhad, syarikat indk mktamad Bank (secara kolektif Kmplan Syarikat ) jika dibantah oleh saya/kami; dan (ii) menghendaki kebenaran nyata daripada saya/kami bagi pendedahan maklmat kepada pihak ketiga bagi tjan yang dinyatakan, saya/kami dengan ini bersetj dan membenarkan Bank mendedahkan kepada mana-mana agennya, penyedia perkhidmatan, jradit, pegam, penasihat profesional, penyedia cagaran dan penjamin di dalam ata di lar Malaysia dan kepada Kmplan Syarikat sama ada Kmplan Syarikat tersebt menetap, terletak, menjalankan perniagaan, diperbadankan ata ditbhkan di dalam ata di lar Malaysia, sebarang maklmat berkaitan dengan saya/kami, rsan saya/kami dan/ata mana-mana akan yang dipegang oleh saya/kami dengan Bank ntk memdahkan perniagaan, operasi, kemdahan dan perkhidmatan oleh ata yang diberikan ata disediakan oleh Bank dan/ata Kmplan Syarikat kepada pelanggan mereka, di mana Bank menganggap berpattan ata bersesaian. Pendedahan kepada Kmplan Syarikat adalah ntk memdahkan operasi, perniagaan, penjalan silang dan tjan lain di pihak Bank dan/ata Kmplan Syarikat dengan syarat sentiasa bahawa pendedahan ntk tjan penjalan silang tidak boleh dilaksanakan jika pendedahan sedemikian dibantah oleh saya/kami dengan menghbngi Bank di nombor telefon ata alamat berikt (yang boleh dibah oleh Bank dari semasa ke semasa melali notis kepada saya/kami): Tingkat 19, Menara Bmiptra Commerce, 11 Jalan Raja Lat, Kala Lmpr, No. Tel: Saya/Kami faham bahawa kad (kad-kad) kredit, apabila dikelarkan adalah sentiasa menjadi milik CIMB Bank dan mesti dikembalikan apabila diminta oleh CIMB Bank. Saya/Kami bersetj ntk menanggng segala jmlah perbelanjaan daripada penggnaan kad (ata kad-kad) kredit yang dikelarkan melali pemohonan ini atapn diatas permintaan sendiri pada bila-bila masa kelak. Saya dengan ini membenarkan maklmat saya yang terkandng di dalam ini didedahkan kepada Malaysia Airline System Berhad [10601-W] ( Malaysia Airlines ) ata mana-mana syarikat yang berkaitannya ntk membolehkan Malaysia Airlines mendaftarkan saya sebagai Ahli Enrich di bawah Program Kesetiaan Enrich. Saya dengan ini memperaki bahawa CIMB Bank Berhad berhak ntk tidak mengelarkan CIMB Enrich MasterCard kepada saya atas apa ja sebab (termask tetapi tidak terhad kepada keengganan ata ketidakpayaan Malaysia Airlines ntk mendaftarkan saya sebagai Ahli Enrich). Saya/Kami mengesahkan telah membaca, memahami dan mengekalkan salinan lembaran penerangan prodk yang mengandngi maklmat penting berkenaan permohonan kad (kad-kad) kredit saya/kami. Frther, where the Bank intends to share my/or information (exclding information relating to my/or affairs or accont) with third parties for strategic alliances, marketing and promotional prposes. / Di mana Bank bercadang ntk berkongsi maklmat saya/kami (tidak termask maklmat berkaitan dengan rsan ata akan saya/kami) dengan pihak ketiga bagi tjan perikatan strategik, pemasaran dan promosi. Please tick / Sila tandakan ( 3 ) I/We hereby give my/or consent to the above disclosre to third parties. / Saya/Kami dengan ini memberikan kebenaran saya/kami terhadap pendedahan di atas kepada pihak ketiga. I/We do not consent to the giving of the above disclosre to third parties. / Saya/Kami tidak membenarkan pendedahan di atas dibat kepada pihak ketiga. 15 PRIVACY NOTICE ACKNOWLEDGEMENT / PENGAKUAN NOTIS PRIVASI I/We hereby acknowledge that I/we have accessed and/or read the Privacy Notice issed by CIMB Grop (which is available at all CIMB branches as well as at the CIMB website at or or has otherwise been made available to me/s) and confirm my/ or agreement to the same. / Saya/Kami dengan ini mengaki bahawa saya/kami telah mengakses dan/ata membaca Notis Privasi yang dikelarkan oleh Kmplan CIMB (yang boleh didapati di sema cawangan CIMB serta di laman web CIMB di ata yang jga tersedia ada kepada saya/kami) dan mengesahkan persetjan saya/kami ntk yang sama. [5/6]

7 16 GOODS & SERVICES TAX (GST) / CUKAI BARANGAN & PERKHIDMATAN (EFFECTIVE / BERKUATKUASA 1 APRIL 2015) I am aware that the pblished fees/charges are inclsive of Goods and Services Tax (GST), where applicable and I hereby frther agree that I shall be liable for all GST payable in connection with or arising ot of credit cards or other cards issed to me nder this application or any accont or any services in connection therewith and yo shall be athorised to debit my credit card accont the same. / Saya sedar bahawa caj/yran yang diterbitkan adalah termask Ckai Barangan dan Perkhidmatan (GST), di mana berkenaan dan saya dengan ini selanjtnya bersetj bahawa saya akan bertanggngjawab ke atas sema GST yang kena dibayar berkaitan dengan ata yang timbl dari kad kredit ata kad-kad lain yang dikelarkan kepada saya di bawah permohonan ini ata mana-mana akan ata perkhidmatan yang berkaitan dengannya dan kam diberi kasa ntk mendebit akan kad kredit saya ntk perkara yang sama. 17 FOREIGN ACCOUNT TAX COMPLIANCE ACT (FATCA) Please complete in BLOCK LETTERS (Complsory) Principal Card Applicant Spplementary Card Applicant Nationality/Contry of Birth Residency/Alternate Nationality Please check ( 3 ) Yes or No for each of the following qestions : 1. Are yo a U.S. Resident? (inclding a crrent work permit) No Yes, Tax Nmber : No Yes, Tax Nmber : 2. Are yo a U.S. Citizen or a Citizen of a U.S. Territory? No Yes, Tax Nmber : No Yes, Tax Nmber : 3. Do yo hold a U.S. Permanent Resident Card (Green Card)? No Yes, Tax Nmber : No Yes, Tax Nmber : I hereby confirm the information provided above is tre, accrate and complete. Sbject to the applicable local laws, I hereby consent for CIMB Grop, its parent or ltimate holding company or any of its affiliates (inclding branches) (collectively known as CIMB ) to share my information with domestic or overseas reglators or tax athorities where necessary to establish my tax liability in any/or the relevant jrisdiction. Where reqired by domestic or overseas reglators or tax athorities, I also nderstand and agree that CIMB may be reqired to obtain additional docments and/or forms, which I will sign, if I am sbject to the relevant jrisdiction s reqirements. Where reqired by domestic or overseas reglators or tax athorities, I nderstand and agree that CIMB may withhold, and pay ot, from my accont(s) sch amonts as may be reqired according to applicable laws, reglations, gidelines and/or agreements with reglators or athorities and directives. I also agree and ndertake to notify the Bank (within 30 calendar days), or provide the information if reqested by the Bank, if there is a change in any information which I have provided to the Bank. Passport / ID No. (please inclde the 8-digit/letter U.S. VISA, where applicable) Passport / ID expiration date (please inclde the Passport / ID expiration date, where applicable) Principal Card Applicant s Signatre / Tandatangan Pemohon Kad Utama : Date / Tarikh : Spplementary Card Applicant s Signatre / Tandatangan Pemohon Kad Tambahan : Date / Tarikh : DOCUMENTS / DOKUMEN 3 A copy of NRIC (both sides) for Principal card / Spplementary card applicant (if any) / Salinan kad pengenalan (depan dan belakang) ntk pemohon Kad Utama / Kad Tambahan (jika ada) 3 Latest salary slips / EA Form / Form BE or B & income tax receipt / EPF Statement with minimm 6-months contribtion / Slip pendapatan terkini / borang EA / borang BE ata B & resit ckai pendapatan / Penyata EPF dengan minima 6-blan smbangan Please retrn the completed application form (together with non-retrnable docments) to any CIMB Bank branch. / Sila kembalikan borang permohonan yang lengkap (bersama dengan dokmen yang tidak akan dikembalikan) ke mana-mana cawangan CIMB Bank. [6/6]