Section A: Type of Accounts A.1 Ringgit Malaysia (MYR) Accounts * Conventional Current Account Savings Account Islamic Current Account i Savings Account - i A.2 Foreign Currency Current Accounts (FCA): Please tick ( ) Business Entity Sole Proprietor Partnership Eligible for protection by PIDM Private Limited Public Listed Others, please indicate: Conventional Islamic ** Purpose & type of currency AUD CAD CNY EUR GBP HKD JPY NZD SGD USD OTHERS*** Non-Export / Individual IFCA Employment Education Services Export Proceeds Goods Export TFCA Proceeds ** ONLY available for Wholesale Banking Customers in the following currencies: AUD,EUR,GBP,SGD,USD ***Subject to Transaction Banking Approval Charges, if any, to be debited from Ringgit savings/current account A.3 Fixed Deposit (FD)/Term Deposit (TD) Terms and Instructions (for multiple FD/TD placements, please attach FD/TD addendum) Conventional Fixed Deposit Foreign Currency Fixed Deposit Islamic Maturity Instructions Term Deposit Withdrawal Upon Maturity Withdrawal Upon Maturity (Interest/Profit Only) Auto Renew (Principal & Interest/Profit) Currency: Placement Instructions: Cash Cheque : Debit Account : Amount/Tenure: RM Months A.4 Business Banking Services echannels For sole proprietors only ATM AmOnline AmMobile A.5 Cheque Book Application (for MYR Current Account/Account-i only) AmOnline Virtual Pin For accounts without ATM Card e-ambiz Inquiry By authorised 3 rd party: Please complete Section E e-ambiz Payment By accountholder Name: Number of cheque books Collection Method Courier to account correspondence address NRIC/Passport No. * Denotes mandatory fields are obligatory fields which are required for the processing of Personal Data to fulfill contractual obligations Page 1 of 7 Version 10 July 2017
Section B: Business Details* B.1 Registered Business Details Registered Name of Business: Registered Address: Account Correspondence Address: (if different from above) Business Status: Resident Non- Resident Business Registration No: Nature of Business: Business Office No.: Business Fax No: Business Email Address: B.2 Small Medium Enterprises (SMEs) Business Category: Small Medium Enterprise (SME) Non-SME Business Type: Annual Sales Turnover (Ringgit Malaysia): No. of Staff: Manufacturing/Manufacturing-Related Services/Agro-based Industries as at financial year: as at financial year: Services and Others B.3 Contact Person Details: Appointment of authorised personnel to perform non-monetary transactions and to receive/disclose your company s information to/ from AmBank (M) Berhad and/or AmBank Islamic Berhad 1. Full Name (as per NRIC/Passport): : Email Address: Account balance inquiry Confirmation of encashment 2. Full Name (as per NRIC/Passport): Mobile No: Confirmation of remittance instrument application/collection Confirmation of debiting/crediting transaction of the said account Email Address: Account balance inquiry Confirmation of encashment 3. Full Name (as per NRIC/Passport): Mobile No: Confirmation of remittance instrument application/collection Confirmation of debiting/crediting transaction of the said account Email Address: Account balance inquiry Confirmation of encashment Confirmation of remittance instrument application/collection Confirmation of debiting/crediting transaction of the said account * Denotes mandatory fields are obligatory fields which are required for the processing of Personal Data to fulfill contractual obligations Page 2 of 7 Version 10 July 2017
Section C: Declaration* C.1 Perbadanan Insurans Deposit Malaysia (PIDM) I/We have received a copy of the PIDM brochure and acknowledge that this product is covered by PIDM. C.2a Foreign Account Tax Compliance Act (FATCA) for Sole Proprietor/Partnership Identifying Specified/Potential U.S. Person (To be completed by the customer - please tick ( ) in the / No column respectively for each of the following questions) No. 1. U.S. Indicia Status Are you a U.S. citizen or resident (including green card holder)? 2. Is U.S. your country of birth? 3. 4. 5. 6. 7. Do you hold a current U.S. residence address or mailing address (including a U.S. post office box)? Do you have a current U.S. telephone number? Do you currently maintain any standing instructions to the U.S.? Do you currently assign power of attorney or signatory authority to a person within the U.S.? Do you currently have a hold mail or in care of address as your sole address? Account Holder Definition: The term U.S person means a person described in section 7701(a)(30) of the Internal Revenue Code: (A) a citizen or resident of the U.S. No C.2b Foreign Account Tax Compliance Act (FATCA) for Associations, Limited Liability Partnerships, Clubs, Society, Trusts of Entity and Companies. Identifying U.S. Reportable Accounts for company (To be completed by all types of entities please ( ) where applicable) a) A Specified U.S. Person 1 b) A Passive Non-Financial Foreign Entity (NFFE) with one or more Controlling Persons who are Substantial U.S. Owners 2 c) A Non-Participating Foreign Financial Institution (NPFFI) 3 Definition: 1 An individual who is a U.S. citizen or U.S. resident, A partnership, corporation, company, or association created or organized in the U.S. or under the laws of the U.S., An estate (other than a foreign estate), or A domestic trust (as defined in Regulations section 301.7701-7 of the Internal Revenue Code). 2 Owns, directly or indirectly, more than 10% (by vote or value) of the stock of any foreign corporation; Owns, directly or indirectly, more than 10% of the profits or capital interests in a foreign partnership; Is treated as an owner of any portion of a foreign trust under sections 671 through 679; or Holds, directly or indirectly, more than a 10% beneficial interest in a trust. 3 A Foreign Financial Institution that does not enter into an agreement with the U.S. IRS. C.3 Choice of language for Terms and Conditions English Bahasa Malaysia C.4 Personal Data Protection Act (PDPA) AmBank Group and its business partners may, from time to time, offer products, promotions and services that may be of interest to you. Say YES to great offers and promotions from AmBank Group and its business partners!, I/we would like to receive marketing promotions from AmBank Group and its business partners. No, not at this point of time. I/We, hereby declare that I/we have read and understood the Privacy Notice of AmBank Group which is made available at AmBank / AmBank Islamic branches and website, and give my/our consent for AmBank Group to process my/our personal data for the intended usage as stated under the Privacy Notice. I/We, hereby, also confirm that this declaration will prevail over any previous declarations made by me/us. Should you decide later that you no longer wish to receive any marketing promotions from AmBank Group and its business partners, all you have to do is notify us by calling +603 2178 8888 or emailing customercare@ambankgroup.com. *Denotes mandatory fields are obligatory fields which are required for the processing of Personal Data to fulfill contractual obligations Page 3 of 7 Version 10 July 2017
I/We agree that our application for products and services provided by AmBank (M) Berhad/ AmBank Islamic Berhad herein shall be governed by the General Terms and Conditions for Accounts and Services, the Specific Terms and Conditions for Foreign Currency Account, the Master Services Terms and Conditions and/or Master Services Agreement (as the case maybe) as may be applicable and amended from time to time which terms and conditions are available at the AmBank Group s website (http:www.ambank.com.my).references to you shall mean AmBank (M) Berhad and/or AmBank Islamic Berhad, as the case maybe. I/We confirm that all information and documents provided to you by us pursuant to this application are true, correct, complete and untampered with. In addition, you shall be entitled to rely on the information and particulars provided by us under this account opening application form for any additional products and services made available by you to us from time to time. In case of any change of particulars, I/we shall immediately notify you in writing of the changes, failing which you are entitled to treat all particulars as provided under this account opening application form as true and accurate. I/We also confirm that I/we are not the subject of any cessation of business/winding up and/or liquidation at the time of this application. I/We hereby declare, certify and confirm that the person(s) whose signature(s) appear below ( Authorised Persons ) is/are acting in accordance with the mandate given by us and have authority to effect all transactions/declaration/confirmation/agreements on our behalf in connection with the products and services applied for - and all such transaction are binding and legally enforceable against us. I/We shall not hold the bank liable for processing the services/accounts that we have applied for as per my/our instruction even though the Authorised Persons named in the board resolution which is obtained at a later date may differ. I/We hereby confirm, acknowledge and understand that we as follows: 1. Open and close account The Authorised Persons are authorised to open and close account with AmBank and AmBank Islamic for any types of account and currency as specified in the account opening forms and sign and deliver other relevant documents, notices or instructions in accordance with the bank s terms and conditions governing such accounts. 2. Subscribe, utilize and terminate the services The Authorised Person are authorised to subscribe for any electronic facilities, transaction banking services, and any other services which may be offered by the bank from time to time subject to the terms and conditions of such services. 3. Authorisation to appoint authorised signatories The Authorised Person is authorised to appoint signatories and appoint users for the services subscribed. The authorised signatories are authorised to operate the accounts in accordance with the signing mandate and/or authority given. Authorised Person: Authorised Person: Page 4 of 7 Version 10 July 2017
To only complete Section D if the Board Resolution does not indicate specimen signature(s) Section D: Authorised Signatories/ Signature Specimen Card Condition of Authorization Please tick ( ) one. Any One to Sign Any Two to sign All to sign Others : Note: Please photocopy this page if additional authorised signatories are required. Page 5 of 7 Version 10 July 2017
Section E: e-ambiz Services* (Please select either A or B) Inquiry User 1 NRIC/Passport No. A. INQUIRY ONLY Applicable for e-ambiz only (Maximum of 10 Characters, no special characters are allowed, eg:.,!?;) Email address Inquiry User 2 (If applicable) NRIC/Passport No. (Maximum of 10 Characters, no special characters are allowed, eg:.,!?;) Note: Please photocopy this page if additional inquiry users are required Email address Primary Security Administrator (Token Custodian) B. INQUIRY AND PAYMENT NRIC/Passport No Email address Designation (Maximum 10 Characters, no special characters allowed, eg:.,!?;) Specimen Signature Secondary Security Administrator (Pin Mailer Custodian) NRIC/Passport No Email address Designation (Maximum 10 Characters, no special characters allowed, eg:.,!?;) Specimen Signature Payment Services* Charging Account Services Offered Basic Package ¹ Please tick ( ) All charges debited from new account Banker s Cheque Internal Fund Transfer Others, please indicate GIRO RENTAS SWIFT (FCY TT) Payroll-IFT Payroll- GIRO EIPP/ProCo ll (Direct debit) EIPP/ProColl (FS/FP²) Debit Method Individual Debit Consolidated Debit ¹Basic Payment Package (Internal Fund Transfer, GIRO, RENTAS, SWIFT-FCY TT) *Denotes mandatory fields - are obligatory fields which are required for the processing of Personal Data to fulfill contractual obligations. ² FS/FP-Floor Stock / Floor Plan Page 6 of 7 Version 10 July 2017
FOR BANK S USE ONLY: Date: CIF: Attended by: Verified by: Approved by: SVS Captured: SVS Validated: Account No: Currency: e-ambiz: 1. 1. 2. 2. 3. 4. 5. 6. 3. 4. 5. 6. Page 7 of 7 Version 10 July 2017