Auto Financing Application (Individual) Enquiries CIMB Islamic Bank Berhad ( H) CIMB Bank Berhad (13491-P)

Transcription

1 Ato Financing Application (Individal) Enqiries CIMB Islamic Bank Berhad ( H) CIMB Bank Berhad (13491-P) 1 APPLICANT DETAILS PERSONAL DETAILS Saltation Mr Madam Miss Others Name As Per NRIC Highest Level of Edcation Obtained* Postgradate Professional Qalification Degree Diploma Secondary Primary Others EMPLOYMENT DETAILS Employer s Name Gender Male Female New NRIC Nmber Old NRIC Nmber* Position Other Identification (complete if if yo do not have an NRIC) Army/ Specify Passport Police Nmber Date of Birth (DD/MM/YYYY) Employer s Address Address* Home Phone Nmber Mobile Phone Nmber Contry Employer s Phone Nmber (se ext to indicate extension nmber) Marital Stats Single Married Others Nmber and Age(s) of Dependant Children* Age(s) Nationality Malaysian Others If not Malaysian, what is yor residence stats? Non-Malaysian Resident Malaysia My 2nd Home Permanent Resident Race Malay Chinese Indian Others Bmiptra Yes No Permanent Home Address Contry Dration at Permanent Address Years Months Crrent Residence Stats Owned - Charged Rented Relatives Owned - Not Charged Company Qarters Parents Mailing Address (complete if if different from above) Employment Type Employed (Fixed) Own Bsiness (Non Professional) Employed (Non Fixed) Unemployed (With Other Income) Unemployed (Withot Income, Pensioner, Hosewife, Stdent) Occpation Date Employed (DD/MM/YYYY) Main Monthly Gross Income Other Monthly Income Type of Company CIMB Grop Non-Profit Organisation Financial Instittion Private Limited Company Government Agency Pblic Limited Company Brsa Listed School/College Mlti-National Company (Non-Financial Instittion) Sole Proprietor/Partnership Size of Crrent Employment Company Small Medim Big Bsiness (<15 employees) (15-50 employees) (>50 employees) Total Working Experience (crrent and all previos employment) Years Months Are yo an existing CIMB Grop cstomer? Yes No EMERGENCY CONTACT DETAILS* Fll Name As In NRIC Relationship with Main Applicant Contry Page 1 of 6 Home Phone Nmber Mobile Phone Nmber * Optional

2 2 SPOUSE DETAILS (Complete Only If Yor Spose Is Not A Garantor) Name As Per NRIC New NRIC Nmber Old NRIC Nmber* Other Identification (complete if yor spose does not have an NRIC) Home Phone Nmber 3 GUARANTOR DETAILS PERSONAL DETAILS Saltation Mr Madam Miss Others Name As Per NRIC Passport Mobile Phone Nmber Army/ Police Specify Nmber Office Phone Nmber Mailing Address (complete if different from above) Gender Male Female New NRIC Nmber Address* Old NRIC Nmber* Other Identification (complete if yo do not have an NRIC) Army/ Specify Passport Police Nmber Date of Birth (DD/MM/YYYY) Relationship to Applicant Contry Highest Level of Edcation Obtained* Postgradate Professional Qalification Degree Diploma Secondary Primary Others EMPLOYMENT DETAILS Employer s Name Department Employer s Address Home Phone Nmber Mobile Phone Nmber Marital Stats Single Married Others Nmber and Age(s) of Dependant Children* Age(s) Nationality Malaysian Others If not Malaysian, what is yor residence stats? Non-Malaysian Resident Malaysia My 2nd Home Permanent Resident Race Malay Chinese Indian Others Bmiptra Yes No Permanent Home Address Contry Dration at Permanent Address Years Months Crrent Residence Stats Owned - Charged Rented Relatives Owned - Not Charged Company Qarters Parents Occpation Date Employed (DD/MM/YYYY) Main Monthly Gross Income Type of Company CIMB Grop Financial Instittion Government Agency Brsa Listed Mlti-National Company (Non-Financial Instittion) Size of Crrent Employment Company Small (<15 employees) Contry Medim (15-50 employees) Total Working Experience (crrent and all previos employment) Years Months Employer s Phone Nmber (se ext to indicate extension nmber) Employment Type Employed (Fixed) Own Bsiness (Non-Professional) Employed (Non Fixed) Unemployed (With Other Income) Unemployed (Withot Income, Pensioner, Hosewife, Stdent) Other Monthly Income Non-Profit Organisation Private Limited Company Pblic Limited Company School/College Sole Proprietor/Partnership Big Bsiness (>50 employees) Are yo an existing CIMB Grop cstomer? Yes No Page 2 of 6 * Optional

3 4 REFEREE DETAILS* Name of Referee Occpation Relationship to Applicant Home Phone Nmber Mobile Phone Nmber Office Phone Nmber (se ext to indicate extension nmber) Address Contry 5 FINANCE AND VEHICLE DETAILS Deal Type Dealer Direct Case Financing Promotion Type Dealer/Seller s Name Salesman s Name Prodct Type Fixed Rate Variable Rate Application Type New Unregistered Reconditioned Used Used Reconditioned Prchase Location Peninslar Malaysia Laban Langkawi Sabah and Sarawak Year Make Date of Registration Registration Nmber Make Model Engine Capacity (CC) <1000 CC CC >2000 CC Fel Type Petrol Diesel Others Price of Vehicle Amont Financed Tenre Months Interest/Profit Rate % Where is the Vehicle Kept? Contry 6 TRADE-IN DETAILS Make Model Registration Nmber Year Make Trade-in Vale 7 DOCUMENTS ENCLOSED Which of the following docments are yo providing with this form? Photocopy of applicant's NRIC/Passport Photocopy of Driving License Photocopy of Registration Card Latest 3 months bank statements Latest 3 months salary slip or other income evidence Latest EA Form/Form B with proof of tax payment/epf ment Page 3 of 6 * Optional

4 Credit Card-i & Credit Card Application Form SMSA Branch Code Employee I/D MINIMUM INCOME PER ANNUM Platinm Visa SIGNATURE World MasterCard Enrich World MasterCard Visa INFINITE Enrich World Elite MasterCard 24,000 60,000 90, , , ,000 1 I WISH TO APPLY FOR THE FOLLOWING CARD (PLEASE CHOOSE A MAXIMUM OF 3 CARD PRODUCTS ONLY) : A. CIMB BANK CREDIT CARD CIMB PETRONAS Platinm MasterCard CIMB Platinm MasterCard CIMB Visa SIGNATURE CIMB Cash Rebate Platinm MasterCard CIMB Visa Platinm (Basic) CIMB Visa INFINITE CIMB World MasterCard CIMB Tesco Platinm MasterCard By applying for the CIMB Tesco Platinm Credit Card, I agree that CIMB Bank may share my information contained in this application form with TESCO STORES (MALAYSIA) SDN BHD (Company No K) ( Tesco Stores ), its sccessor or any of its related companies to enable me to enjoy the rewards, services and benefits inclding accmlation of Tesco Clbcard points offered nder the CIMB Tesco Platinm Credit Card. To start enjoying and earning Tesco Clbcard points, kindly insert yor existing Tesco Clbcard No. here: If yo do not have yor Clbcard nmber with yo, please call or Clbcard Helpline at for immediate assistance. If yo are not an existing Tesco Clbcard member, Tesco Stores may contact yo on the application of a Tesco Clbcard in order for yo to enjoy Tesco Clbcard rewards and benefits. CIMB Enrich Platinm MasterCard CIMB Enrich World MasterCard CIMB Enrich World Elite MasterCard My Enrich Card No. : I do not have an Enrich Card and wish to be enrolled as a new Enrich member nder the Enrich Freqent Flyer Programme. I hereby consent to CIMB Bank sharing the information contained in this application form with Malaysia Airlines Berhad ( X), its sccessor or any of its related companies which pon receipt of my information herein will then consider my application for the same. B. CIMB ISLAMIC CREDIT CARD-i CIMB Islamic PETRONAS Gold MasterCard CIMB Islamic Platinm MasterCard Important Note: (1) Additional credit card-i/credit card will share a combined credit limit. (2) Please sign within the signatre box. Principal Credit Card-i/Credit Card Applicant s Signatre : Date : 2 MY PERSONAL DETAILS Name To Appear On Card (Not More Than 19 Letters) : Mother s Maiden Name : 3 MY MAILING PREFERENCE 3.1 Address (Mandatory) : Credit card statement will be sent to yor . For existing cardmembers, yor other statements will also be sent to this address. If address is not provided, paper statement will be sent to yor card mailing address. 3.2 Card Mailing Address : Home Address Office Address 4 CIMB TOUCH N GO ZING AUTOMATIC RELOAD AMOUNT CIMB Toch n Go Zing Card (Toch n Go card linked to CIMB Bank/CIMB Islamic Bank Credit Card) I wold like to have the CIMB Toch n Go Zing Card with the following atomatic reload amont Principal Card Note : If the ato reload amont is not specified, CIMB Bank/CIMB Islamic Bank will atomatically set the defalt reload amont to 100. Cstomer s NRIC / Passport No. : (Complsory) Page 4 of 6

5 DECLARATION/DISCLOSURE BY APPLICANT** ** This declaration shall apply to all CIMB Bank Berhad and/or CIMB Islamic Berhad, as the case may be, ( the Bank ) prodct(s) which yo apply for as stated in this application form and above table. FOR ALL PRODUCTS: (i) I/We declare that I/we have/do not have otstanding debt payment obligation from banks and non-banks (e.g. cooperative bilding societies, credit companies and merchants that provide credit sales) Particlars of the main applicant s otstanding debt payment obligation are as follows (no declaration from the main applicant denotes that this declaration is not applicable) : No. Name of Entity Amont of Otstanding Debt () Monthly Instalment Amont () 1 2 (ii) I/We declare that the information frnished in this form are tre, accrate and complete and I/we have not withheld any information which may prejdice my/or financing/loan application or have a bearing on yor financing decision. (iii) Application(s) remains the Bank s property regardless of whether the facility is approved and the Bank reserves the right to reject the application(s) at its sole discretion withot any reasons whatsoever. (iv) I/We have not committed any act of bankrptcy and/or been adjdged a bankrpt. (v) I/We shall comply with the Bank s reqirements in respect of my/or loan/financing application and nderstand that the Bank s offer of the loan/ financing shall be sbject to the Bank performing any necessary verification. The Bank refers to CIMB Bank Berhad or CIMB Islamic Bank Berhad (as the case may be), being the licensed financial instittion offering the loan/financing prodct(s) referred to this application form. (vi) I/We confirm that 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 grant and/or contined maintenance of the facility/ accont; and/or recovery of debts owing nder the facility/accont; and/or any prpose related to or in connection with the 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. (vii) In connection with the Bank Negara Gidelines on Credit Transactions and Exposres with Connected Parties, I/we hereby declare that (no declaration from the applicant(s) denotes that this declaration is not applicable) : I am a staff of the CIMB Grop 1 To the best of my knowledge, I have close relative(s) 2 employed nder the CIMB Grop. Particlars of my close relatives in CIMB Grop and whether they have acted as my garantor : Name I/C / Passport No. Relationship Acted As Garantor (Indicate Yes or No) Yes Yes No No (viii) Sbject to the provisions below which (i) prohibit disclosre of information to 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 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 ( the 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. I/We hereby frther confirm my/or consent to the information relating to me/s being forwarded to Bank Negara Malaysia and/or any brea or agencies approved by Bank Negara Malaysia. 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 effected 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.: 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, I/We hereby give my/or consent to the above disclosre to third parties. I/We do not consent to the giving of the above disclosre to third parties. (ix) 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. (x) 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. 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. CIMB Toch n Go Zing Card In addition to the declaration where I have confirmed that any credit card issed to me shall be sbject to the Bank s Cardholder Agreement, I also agree to abide by the terms and conditions of the Toch n Go Zing Card ( the Card ) and any other terms and conditions imposed by Toch n Go Sdn. Bhd. ( TNGSB ) and/or the Bank from time to time 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 100, 200 or 300 and that the atomatic reload fee of 1.59 is payable. I confirm and irrevocably athorise 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 50 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 In the event that my Card does not have any accont balance when I cancel my Card, no processing fee will be charged. A 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 Zing Card remains the property of TNGSB and mst be retrned to TNGSB pon reqest. Page 5 of 6

6 DECLARATION/DISCLOSURE BY APPLICANT**... CONTINUED (xi) For Credit Card 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 credit card(s) issed to me/s shall be sbject to the Bank s Cardholder Terms and Conditions ( Cardmember Agreement ) which is available in the Bank s website at or and I/We frther agree to be bond by the terms and conditions set forth in the Cardmember Agreement pon activation 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 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. (xii) For Goods & Services Tax (GST) (Effective 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 the prodcts applied for nder this application form or any accont or any services in connection therewith and yo shall be athorised to debit my accont for the same. PRIVACY NOTICE ACKNOWLEDGEMENT I hereby acknowledge that I 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) and confirm my agreement to the same. CONSENT & AUTHORISATION I/We hereby: (i) (ii) Irrevocably athorise the named insrance company or takafl operator or any other insrance company or takafl operator acceptable to the Bank, the insrer or takafl operator of the said to forward to the Bank commencing from the date hereof, all copies of the insrance or takafl policies and/or renewal notices/policies ndertaken by me/s; Athorise the Bank to commnicate on my/or behalf on all matters relating to the aforesaid insrance or takafl policy and consent to the named insrance company or takafl operator commnication with the Bank on all sch matters; and (iii) Confirm that the athority contained herein is valid and binding to me/s so long as the insrance or takafl policy and any renewal/thereon is sbsisting. INSURANCE/TAKAFUL RENEWAL REMINDER SERVICE Optional - Please (3) in the event yo wish to receive the reminder service. I/We wold like to receive the insrance or takafl renewal reminders issed by the Bank s approved panel of insrance company or takafl operator. I/We acknowledge that the insrance or takafl renewal reminder service is an extended service and I/we hereby give my/or consent to the Bank to disclose my/or relevant information to the Bank s approved panel of insrance company or takafl operator for prposes of sending to me/s the renewal reminders. DECLARATION ON FATCA (INDIVIDUAL) Please check 3 Yes or No for each of the following qestions: Yes No 1. Are yo a U.S. Resident? (inclding a crrent work permit) If yes, Tax Nmber: 2. Are yo a U.S. Citizen or a Citizen of a U.S. Territory? If yes, Tax Nmber: 3. Do yo hold a U.S. Permanent Resident Card (Green Card)? If yes, Tax Nmber: I/We hereby confirm the information provided and declarations above are tre, accrate and complete. Sbject to the applicable local laws, I/we hereby give my/or consent to the Bank, the Grop Companies and/or any of their licensed financial instittion affiliates (inclding branches) (collectively as CIMB ) to share my/or information with domestic or overseas governmental, spervisory or reglatory athorities where necessary to establish my/or tax liability in any relevant jrisdiction. Where reqired by domestic or overseas governmental, spervisory or reglatory athorities, I/we also nderstand and agree that CIMB may be reqired to obtain additional docments and/or forms, which I/we will sign, if I/we am/are sbjected to the relevant jrisdiction s reqirements. Where reqired by domestic or overseas governmental, spervisory or reglatory athorities, I/we nderstand and agree that CIMB may withhold, and pay ot, from any of my/or accont(s) sch amonts as may be reqired accordingly to applicable laws, reglations, directives, gidelines and/or agreements with and/or from domestic or overseas governmental, spervisory or reglatory athorities. I/We also agree and ndertake to notify CIMB (within 30 calendar days), or provide the information if reqested by CIMB, if there is a change in any information which I/we have provided to CIMB. I hereby confirm having read, nderstood and retained a copy of Prodct Disclosre Sheet that explains the benefits and my dties to my application for the Prodct(s) that I/we applied for. I am aware that the fll terms and conditions of the prodct(s) that I applied for is/are also available in: CIMB Hire Prchase and CIMB Credit Card : CIMB Islamic Hire Prchase and CIMB Islamic Credit Card : Main Applicant s Signatre : Date : Garantor s Signatre : Date : BANK USE ONLY Serviced by : Application ID : Otlet : Date : Page 6 of 6