maybank card form 1.0

7252019 Maybank Card Form 10

httpslidepdfcomreaderfullmaybank-card-form-10 114

Age Eligibility Kelayakan Umur Principal Card Kad Utama - 21 years old 21 tahun Supplementary Card Kad Tambahan - 18 years old18 tahunAge Limit Had Umur - 65 years old 65 tahun

For Bank Use Untuk Kegunaan Bank

Name Nama FE CSE RB DSE TSE

PF No

Branch

Branch Code

Date Received

Tel No

LG (PF No)

Campaign Code

We wish to apply for ( please tick where applicable ) Saya Kami ingin memohon ( sila tandakan yang mana berkenaan )Credit Card Kad Kredit

Charge Card Kad Caj

APPLICANT PERSONAL INFORMATION MAKLUMAT PERIBADI PEMOHON1

Mr Encik Mdm Puan Ms Cik Others Lain-lain

Gender Jantina Male Lelaki Female Perempuan

Nationality Warganegara

Name to appear on card Nama untuk dicetak pada kad Maximum 19 characters Tidak melebihi 19 huruf)

Name as in NRIC or Passport

___________________________________________________________________________________

___________________________________________________________________________________

Mothers Name Nama ibu ____________________________________________________

Religion Agama _______________________________

MAYBANK WORLD MASTERCARD

VISA PLATINUM

MAYBANK MANCHESTER UNITED VISA INFINITE

MAYBANK VISA INFINITE

MAYBANK VISA SIGNATURE

PETRONAS MAYBANK VISA PLATINUM

VISA GOLD

MASTERCARD GOLD

MASTERCARD PLATINUM

PETRONAS MAYBANK VISA GOLD

MAYBANK MANCHESTER UNITED VISA CARD

SONY CARD

OTHERS LAIN-LAIN ________________________

Marital Status Taraf Perkahwinan

Single Bujang Married Berkahwin

Widow Balu Divorced Bercerai

No of Dependants Bilangan Tanggungan ______________________________________

House Tel No No Tel Rumah ________________________________________________

HP No No Tel Bimbit ________________________________________________________

E-Mail E-Mel _________________________________________________________________

Residential Address Alamat Kediaman ______________________________________

___________________________________________________________________________________

_____________________________________________Postcode Poskod____________________

City Bandar ______________________________State Negeri ________________________

Residential Status Taraf KediamanOwn Sendiri Tenant Sewa

Parentsrsquo Milik Ibu Bapa Relativesrsquo Milik Saudara

Others Lain-lain _______________________________________

Years of Occupancy Tempoh Menetap ____________________

Education level Tahap Pendidikan

Primary Pendidikan Rendah Diploma Diploma

Secondary Pendidikan Menengah Degree Ijazah

Masters Ijazah Lanjutan Doctorate Kedoktoran

Professional Quali1047297cation Kelayakan Profesional

APPLICANT EMPLOYMENT INFORMATION MAKLUMAT PEKERJAAN PEMOHON2

Name of Employer or Firm Nama Majikan atau Firma

__________________________________________________________________________________

Designation Jawatan __________________________________________________________

Nature of Business Jenis Perniagaan _________________________________________

Business Classi1047297cation

Sole Proprietorship Milik Sendiri

Partnership Perkongsian

Sdn Bhd

MNC Public Listed MNC Senarai

Government Kerajaan

Others Lain-lain

Length of Service Tempoh Perkhidmatan ___________________________________

Office Address Alamat Pejabat _____________________________________________

___________________________________________________________________________________

____________________________________________ Postcode Poskod____________________

City Bandar ______________________________ State Negeri ________________________

Office Tel No No Tel Pejabat __________________________________________________

Office Fax No No Faks Pejabat ________________________________________________

Terms of Employment Terma Pekerjaan

Contract Kontrak Permanent Kekal

Malaysia Others Lain-lain _______________

(Personal security veri1047297cation Pengesahan keselamatan Peribadi)

1

Identi1047297cation Document

Dokumen Pengenalana Copy of NRIC (both sides) or passport supplementary applicants included Salinan Kad Pengenalan (depan amp belakang) atau pasport termasuk pemohon tambahan

Salaried Bergajib Latest BE form with official tax receipt Borang BE terkini serta resit cukai rasmic Latest 3 months salary slip OR Latest EPF Statement Penyata gaji 3 bulan terkini ATAU Penyata KWSP terkini

Self Employed

Berkerja Sendirid Copy of Business Registration latest 6 months bank statements and BE Form with official tax receipt

Salinan Pendaftaran Perniagaan penyata bank 6 bulan terakhir dan Borang BE terkini serta resit cukai rasmi

e Letter of employer con1047297rming duration of employment contract in Malaysia and Visa Work Permit Applicant must be a Maybankaccount holder Surat daripada majikan mengesahkan tempoh kontrak perkerjaan di Malaysia dan Permit Kerja Permohon mestimerupakan pemegang akaun Maybank

ExpatriatesPekerja Asing

TYPE OF APPLICATIONS

JENIS PERMOHONANDOCUMENT REQUIRED

DOKUMEN DIPERLUKAN

f Copy of Degree Certi1047297cate Professional Quali1047297cation and employment letter OR 3 months salary slip Salinan Ijazah Kelayakan Professional dan surat tawaran kerja ATAU penyata gaji 3 bulan

Graduates

Graduan

Card Type Jenis Kad

Minimum Annual Income

Pendapatan Tahunan Minimum

P ETRONAS Maybank Visa Sony Card Visa

Manchester United Visa Card Maybank Cards

Gold American Expressreg Card

Singapore Airlines KrisFlyer

American Expressreg Gold Card PlatinumWorld MasterCard Visa In1047297nite

Maybank Cards Premier

RM RM RM RM

Signature

RM

SINGAPORE AIRLINES KRISFLYERAMERICAN EXPRESSreg GOLD CREDIT CARD



APPLICANT ADDITIONAL INFORMATION MAKLUMAT TAMBAHAN PEMOHON3

HP No No Tel Bimbit

BILLING ADDRESS AND CARD DELIVERY ALAMAT SURAT-MENYURAT DAN PENGHANTARAN KAD

Please send my statement to Sila hantar penyata saya ke

View my statement on wwwmaybank2ucom and e-mail

Lihat Penyata Akaun saya di wwwmaybank2ucom dan e-mel

E-mail address Alamat e-mel

I want my hardcopy statement to be mailed to me at RM1 per month

Saya ingin Penyata Akaun saya dikirimkan pada kadar RM1 sebulan

Billing address Alamat surat-menyurat

Please send my card to Sila hantar kad saya ke

Maybank branch Cawangan Maybank

Note No delivery will be made to international and PO Box addresses

Nota Penghantaran tidak akan dibuat ke alamat antarabangsa dan alamat peti surat

2



4

SINGAPORE AIRLINES KRISFLYER

AMERICAN EXPRESSreg GOLD CREDIT CARD

Charge Card Kad Caj


VISA PLATINUM





VISA GOLD

MASTERCARD GOLD

MASTERCARD PLATINUM



SONY CARD

OTHERS LAIN-LAIN ________________________

3

Mr Encik Mdm Puan Ms Cik

Others Lain-lain



5

3

4






J

PAYMENT CHARGES CAJ BAYARAN

6

SIGNATURE

lt



Jan 2015 1

PDPA Form for Individual Customers

(Borang PDPA Untuk Pelanggan-Pelanggan Individu)

Please complete in BLOCK LETTERS(Sila lengkapkan dengan HURUF BESAR)

Name _______________________________(Nama)

Identification Card Number _______________________________(Nombor Kad Pengenalan)

In order to process this application and subsequently to continue performing the contractual agreements

entered between you and any entity within Maybank Group we may need to disclose your personal data to

other entities within Maybank Group and other external parties Maybank Group refers to Malayan Banking

Berhad (ldquoMaybankrdquo) including its branches in Malaysia and in other countries as well as its local and overseassubsidiaries The external parties we disclose your personal data to may include but not limited to (1)

governmental and regulatory bodies such as Bank Negara Malaysia and Securities Commission (2) our business

strategic partners andor (3) agents andor outsourcing vendors (collectively ldquoExternal Partiesrdquo) These

External Parties may locate store maintain andor process your personal data within or outside of Malaysia

(Untuk memproses permohonan ini dan selanjutnya meneruskan perlaksanaan perjanjian-perjanjian kontrak

yang dimeterai antara anda dan mana-mana entiti dalam Kumpulan Maybank kami mungkin perlu

mendedahkan data peribadi anda kepada entiti-entiti lain dalam Kumpulan Maybank dan pihak-pihak luar

yang lain Kumpulan Maybank merujuk kepada Malayan Banking Berhad (ldquoMaybankrdquo) termasuk cawangan-

cawangannya di Malaysia dan di negara-negara lain serta juga anak-anak syarikat tempatan dan luar negara

Pihak luar yang kami dedahkan data peribadi anda mungkin termasuk tetapi tidak terhad kepada (1) badan-

badan kerajaan dan kawal selia seperti Bank Negara Malaysia dan Suruhanjaya Sekuriti (2) rakan-rakan niaga

strategik kami danatau (3) agen-agen danatau vendor-vendor penyumberan luar (secara kolektif Pihak

Luar) Pihak Luar ini boleh mencari menyimpan mengekalkan danatau memproses data peribadi anda didalam atau di luar Malaysia)

Under the Personal Data Protection Act (PDPA) 2010 we are required to obtain your explicit consent when we

collect and process your sensitive personal data We collect your sensitive personal data in order to assess

your application and to administer the products and services that you have signed up for

(Di bawah Akta Perlindungan Data Peribadi (PDPA) 2010 kami dikehendaki memperolehi persetujuan jelas

anda apabila kami mengumpul dan memproses data peribadi sensitif anda Kami mengumpul data peribadi

sensitif anda untuk menilai permohonan anda dan untuk mentadbirkan produk-produk dan perkhidmatan-

perkhidmatan yang anda telah meterai perjanjiannya)

From time to time we other entities within Maybank Group and or our strategic partners with whom we

have a relationship with for specific products services and promotions (collectively ldquoOther Entitiesrdquo) may

have information about products services and promotions that may be of interest to you To receive such

information your consent is required for us to process disclose andor share your informationdata with

Other Entities Accordingly please mark your preference by ticking the appropriate box in the declaration

below

(Dari semasa ke semasa kami termasuk entiti-entiti lain dalam Kumpulan Maybank dan atau rakan kongsi

strategik yang kami mempunyai hubungan berkenaan produk perkhidmatan dan promosi tertentu (secara

kolektif ldquoEntiti-entiti Lainrdquo) mungkin memiliki maklumat tentang produk-produk perkhidmatan-

perkhidmatan dan promosi-promosi yang mungkin menarik minat anda Untuk mendapatkan maklumat

sedemikian persetujuan anda diperlukan untuk kami memproses mendedah danatau berkongsi

maklumatdata anda dengan Entiti-entiti Lain Selanjutnya sila letakkan pilihan anda dengan menandakan

kotak berkenaan dalam deklarasi di bawah)



Jan 2015 2

Declaration

(Deklarasi)By signing this form I am declaring that I have read understood and agree to terms of the Maybank Group

Privacy Notice and I am expressly consenting to and authorising Maybank Group

(Dengan menandatangani borang ini saya mengisytiharkan bahawa saya telah baca dan fahami serta

bersetuju untuk tertakluk kepada Notis Privasi Kumpulan Maybank dan saya menyatakan persetujuan danmemberi kuasa kepada Kumpulan Maybank)

(i) To request for and to obtain all the personal information and data in this form for the purpose of

processing this application and all other purposes which are required in relation to any products

services and promotions offered by Maybank Group

(Untuk meminta dan memperolehi kesemua maklumat dan data peribadi dalam borang ini bagi tujuan

memproses permohonan ini dan semua tujuan-tujuan lain yang diperlukan berkaitan dengan mana-

mana produk perkhidmatan dan promosi yang ditawarkan oleh Kumpulan Maybank)

(ii) To disclose my personal data to the Other Entities and External Parties when required for the purposes

stated therein andor

(Untuk mendedahkan data peribadi saya kepada Entiti-entiti Lain dan Pihak Luar apabila dikehendakibagi tujuan yang dinyatakan didalamnya danatau)

(iii) To collect and process my sensitive personal data for the purpose of this application (where

applicable)

(Untuk mengumpul dan memproses data sensitif peribadi saya untuk tujuan permohonan ini yang mana

berkaitan)

By signing this form Iwe further confirm that all personal data that Iwe have provided are all true up-to-

date and accurate Should there be any changes to any of myour personal data Iwe shall notify Maybank

Group immediately

(Dengan menandatangani borang ini sayakami seterusnya mengesahkan bahawa kesemua data peribadi yang

sayakami telah berikan adalah semuanya benar terkini dan tepat Sekiranya terdapat apa-apa perubahan

pada mana-mana data peribadi sayakami sayakami akan memaklumkan kepada Kumpulan Maybank dengan

serta merta)

With regards to promotional and marketing materials(Berkenaan dengan bahan-bahan promosi dan pemasaran)

Yes Iwe expressly agree to Maybank Group andor Other Entities processing myour personal data forpromotional and marketing purposes(Ya sayakami menyatakan persetujuan untuk Kumpulan Maybank danatau Entiti-entiti Lainmemproses data peribadi sayakami untuk tujuan promosi dan pemasaran)

No Iwe do not agree to Maybank Group andor Other Entities processing myour personal data forpromotional and marketing purposes(Tidak sayakami tidak bersetuju untuk Kumpulan Maybank danatau Entiti-entiti Lain memprosesdata peribadi sayakami untuk tujuan promosi dan pemasaran)

Signature __________________________________________(Tandatangan)

Date _______________________________

(Tarikh)



1

Account Opening Form ndashSupplementary form for individuals

This form must be completed by any individual who wishes to open an account

Please complete in BLOCK LETTERS

Name _______________________________

Country of Birth _______________________________

Please check ldquo rdquo Yes or No for each of the following questions Yes No

1 Are you a US Citizen 2 Do you hold a US Permanent Resident Card (Green Card) 3 Are you a US Resident

4 If you have responded ldquoNordquo to the questions above then please tick the box below

Non-US person Declaration

I represent and declare that the information provided above is true accurate and complete I understand that the termUS person means any citizen or resident of the United States

I hereby consent for Malayan Banking Berhad or any of its affiliates including branches (collectively ldquothe Bankrdquo) toreport my information to regulatory authorities in accordance with the requirements of Foreign Account Tax ComplianceAct as may be stipulated by applicable laws regulations agreement or regulatory guidelines or directives

I hereby consent that the Bank may withhold from my account(s) such amounts in accordance with the requirements ofForeign Account Tax Compliance Act as may be stipulated by applicable laws regulations agreement or regulatoryguidelines or directives

I hereby consent that the Bank may classify me as a recalcitrant account holder andor suspend recall or terminate myaccount(s) andor facilities granted to me in the event I fail to provide accurate and complete information andordocumentation as the Bank may require

I undertake to notify the Bank in writing within 30 calendar days if there is a change in any information which I haveprovided to the Bank

Signature _______________________________

Date _______________________________

Definitions applicable

The term US person or United States person means a person described in section 7701(a)(30) of the InternalRevenue CodeThe term lsquolsquoUnited States personrsquorsquo meansmdash

(A) a citizen or resident of the United States



2

For Office Use

Section A

To be filled by Relationship Manager Questions below to be considered in conjunction with all documents amp forms collected fromcustomers (including this form)

US Indicia Status YesNoAction required if ldquoYesrdquo

(FATCA Documentation Checklist)

1 Have the account holder(s) provided anyindication that the account holder(s) areUS citizen or resident

To obtain either (i) Form W-9 or(ii) Appropriate documentation and Form W-8BEN

2 Have the account holder(s) provided a USplace of birth

To obtain either (i) Form W-9 or(ii) Certificate of Loss of Nationality and(iii) Appropriate documentation and Form W-8BEN

3 Have the account holder(s) provided a USUS address (including PO Box)


4 Have the account holder(s) provided only aUS telephone number


5 Have the account holder(s) provided anystanding instructions to transfer funds to anaccount maintained in the US


6 Have the account holder(s) provided a UStelephone number and a non UStelephone number

To obtain either (i) Form W-9 or(ii) Appropriate documentation or form W-8BEN

7 Have the account holder(s) granted Powerof Attorney to an Attorney with a US

address

To obtain either (i) Form W-9 or

(ii) Appropriate documentation or form W-8BEN

8 Have the account holder(s) provided only abullhold mailŽ or bullin care ofŽ address that is thesole address for this account


Where all questions above are answered as no bullappropriate documentationŽ asbelow should still be obtained

bullAppropriate documentationŽ refers to documentation to establish the person(s) foreign status The documentation must contain apermanent residence address outside of the US and must be one of the following documents(i) Certificate of residence (issued by tax officials)(ii) Government identification document (such as Identification Card)

Customer can also provide alternative documentation such as withholding certificate a form of documentary evidence described in[sect11471 hellip3(c)(5)(i)(B) hellipFATCA Regulation] evidencing citizenship in a country other than the United States and a reasonablewritten explanation of the account holders renunciation of US citizenship at birth in order to establish the account holders status as aforeign person

If the permanent address listed on the bullappropriate documentationŽobtained differs from the address provided in the application formensure that the bullappropriate documentationŽindicates the country in which the account holder(s) is a citizen or resident

In the absence of such documentation relationship manager should obtain form W-8 BEN from account holder(s)

W-8BEN form should not contain a permanent residence address in the US to conclude a customers status as bullNon USŽ



3

Section B

Bankrsquos assessment of customer(s)rsquo FATCA classification Customer is

Non US person

Specified US person

Recalcitrant customer with US Indicia

Recalcitrant customer without US Indicia

Recalcitrant customer that are passive NFFEs

Recalcitrant customer that is US person

Recalcitrant customer that is dormant account

Declaration and acknowledgement

I declare that the required account opening checks have been performed for the customer(s) listed above and that the information

provided is true correct and updated

Maybank employee name and employee ID Maybank employee signature Date



1

Borang Pembukaan Akaun ndash Borang Tambahan untuk Individu

Borang ini hendaklah dilengkapkan oleh mana-mana individu yang ingin membuka akaun

Sila lengkapkan dengan HURUF BESAR

Nama ________________________________

Negara Kelahiran _______________________

Sila tanda Ya atau Tidak bagi setiap soalan berikutYa Tidak

1 Adakah anda seorang warganegara Amerika Syarikat

2 Adakah anda mempunyai kad pemastautin tetap Amerika Syarikat (Green Card)

3 Adakah anda seorang pemastautin Amerika Syarikat

4 Sekiranya anda telah menandakan Tidak kepada soalan di atas sila tandakan

kotak di bawah

Non-US person

Deklarasi

Saya memberi representasi dan mengaku bahawa maklumat yang diberikan di atas adalah benar tepat dan lengkap Saya memahami

bahawa terma US person bermaksud mana-mana warganegara atau pemastautin Amerika Syarikat (ldquoASrdquo)

Saya dengan ini membenarkan Malayan Banking Berhad atau mana-mana anggota kumpulannya termasuk cawangan (secara kolektif

Bank) untuk melaporkan maklumat saya kepada pihak berkuasa mengikut peruntukan dibawah Foreign Account Tax Compliance Act

yang telah ditetapkan oleh undang-undang peraturan-peraturan perjanjian atau garis panduan atau arahan yang berkenaan

Saya dengan ini membenarkan Bank untuk menahan sebarang amaun dari akaun saya mengikut kehendakan di bawah Foreign Account

Tax Compliance Act yang telah ditetapkan oleh undang-undang peraturan-peraturan garis panduan atau arahan yang berkenaan

Saya dengan ini membenarkan Bank untuk mengklasifikasikan saya sebagai pemegang akaun rekalsitran danatau menggantung menarik

balik atau menamatkan akaun saya danatau kemudahan yang diberikan kepada saya sekiranya saya gagal memberikan maklumat tepat

dan lengkap danatau dokumentasi yang dikehendaki oleh Bank

Saya mengakujanji untuk memaklumkan Bank secara bertulis dalam tempoh 30 hari kalender jika terdapat sebarang perubahan kepada

maklumat yang telah saya berikan kepada Bank

Tandatangan ______________________

Tarikh ____________________________

Takrifan terpakai

Terma ldquoUS personrdquo atau ldquoUnited Statesrdquo person bermaksud seseorang yang ditakrifkan di bawah Seksyen 770(a)(30) Internal Revenue

Code

Terma United States personrdquo bermaksudndash

(A) Seorang warganegara atau pemastautin AS



2

Untuk Kegunaan Pejabat

Bahagian A

Untuk diisi oleh Pengurus Perhubungan Soalan-soalan di bawah untuk dipertimbangkan dengan semua dokumen amp borang yangdikumpul daripada pelanggan (termasuk borang ini)

US Indicia Status YaTidak Tindakan diperlukan jika ldquoYardquo (Senarai Dokumentasi FATCA)

1 Adakah pemegang akaun memberikan apa-apapetunjuk bahawa pemegang akaun adalahwarganegara Amerika Syarikat ataupermastautin

Untuk mendapatkan sama ada(i) Borang W-9 atau(ii) Dokumentasi yang sesuai dan Borang W-8BEN

2 Adakah pemegang akaun menyatakan tempatlahir di US

Untuk mendapatkan sama ada(i) Borang W-9 atau(ii) Sijil Kehilangan Kewarganegaraan dan(iii) Dokumentasi yang sesuai dan Borang W-8BEN

3 Adakah pemegang akaun menyatakan alamat US(termasuk PO Box)


4 Adakah pemegang akaun hanya menyatakanhanya satu nombor telefon US


5 Adakah pemegang akaun memberikan apa-apaarahan tetap untuk memindahkan dana kepadaakaun yang disenggarakan di US


6 Adakah pemegang akaun memberikan nombortelefon US dan nombor telefon bukan US


7 Adakah pemegang akaun memberikan KuasaWakil kepada Peguam dengan alamat US


8 Adakah pemegang akaun memberikan hanyapegangan surat atau dalam jagaan alamatsebagai alamat tunggal untuk akaun ini


Di mana semua soalan-soalan di atas dijawab bullTidak adaŽdokumentasi yang sesuai seperti di bawah masih perlu diperolehi

bullDokumentasi yang sesuaiŽmerujuk kepada dokumentasi untuk membuktikan orang yang berstatus asing Dokumentasi ini mestimengandungi alamat tempat tinggal tetap di luar Amerika Syarikat dan mesti terdiri daripda salah satu dokumen-dokumen sepertiberikut

(i) Sijil pemaustautin (dikeluarkan oleh pegawai-pegawai cukai)(ii) Dokumen pengenalan Kerajaan (seperti Kad Pengenalan)

Pelanggan boleh juga memberikan dokumentasi alternatif seperti sijil pegangan satu bentuk keterangan dokumen seperti yangdinyatakan dalam sect 11471-3 (c) (5) (i) (B) hellipPeraturan FATCA untuk membuktikan kewarganegaraan di negara lain selain daripadaAmerika Syarikat dan penjelasan yang munasabah dalam bentuk tulisan penolakan pemegang akaun kewarganegaraan AmerikaSyarikat untuk membuktikan status pemegang akaun sebagai orang asing

Jika alamat tetap disenaraikan di dokumentasi yang sesuai yang diperolehi berbeza daripada alamat yang diberikan di dalamborang permohonan pastikan bahawa dokumentasi yang sesuai yang menunjukkan negara di mana pemegang akaun adalahseorang warganegara atau pemastautin

Jika tiada dokumentasi seperti yang dikehendaki Pengurus Perhubungan perlu mendapatkan borang W-8 BEN daripada pemegangakaun

Borang W-8BEN tidak seharusnya mengandungi alamat tempat tinggal tetap di US untuk membuat kesimpulan status pelanggansebagai Non US



3

Bahagian B

Penilaian Bank untuk klasifikasi FATCA pelanggan Pelanggan adalah

Non US person

Specified US person

Pelanggan Recalcitrant dengan US Indicia Recalcitrant customer with US Indicia

Pelanggan Recalcitrant tanpa US Indicia Recalcitrant customer without US Indicia

Pelanggan Recalcitrant yang pasif NFFEs Recalcitrant customer that are passive NFFEs

Pelanggan Recalcitrant yang US person Recalcitrant customer that is US person

Pelanggan Recalcitrant account yang dormant Recalcitrant customer that is dormant account

Pengisytiharan dan pengakuan

Saya mengaku bahawa semakan akaun pembukaan telah dijalankan untuk pelanggan yang disenaraikan di atas dan maklumat yangdiberikan adalah benar betul dan kemaskini

Nama pekerja Maybank dan pekerja ID Tandatangan pekerja Maybank Tarikh



APPLICANT ADDITIONAL INFORMATION MAKLUMAT TAMBAHAN PEMOHON3

HP No No Tel Bimbit

BILLING ADDRESS AND CARD DELIVERY ALAMAT SURAT-MENYURAT DAN PENGHANTARAN KAD

Please send my statement to Sila hantar penyata saya ke

View my statement on wwwmaybank2ucom and e-mail

Lihat Penyata Akaun saya di wwwmaybank2ucom dan e-mel

E-mail address Alamat e-mel

I want my hardcopy statement to be mailed to me at RM1 per month

Saya ingin Penyata Akaun saya dikirimkan pada kadar RM1 sebulan

Billing address Alamat surat-menyurat

Please send my card to Sila hantar kad saya ke

Maybank branch Cawangan Maybank

Note No delivery will be made to international and PO Box addresses

Nota Penghantaran tidak akan dibuat ke alamat antarabangsa dan alamat peti surat

2



4



Charge Card Kad Caj


VISA PLATINUM





VISA GOLD

MASTERCARD GOLD

MASTERCARD PLATINUM



SONY CARD

OTHERS LAIN-LAIN ________________________

3


Others Lain-lain



5

3

4






J


6

SIGNATURE

lt



Jan 2015 1




Name _______________________________(Nama)






























below










Jan 2015 2

Declaration















applicable)


berkaitan)



Group immediately




serta merta)





Date _______________________________

(Tarikh)



1




Name _______________________________

Country of Birth _______________________________










Signature _______________________________

Date _______________________________






2

For Office Use

Section A

















address













3

Section B


Non US person

Specified US person












1




Nama ________________________________







kotak di bawah

Non-US person

Deklarasi













Tandatangan ______________________

Tarikh ____________________________

Takrifan terpakai


Code





2


Bahagian A




























3

Bahagian B


Non US person

Specified US person











4



Charge Card Kad Caj


VISA PLATINUM





VISA GOLD

MASTERCARD GOLD

MASTERCARD PLATINUM



SONY CARD

OTHERS LAIN-LAIN ________________________

3


Others Lain-lain



5

3

4






J


6

SIGNATURE

lt



Jan 2015 1




Name _______________________________(Nama)






























below










Jan 2015 2

Declaration















applicable)


berkaitan)



Group immediately




serta merta)





Date _______________________________

(Tarikh)



1




Name _______________________________

Country of Birth _______________________________










Signature _______________________________

Date _______________________________






2

For Office Use

Section A

















address













3

Section B


Non US person

Specified US person












1




Nama ________________________________







kotak di bawah

Non-US person

Deklarasi













Tandatangan ______________________

Tarikh ____________________________

Takrifan terpakai


Code





2


Bahagian A




























3

Bahagian B


Non US person

Specified US person











5

3

4






J


6

SIGNATURE

lt



Jan 2015 1




Name _______________________________(Nama)






























below










Jan 2015 2

Declaration















applicable)


berkaitan)



Group immediately




serta merta)





Date _______________________________

(Tarikh)



1




Name _______________________________

Country of Birth _______________________________










Signature _______________________________

Date _______________________________






2

For Office Use

Section A

















address













3

Section B


Non US person

Specified US person












1




Nama ________________________________







kotak di bawah

Non-US person

Deklarasi













Tandatangan ______________________

Tarikh ____________________________

Takrifan terpakai


Code





2


Bahagian A




























3

Bahagian B


Non US person

Specified US person













J


6

SIGNATURE

lt



Jan 2015 1




Name _______________________________(Nama)






























below










Jan 2015 2

Declaration















applicable)


berkaitan)



Group immediately




serta merta)





Date _______________________________

(Tarikh)



1




Name _______________________________

Country of Birth _______________________________










Signature _______________________________

Date _______________________________






2

For Office Use

Section A

















address













3

Section B


Non US person

Specified US person












1




Nama ________________________________







kotak di bawah

Non-US person

Deklarasi













Tandatangan ______________________

Tarikh ____________________________

Takrifan terpakai


Code





2


Bahagian A




























3

Bahagian B


Non US person

Specified US person











Jan 2015 1




Name _______________________________(Nama)






























below










Jan 2015 2

Declaration















applicable)


berkaitan)



Group immediately




serta merta)





Date _______________________________

(Tarikh)



1




Name _______________________________

Country of Birth _______________________________










Signature _______________________________

Date _______________________________






2

For Office Use

Section A

















address













3

Section B


Non US person

Specified US person












1




Nama ________________________________







kotak di bawah

Non-US person

Deklarasi













Tandatangan ______________________

Tarikh ____________________________

Takrifan terpakai


Code





2


Bahagian A




























3

Bahagian B


Non US person

Specified US person











Jan 2015 2

Declaration















applicable)


berkaitan)



Group immediately




serta merta)





Date _______________________________

(Tarikh)



1




Name _______________________________

Country of Birth _______________________________










Signature _______________________________

Date _______________________________






2

For Office Use

Section A

















address













3

Section B


Non US person

Specified US person












1




Nama ________________________________







kotak di bawah

Non-US person

Deklarasi













Tandatangan ______________________

Tarikh ____________________________

Takrifan terpakai


Code





2


Bahagian A




























3

Bahagian B


Non US person

Specified US person











1




Name _______________________________

Country of Birth _______________________________










Signature _______________________________

Date _______________________________






2

For Office Use

Section A

















address













3

Section B


Non US person

Specified US person












1




Nama ________________________________







kotak di bawah

Non-US person

Deklarasi













Tandatangan ______________________

Tarikh ____________________________

Takrifan terpakai


Code





2


Bahagian A




























3

Bahagian B


Non US person

Specified US person











2

For Office Use

Section A

















address













3

Section B


Non US person

Specified US person












1




Nama ________________________________







kotak di bawah

Non-US person

Deklarasi













Tandatangan ______________________

Tarikh ____________________________

Takrifan terpakai


Code





2


Bahagian A




























3

Bahagian B


Non US person

Specified US person











3

Section B


Non US person

Specified US person












1




Nama ________________________________







kotak di bawah

Non-US person

Deklarasi













Tandatangan ______________________

Tarikh ____________________________

Takrifan terpakai


Code





2


Bahagian A




























3

Bahagian B


Non US person

Specified US person











1




Nama ________________________________







kotak di bawah

Non-US person

Deklarasi













Tandatangan ______________________

Tarikh ____________________________

Takrifan terpakai


Code





2


Bahagian A




























3

Bahagian B


Non US person

Specified US person











2


Bahagian A




























3

Bahagian B


Non US person

Specified US person











3

Bahagian B


Non US person

Specified US person









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