SuppCd Bk

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.
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or passport.
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obligated to disclose reasons for rejecting an application.
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Supplementary Card / Kad Tambahan
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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
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Malaysia, Sabah and Sarawak, except to P.O.Box addresses / 1RWD
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Annual Income / 3HQGDSDWDQ7DKXQDQ50
Designation / -DZDWDQ
-
Date of Birth / 7DULNK/DKLU
Monthly Bill /Bil Bulanan
-
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
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Duplicate statement - Supplementary Cardmember will be sent a personal
statement with a copy sent to Principal Cardmember. / Penyata
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Joint statement - Principal and Supplementary Card activities are
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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
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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
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liabiliti dan obligasi Pemegang Kad Utama serta Pemegang
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Please tick
where applicable in relation to the above provision. / Sila
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Yes / Ya
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Name / Nama
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Declaration:
Postcode / Poskod
House Tel. No. / 1R7HO5XPDK
Office / Pejabat
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Race / Bangsa
NRIC No. / Passport No. / 1R.31R3DVSRUW
Contact Details / %XWLUEXWLU3HUKXEXQJDQ
Home / 5XPDK
Please courier to my billing address / 6LODKDQWDUNHDODPDW
surat-menyurat saya
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Collect at Maybank branch / 3HQJDPELODQGLFDZDQJDQ0D\EDQN
Religion / Agama
Salutation / Gelaran
Mr / Encik
Ms / Cik
Name as in NRIC or Passport /
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Billing Address And Collecting Branch /Alamat
Surat-menyurat Dan Cawangan Pengambilan Kad
Bill To / Bil Ke
Nationality / Warganegara
Name as in NRIC or Passport /
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Principal Maybank Credit Card Account No. /
Pemegang Kad Utama Nombor Akaun Kad Kredit Maybank
My Supplementary Cardmember will share my credit limit. /
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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
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approved credit limit. / 1RWD+DGNUHGLWPLQLPD\DQJGLWHWDSNDQWLGDN
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Credit Limit / Had Kredit
I would like to assign
% or RM
of my credit limit to my Supplementary Cardmember.
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% atau RM
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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.
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Name / Nama
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Fax to / Faks ke
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or call / DWDXKXEXQJL
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or e-mail to / DWDXHPHONHSDGD
[email protected]

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