PERMOHONAN PERKHIDMATAN PELABURAN SAHAM PB SHARELINK - INDIVIDU/ APPLICATION FOR PB SHARELINK SHARE INVESTMENT SERVICES - INDIVIDUAL
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1 Individual - Non-Margin PEOHONAN PERKHIDMATAN PELABURAN SAHAM PB SHARELINK - INDIVIDU/ APPLICATION FOR PB SHARELINK SHARE INVESTMENT SERVICES - INDIVIDUAL 1) PERKHIDMATAN YANG DIPOHON / SERVICE APPLIED FOR Jenis Perkhidmatan / Service Type Cagaran Permulaan Yang Ditawarkan / Initial Collateral Offerred Collaterised Trading/ Cash Trading* Saham / Shares Simpanan Tetap/ Fixed Deposits Tunai/ Lain-lain/ Cash/ Other Cawangan / Branch Unit Pelaburan Saham/ Share Investment Unit : : : 2) BUTIR-BUTIR PEMOHON / PARTICULARS OF APPLICANT(S) Nama (seperti Kad Pengenalan) / (as per IC) No. Kad Pengenalan Baru/ New IC No. No. Kad Pengenalan Lama/ Pasport/ Old IC/ Passport No. Pemohon 1/ Applicant 1 Pemohon 2 (Jika Bersama)/ Applicant 2 (If Joint) Tarikh Lahir / of Birth (dd/mm/yy) (dd/mm/yy) Jantina / Gender Bangsa / Race Bumiputra / Bumiputra Warganegara / Nationality Alamat / Address Male/ Female* Chinese/ Malay/ Indian/ Other* Please specify: No/ Yes* Male/ Female* Chinese/ Malay/ Indian/ Other* Please specify: No/ Yes* Poskod / Postcode Adakah anda tinggal tetap di M'sia? / Are you permanently residing in M'sia? No. Telefon / Telephone No. / Emel (TB /HP) (TB /HP) (R /H) (R /H) Taraf Perkahwinan / Marital Status Jumlah Tangungan / No. of Dependents Orang yang patut dihubungi (sekira berlaku kecemasan) / Persons to contact (in case of emergency) Single/ Married/ Divorced/ Other* Relationship Telephone No. Single/ Married/ Divorced/ Other* Relationship Telephone No. 1
2 3) PEKERJAAN/ OCCUPATION Pekerjaan / Employment Nama Majikan / of Employer Jenis Perniagaan / Nature of Business Kedudukan / Position Tempoh Perkhidmatan / Length of Service Alamat Pejabat / Office Address Under Employment/ Self-Employed/ Retired/ Unemployed/ Other* Under Employment/ Self-Employed/ Retired/ Unemployed/ Other* Poskod / Postcode No. Telefon / Telephone No. (P /O 1) (P /O 1) (P /O 2) (P /O 2) No. Faks / Fax No. Pendapatan Bulanan Kasar / Gross Monthly Income Alamat surat-menyurat / Mailing Address Residence/ Office* 1,000 or below 1,001-2,000 2,001-3,000 3,001-5,000 5,001-7,500 7,501-10,000 Above 10,000 5) CARA PENGHANTARAN / MODE OF DELIVERY Nota Kontrak/ Contract Physical/ econtract Note* Note Penyata/ Statement Physical/ econtract Note* 1,000 or below 1,001-2,000 2,001-3,000 3,001-5,000 5,001-7,500 7,501-10,000 Above 10,000 4) TELEFON & ALAMAT SURAT-MENYURAT DIPILIH / PREFERRED TELEPHONE & MAILING ADDRESS Telefon / Telephone Handphone/ House/ Office* 6) LAIN-LAIN MAKLUMAT / OTHER INFOATION Handphone/ House/ Office* Akaun sedia ada dengan Savings Acc. No. : Savings Acc. No. : Public Bank / Existing Current Account No. : Current Account No. : Account with Public Bank Fixed Deposit Acc. No.: Fixed Deposit Acc. No.: 7) DOKUMEN DISERAHKAN / DOCUMENTS SUBMITTED Residence/ Office* a. Salinan K.P./ Pasport / Photocopy of NRIC/ Passport b. Borang BE atau e-be terbaru / Latest Form BE or e-be c. Resit Tax / Tax Receipt for last 2 years d. Slip Gaji / Salary Slip for the last 3 months e. Penyata Bank / Bank Statement for the last 3 months f. Penyata BMD terbaru / Latest BMD Statement g. Lain-lain / Others (Sila nyatakan / Please specify) 7) PENGAKUAN / DECLARATION Bahagian I / Part I 1. Dengan ini, saya/kami mengesahkan bahawa maklumat di atas adalah benar dan betul dan memberi kuasa kepada Bank atau wakil Bank untuk mendapatkan maklumat berkaitan dengan permohonan ini dari mana-mana sumber (yang mana berkenaan)./ I/We hereby declare that the above information is true and correct and authorise the Bank or the Bank's representative to obtain information in respect of to this application from any source (to which the same may apply) Dengan ini, saya/kami mengesahkan bahawa maklumat di atas adalah benar dan betul dan memberi kuasa kepada Bank atau wakil Bank untuk mendapatkan maklumat berkaitan dengan permohonan ini dari mana-mana sumber yang sesuai. / As the information furnished are true and correct and I/We hereby authorize you to verify the same from any source as you may in your sole discretion herein deem appropriate. Penerimaan permohonan ini oleh Bank bukan merupakan persetujuan Bank secara automatik untuk memberi saya/kami perkhidmatan tersebut. / The acceptance of this application by the Bank does not constitute the Bank's automatic agreement to grant me/us the service. 2
3 4. Bank berhak untuk menolak permohonan ini tanpa memberi APA-APA sebab. / The Bank has the right to reject this application without assigning ANY reasons thereto Perkhidmatan ini, jika diluluskan oleh Bank, adalah tertakluk kepada semakan semula, pengurangan atau pembatalan sebelum penyelesaian perkhidmatan tersebut mengikut budi bicara mutlak Bank. / The service, if approved by the Bank is/are subject to revision, reduction or cancellation prior to the conclusion of the service in the absolute discretion of the Bank. Bank mempunyai hak mutlak untuk menahan wang dalam mana-mana daripada akaun saya/kami yang lain dengan Bank dan apa-apa cagaran/cagaran-cagaran dan/atau hartanah/hartanah-hartanah yang dipegang oleh Bank untuk membayar apa-apa pendahuluan/pinjaman, sekiranya ada, yang terhutang dengan Bank dengan memberikan notis terlebih dahulu kepada saya/kami. / The Bank has the absolute right to retain moneys on any of my/our other accounts with the Bank and any security/ies and/or property/ies held by the Bank to off-set any advance/loan, if any, owing to the Bank with prior notice to me/us. 7. Dengan ini, saya/kami mengakui bahawa saya/kami tidak mempunyai hubungan persaudaraan dengan mana-mana pengarah, pemegang saham terbesar, pengarah eksekutif atau pegawai kredit Bank sebagai tanggungannya, termasuk sebagai isteri atau suami, tanggungan kepada isteri atau suami, anak-anak (termasuk anak tiri dan anak angkat), ibu bapa dan saudara mara terdekat. Ini adalah bagi memastikan pematuhan pada Garis panduan Bank Negara Malaysia mengenai Urus niaga Kredit dan Pendedahan kepada Pihak-pihak Berkaitan dengan Bank dan sebagai mematuhi dasar Bank berhubung dengan larangan bagi urus niaga pemberian kredit kepada pihak-pihak berkaitan di atas. Saya/Kami mengaku janji untuk memaklumkan kepada Bank dengan serta-merta sekiranya hubungan seumpama itu terjalin pada masa hadapan. Bank mempunyai hak untuk menarik balik kemudahan sekiranya syarat/syarat-syarat tersebut tidak dipatuhi / I/We hereby declare that I/we am/are not related to any director controlling shareholder, executive officer or credit officer of the Bank as a dependent thereof, including whether as spouse, dependents of spouse, children (including step children and adopted children) and parent(s) and close relatives. This is to ensure compliance to Bank Negara Malaysia s Guidelines on Credit Transactions and Exposures with Connected Parties of the Bank and in compliance with the Bank s policy on the prohibition of granting credit transactions to the above-mentioned connected parties. I/We undertake to inform the Bank immediately in the event that any such relationship as stated above arises in the future. The Bank has the right to recall the facility/ies if this condition is not complied with. 8. Dengan ini, saya/kami bersetuju dan berwaad, secara bersesama dan berasingan, untuk menyelesaikan sepenuhnya semua kemudahan kredit yang diberi kepada saya/kami sebelum berlakunya apa-apa peristiwa yang akan menyebabkan mana-mana pengarah, pegawai atau kakitangan Bank atau subsidiarinya mempunyai hubungan persaudaraan dengan saya atau mana-mana daripada kami seperti yang tersebut di atas. / I/We hereby agree and convenant, jointly and severally, to fully settle all credit facilities extended to me/us prior to the happening of any event that will cause any director, officer or employee of the Bank or its subsidiaries to become related to me/us as aforesaid. 9. Saya/Kami mengaku janji secara bersesama dan berasingan, untuk menanggung rugi Bank atau mana-mana pengarah atau pegawai atau kakitangan Bank terhadap apa-apa juga liabiliti walau bagaimana sekalipun ia berlaku berikutan daripada tindakan/ prosiding/tuntutan terhadap Bank atau mana-mana pengarah, pegawai atau kakitangan Bank berkaitan dengan ketidakpatuhan terhadap mana-mana peruntukan dalam Akta Perkhidmatan Kewangan 2013 serta garis panduan atau arahan yang dikelurkan oleh Bank Negara dari semasa ke semasa. /I/We further undertakes jointly and severally to indemnify the Bank or any director or officer or employee of the Bank against any liabilites whatsoever arising from any actions/proceedings/claims against the Bank or any director, officer or employee of the Bank in connection with non-compliance with any provisions of the Financial Services Act 2013 and any Guidelines or directives issued by Bank Negara Malaysia from time to time Pada tarikh semasa, saya/kami bukanlah seorang bankrap dan tidak ada sebarang tindakan kebankrapan terhadap saya/kami dibawah undang-undang Malaysia atau pun dibawah mana-mana perundangan yang lain. / At the date hereto, I/We am/are not an undischarged bankrupt and that no bankruptcy proceedings have been instituted against me/us under the laws of Malaysia or in another jurisdiction. Semua terma dan syarat lain yang tidak disebut secara khusus di atas hendaklah di masukkan dalam Surat (Surat-surat) Tawaran dan dokumen berkaitan dengan permohonan ini. / All other terms and conditions not specifically mentioned above are to be incorporated in the Letter(s) of Offer and the documents in relation to this application. Saya/Kami telah membaca dan mamahami terma dan syarat diatas bagi permohonan perkhidmatan. Saya/Kami memberi kuasa kepada pihak Bank untuk memberi sebarang maklumat yang difikirkan perlu kepada Public Investment Bank Berhad (PIVB) untuk membolehkan PIVB membuka satu akaun urus niaga atas nama saya/kami. Dengan ini, saya/kami mengaku faham perkhidmatan oleh pihak Bank adalah tertakluk kepada PIVB bersetuju untuk membuka satu akaun urus niaga atas nama saya/kami. Dengan ini, saya/kami mengaku janji dan bersetuju untuk terikat dengan terma dan syarat seperti yang disebut didalam ini termasuk sebarang pertukaran dari masa ke semasa. / I/We have read and understood the above terms and conditions for applications for the service. I/We authorise the Bank to provide whatever information deemed necessary to Public Investment Bank Berhad (PIVB) in order for PIVB to open a trading account in my/our name. I/We hereby understand that the granting of any service by the Bank is conditional upon PIVB agreeing to open a trading account in my/our name. I/We hereby undertake and agree to be bound by the terms and conditions as mentioned therein including any amendments thereto from time to time. Part II/ Bahagian II 1. Saya/ Kami memahami bahawa untuk memberi atau untuk terus memberi perkhidmatan/kemudahan, maklumat peribadi dan kredit saya/ kami mungkin didedahkan, dikongsi dengan atau diterima daripada pihak ketiga, badan, biro, perbadanan atau agensi pelaporan kredit yang terutamanya dinyatakan di bawah. Bank mungkin tidak dapat memberi atau terus memberikan perkhidmatan/kemudahan kecuali Bank boleh mendedahkan kepada, berkongsi dengan atau menerima maklumat peribadi atau kredit daripada pihak ketiga berkenaan / I/We understand that in order to provide or continue to make available the services/ facility/ies my/our personal or credit information may be disclosed to, shared with or received from relevant third parties, bodies, bureaux, corporation or credit reporting agencies more particularly stated below. The Bank will not be able to provide or continue to provide me/us with the services/ facility/ies unless the Bank can disclose, share with or receive such personal or credit information from the said relevant third parties 3
4 2. Dengan ini, saya/kami mengizinkan dan membenarkan maklumat peribadi dan kredit tersebut dikemukakan atau dimaklumkan oleh Bank kepada penjamin-penjamin (jika berkenaan) atau kepada syarikat-syarikat dalam Kumpulan PBB termasuk Public Islamic Bank Berhad dan Public Investment Bank Berhad. / I/We hereby consent and authorise that my/our personal and credit information may be forwarded or made known by the Bank to the guarantors (if applicable) or the companies in the PBB Group including Public Islamic Bank Berhad and Public Investment Bank Berhad. 3. Dengan ini, saya/kami mengizinkan dan membenarkan semua maklumat berkaitan dengan kemudahan/perkhidmatan yang diberi kepada saya/kami dikemukakan kepada Public Investment Bank Berhad, Bursa Malaysia Berhad atau Bursa Malaysia Depository Sdn Bhd atau manamana biro atau agensi yang ditubuhkan atau diluluskan oleh Bank Negara Malaysia (BNM) atau yang didaftarkan atau dilesenkan di bawah Akta Agensi Pelaporan Kredit 2010 termasuk Biro Kredit Pusat, Sistem Maklumat Pinjaman Peminjam, Sistem Maklumat Cek Tak Laku (DCheqs), Sistem Maklumat Rujukan Kredit Pusat (CCRIS), FIS Data Reference Sdn Bhd (FIS), RAM Credit Information Sdn Bhd (RAMCI), CTOS Data Systems Sdn Bhd (CTOS), Credit Bureau Malaysia Sdn Bhd (CBM), Dun & Bradstreet (Malaysia) Sdn Bhd (D&B), Basis Corporation Sdn Bhd (Basis) serta badan, biro, perbadanan atau agensi pelaporan kredit seumpamanya, mengikut keadaannya, bagi tujuan untuk mengumpul maklumat daripada institusi-institusi kewangan berkenaan dengan kemudahan yang diberi atau akaun yang dikekalkan dengan institusi kewangan tersebut dan/atau semakan kemudahan dan/atau perkhidmatan. I/We hereby consent and authorise that all information relating to the facility/ies granted to me/us may be forwarded to Public Investment Bank Berhad, Bursa Malaysia Berhad or Bursa Malaysia Depository Sdn Bhd or any bureau or agencies established or approved by Bank Negara Malaysia (BNM) or registered and licensed under the Credit Reporting Agencies Act 2010 including the Central Credit Bureau, the Borrower Loans Information System, Dishonoured Cheque Information System (DCheqs), Central Credit Reference Information System (CCRIS), FIS Data Reference Sdn Bhd (FIS), RAM Credit Information Sdn Bhd (RAMCI), CTOS Data Systems Sdn Bhd (CTOS), Credit Bureau Malaysia Sdn Bhd (CBM), Dun & Bradstreet (Malaysia) Sdn Bhd (D&B), Basis Corporation Sdn Bhd (Basis)and other such bodies, bureaux, corporations or credit reporting agencies, as the case may be, for the purpose of collecting information from financial institutions regarding facilities granted or accounts maintained with such financial institutions and/or review of the facility/ies and/or the services. 4. Dengan ini, saya/ kami bersetuju untuk membayar semua fi, caj dan perbelanjaan, dan apa-apa cukai yang perlu dibayar, sama ada yang dikuatkuasakan pada masa ini atau yang akan dilaksanakan dan yang boleh dicaj di bawah undang-undang, termasuk tetapi tidak terhad kepada Cukai Barang dan Perkhidmatan (GST) ke atas fi, caj dan perbelanjaan seumpamanya yang berkaitan dengan kemudahan/perkhidmatan berkenaan. "/ I/We hereby agree to pay all fees, charges and expenses, and any applicable tax payable, whether currently in force or to be implemented and chargeable by law, including but not limited to Goods and Services Tax (GST) on such fees, charges and expenses in connection with the facility/ies/ services." Part III/ Bahagian III 1. Dengan ini, saya/kami mengemukakan untuk pertimbangan tuan permohonan saya/kami bagi perkhidmatan PB Sharelink seperti yang dinyatakan di bawah / I/We hereby submit for your consideration my/our application for the PB Sharelink service below :- Jenis Perkhidmatan / Service Type Tandatangan Pelanggan / Applicant's Collaterised Trading/ Cash Trading* > > Verified Nama / No. K.P. / NRIC No. Tarikh / 4
5 UNTUK KEGUNAAN BANK SAHAJA / FOR BANK'S USE ONLY A) To be Completed by Share Investment Unit The following have been confirmed in order:- [ ] A/A No. assigned [ ] BNM Loan Sectoral Code [ ] Two ( 2 ) photocopies of NRIC / passport [ ] For joint account, to indicate name of Beneficial Owner [ ] Referred/ Marketed by: SIU/ Branch/ SIBC/ Walk In/ Other* Please indicate here: [ ] Other, please specify Recommendation/ Comments:- Net BFE Trading Limit > > Verified Designation B) To be Completed by Share Investment Business Centre [X] Search Results [ ] CTOS [ ] BRIS [ ] BMC [ ] FRD Net BFE Limit Trading Limit Processing/ Recommendation Approving Authority Processed by: Approved/ Rejected* by: > > Designation 5
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