The Manager / Pengurus HSBC Amanah Malaysia Berhad (Company No. / No. Syarikat: 807705-X) Please open an account in our name with the following details / Sila buka satu akaun atas nama kami dengan butiran yang berikut: Please ( ) where applicable / Sila ( ) mana yang berkenaan: Account Requirement / Keperluan Akaun I / We would like to apply for / Saya/Kami ingin memohon untuk Business Account Application Form Borang Permohonan Akaun Perniagaan Please submit this completed form to your nearest HSBC Amanah branch Sila kemukakan borang yang telah dilengkapi ini kepada cawangan HSBC Amanah yang terdekat BusinessVantage-i Eligible for protection by PIDM / Layak untuk dilindungi oleh PIDM Foreign Currency Account-i Currency Type Eligible for protection by PIDM / Layak untuk dilindungi oleh PIDM Customer Information / Maklumat Pelanggan (Please complete all sections / Sila lengkapkan semua bahagian) We are a: Limited Company Kami adalah: Syarikat Berhad Sole Proprietorship Perniagaan Tunggal Limited Liability Partnership Perkongsian Liabiliti Terhad Registered Club / Society / Association Kelab / Pertubuhan / Persatuan Berdaftar Partnership Perkongsian We are a: Kami adalah: Non-Bumiputra controlled company Syarikat bukan kawalan Bumiputra Bumiputra controlled company Syarikat kawalan Bumiputra Type of Issued Shares : In what form are these shares issued? Jenis Saham yang Diterbitkan: Dalam bentuk apa saham-saham tersebut diterbitkan? [For Limited Company Only / Untuk Syarikat Berhad sahaja] Registered Shares / Saham Berdaftar: Shares / Syer Bearer Shares / Saham Pembawa: Bearer Shares are physical certificates of ownership that have no record of stock owners ie. no names of owners Saham Pembawa adalah sijil pemilikan fizikal yang tidak mempunyai rekod pemilik saham ie. tiada nama pemilik Shares / Syer Registered name / Nama berdaftar: Registered no. / No. Berdaftar: Date of registration / incorporation (dd/mm/yy): Tarikh pendaftaran / diperbadankan (tt/bb/tt): Country of registration / incorporation: Negara didaftarkan / diperbadankan: Trading as Name / Berdagang atas Nama Trading As or Doing Business As name (if applicable): Berdagang atas atau Menjalankan Perniagaan atas nama (jika berkenaan): Mailing address (please provide street address): Alamat surat-menyurat (sila berikan alamat jalan): Business address (if different from Registered address): Alamat perniagaan (jika berbeza daripada alamat Berdaftar): : Registered office address in the Place of incorporation: Alamat pejabat Berdaftar di Tempat diperbadankan: : Business telephone no. / No. telefon Perniagaan: Business fax no. / No. faksimili Perniagaan: : Business e-mail / Emel Perniagaan : Business website / Laman sesawang Perniagaan: 1
Details of Contact Person / Butir-butir Orang Perhubungan Name / Nama: Telephone no. / No. telefon: Mobile no. / No. telefon mudah alih: Email address / Alamat emel: Business Information / Maklumat Perniagaan Please complete this section to help us understand your business needs. / Sila lengkapkan bahagian ini bagi membantu kami memahami keperluan perniagaan anda. Business Vantage-i Eligible for protection by PIDM / Layak untuk dilindungi oleh PIDM 1. Purpose of Banking Relationship / Tujuan Hubungan Perbankan: [you can select more than 1 item below / anda boleh memilih lebih daripada 1 perkara di bawah] Business Operations (eg. salary) / Operasi Perniagaan (cth. gaji) Trade (eg. payments & receipts) / Perdagangan (cth. pembayaran & resit) Investment / Pelaburan Financing / payment / Pembiayaan / pembayaran Others / Lain-lain: (please specify) / (sila nyatakan) 2. Nature of activities / Jenis aktiviti: e.g. types of transaction (cash, cheque, telegraphic transfer, inter-company transfers, etc.) / cth. jenis transaksi (tunai, cek, pindahan telegraf, pindahan antara-syarikat, dan lain-lain) Nature of business / industry / Jenis perniagaan / industri : 1. 2. Types and countries of counter parties / Jenis dan negara pihak balas (for which funds transfer through the account) Source of funds for initial deposit / Sumber dana untuk deposit permulaan (yang mana dana-dana dipindahkan melalui akaun) Own funds Dana sendiri Inter-company transfer Pindahan antara-syarikat others / Lain-lain 1. Type: Jenis: e.g. buyers/sellers/inter-co 2. Type: Jenis: e.g. buyers/sellers/inter-co 3. Type: Jenis: e.g. buyers/sellers/inter-co 4. Type: Jenis: e.g. buyers/sellers/inter-co 5. Type: Jenis: e.g. buyers/sellers/inter-co Source of on-going funds / Sumber dana untuk berterusan Own funds Dana sendiri Inter-company transfer Pindahan antara-syarikat others / Lain-lain Expected source and origin of funds passing through the account: Sumber dan asal dana yang dijangka dihantar melalui akaun: [you can select more than 1 item below] [anda boleh memilih lebih daripada 1 perkara di bawah] From Shareholders / Beneficial Owners Dari Pemegang Syer / Pemilik Benefisial Business Income (eg. from buyers) Pendapatan Perniagaan (cth. daripada pembeli) Return on Investment / Pulangan Pelaburan Others / Lain-lain: (please specify/sila nyatakan) Source of Wealth / Sumber Kekayaan [you can select more than 1 item below / anda boleh memilih lebih daripada 1 perkara di bawah] What is the principal source of wealth for the business? / Apakah sumber utama kekayaan untuk perniagaan? Intra-group financing / Pembiayaan intra-kumpulan Business income (accumulated profit / retained earnings) / Pendapatan perniagaan (keuntungan terkumpul/ perolehan tertahan) Transfer from other HSBC account / Pemindahan dari akaun HSBC yang lain Business loan/financing / Pinjaman/Pembiayaan perniagaan Investment by Ultimate Beneficial Owner / Partner / Pelaburan oleh pemilik benefisial / rakan kongsi utama Sale of property / Penjualan harta External investment / Pelaburan luar Others / Lain-lain: (please specify / sila nyatakan) Will this continue to be the principal source of wealth for the future? / Adakah ini akan berterusan menjadi sumber utama kekayaan untuk masa depan? Yes / Ya No / Tidak If no, please advise principal source of wealth for the future / Jika tidak, sila nyatakan sumber utama kekayaan untuk masa depan: Intra-group financing / Pembiayaan intra-kumpulan Business income (accumulated profit / retained earnings) / Pendapatan perniagaan (keuntungan terkumpul/ perolehan tertahan) Transfer from other HSBC account / Pemindahan dari akaun HSBC yang lain Business loan/financing / Pinjaman/Pembiayaan perniagaan Investment by Ultimate Beneficial Owner / Partner / Pelaburan oleh pemilik benefisial / rakan kongsi utama Sale of property / Penjualan harta External investment / Pelaburan luar Others / Lain-lain: (please specify/ sila nyatakan) The country(ies) in which the business attained the initial and on-going source of wealth / Negara(-negara) yang mana perniagaan mencapai sumber kekayaan yang awal dan berterusan: 2
Anticipated monthly activities / Aktiviti-aktiviti bulanan yang dijangka: Total Credits / Jumlah keseluruhan Kredit: Total Value / Jumlah Nilai keseluruhan: Total Debits / Jumlah keseluruhan Debit: Total Value / Jumlah Nilai keseluruhan: Is the business regulated by any regulatory authority? / Adakah perniagaan dikawalselia oleh mana-mana pihak berkuasa kawalselia? No / Tidak Yes (Name of regulatory authority) / Ya (Nama pihak berkuasa kawalselia) Foreign Currency Account-i Eligible for protection by PIDM / Layak untuk dilindungi oleh PIDM Currency Type / Jenis Matawang: (please specify / sila nyatakan) 1. Purpose of Banking Relationship / Tujuan Hubungan Perbankan: [you can select more than 1 item below / anda boleh memilih lebih daripada 1 perkara di bawah] Business Operations (eg. salary) / Operasi Perniagaan (cth. gaji) Trade (eg. payments & receipts) / Perdagangan (cth. pembayaran & resit) Investment / Pelaburan Financing / payment / Pembiayaan / pembayaran Others / Lain-lain: (please specify) / (sila nyatakan) 2. Nature of activities / Jenis aktiviti: e.g. types of transaction (cash, cheque, telegraphic transfer, inter-company transfers, etc.) / cth. jenis transaksi (tunai, cek, pindahan telegraf, pindahan antara-syarikat, dan lain-lain) Nature of business / industry / Jenis perniagaan / industri : 1. Types and countries of counter parties / Jenis dan negara pihak balas (for which funds transfer through the account) (yang mana dana-dana dipindahkan melalui akaun) 1. Type: Jenis: 2. Type: Jenis: 3. Type: Jenis: 4. Type: Jenis: 5. Type: Jenis: e.g. buyers/sellers/inter-co e.g. buyers/sellers/inter-co e.g. buyers/sellers/inter-co e.g. buyers/sellers/inter-co e.g. buyers/sellers/inter-co 2. Source of funds for initial deposit / Sumber dana untuk deposit permulaan Own funds Inter-company transfer others / Lain-lain Dana sendiri Pindahan antara-syarikat Source of on-going funds / Sumber dana untuk berterusan Own funds Inter-company transfer others / Lain-lain Dana sendiri Pindahan antara-syarikat Expected source and origin of funds passing through the account: Sumber dan asal dana yang dijangka dihantar melalui akaun: [you can select more than 1 item below] [anda boleh memilih lebih daripada 1 perkara di bawah] From Shareholders / Beneficial Owners Dari Pemegang Syer / Pemilik Benefisial Business Income (eg. from buyers) Pendapatan Perniagaan (cth. daripada pembeli) Return on Investment / Pulangan Pelaburan Others / Lain-lain: (please specify/sila nyatakan) Anticipated monthly activities / Aktiviti-aktiviti bulanan yang dijangka: Total Credits / Jumlah keseluruhan Kredit: Total Value / Jumlah Nilai keseluruhan: Total Debits / Jumlah keseluruhan Debit: Total Value / Jumlah Nilai keseluruhan: Is the business regulated by any regulatory authority? / Adakah perniagaan dikawalselia oleh mana-mana pihak berkuasa kawalselia? No / Tidak Yes (Name of regulatory authority) / Ya (Nama pihak berkuasa kawalselia) Foreign Currency Account-i Eligible for protection by PIDM / Layak untuk dilindungi oleh PIDM Currency Type / Jenis Matawang: (please specify / sila nyatakan) 1. Purpose of Banking Relationship / Tujuan Hubungan Perbankan: [you can select more than 1 item below / anda boleh memilih lebih daripada 1 perkara di bawah] Business Operations (eg. salary) / Operasi Perniagaan (cth. gaji) Trade (eg. payments & receipts) / Perdagangan (cth. pembayaran & resit) Investment / Pelaburan Financing / payment / Pembiayaan / pembayaran Others / Lain-lain: (please specify) / (sila nyatakan) 2. Nature of activities / Jenis aktiviti: e.g. types of transaction (cash, cheque, telegraphic transfer, inter-company transfers, etc.) / cth. jenis transaksi (tunai, cek, pindahan telegraf, pindahan antara-syarikat, dan lain-lain) 1. 2. Nature of business / industry / Jenis perniagaan / industri : 3
Types and countries of counter parties / Jenis dan negara pihak balas (for which funds transfer through the account) (yang mana dana-dana dipindahkan melalui akaun) 1. Type: Jenis: 2. Type: Jenis: 3. Type: Jenis: 4. Type: Jenis: 5. Type: Jenis: e.g. buyers/sellers/inter-co e.g. buyers/sellers/inter-co e.g. buyers/sellers/inter-co e.g. buyers/sellers/inter-co e.g. buyers/sellers/inter-co Source of funds for initial deposit / Sumber dana untuk deposit permulaan Own funds Inter-company transfer others / Lain-lain Dana sendiri Pindahan antara-syarikat Source of on-going funds / Sumber dana untuk berterusan Own funds Inter-company transfer others / Lain-lain Dana sendiri Pindahan antara-syarikat Expected source and origin of funds passing through the account: Sumber dan asal dana yang dijangka dihantar melalui akaun: [you can select more than 1 item below] [anda boleh memilih lebih daripada 1 perkara di bawah] From Shareholders / Beneficial Owners Dari Pemegang Syer / Pemilik Benefisial Business Income (eg. from buyers) Pendapatan Perniagaan (cth. daripada pembeli) Return on Investment / Pulangan Pelaburan Others / Lain-lain: (please specify/sila nyatakan) Anticipated monthly activities / Aktiviti-aktiviti bulanan yang dijangka: Is the business regulated by any regulatory authority? / Adakah perniagaan dikawalselia oleh mana-mana pihak berkuasa kawalselia? Total Credits / Jumlah keseluruhan Kredit: Total Value / Jumlah Nilai keseluruhan: Total Debits / Jumlah keseluruhan Debit: Total Value / Jumlah Nilai keseluruhan: No / Tidak Yes (Name of regulatory authority) / Ya (Nama pihak berkuasa kawalselia) Paid up capital (in Ringgit Malaysia) / Modal berbayar (dalam Ringgit Malaysia) Business s annual sales turnover (in Ringgit Malaysia) / Perolehan jualan tahunan perniagaan (dalam Ringgit Malaysia): Number of employees / Bilangan pekerja: Name of parent company (if any) / Nama syarikat induk (jika ada): Subsidary companies (in / outside Malaysia) (if applicable) / Anak-anak Syarikat (dalam / di luar Malaysia) (jika berkenaan) : Country where parent company is based / Negara di mana syarikat induk berpangkalan: Associate companies (if applicable) / Syarikat-syarikat Bersekutu (jika berkenaan): Is company publicly traded? / Adakah syarikat didagangkan secara umum? No If Yes, name of stock exchange Tidak Jika Ya, nama bursa saham Is parent company publicly traded? / Adakah syarikat induk didagangkan secara umum? No If Yes, name of stock exchange Tidak Jika Ya, nama bursa saham What are the banks you bank with? / Apakah nama bank-bank yang anda berbankan? Cheque Book Application / Automated Cheque Book Re-ordering / Permohonan Buku Cek / Pesanan Semula Buku Cek Secara Otomatik Two cheque books will be automatically issued upon account opening. If you require more, kindly indicate below / Dua buku cek akan dikeluarkan secara otomatik semasa pembukaan akaun. Jika anda memerlukan lebih, sila nyatakan di bawah: Please issue an additional / Sila keluarkan tambahan cheque books upon account opening / buku cek semasa pembukaan akaun. To enjoy Automated Cheque Book Re-ordering facility, please indicate below the number of cheque books for each re-order / Untuk menikmati kemudahan Pesanan Semula Buku Cek Secara Otomatik, sila nyatakan di bawah nombor buku cek untuk setiap pesanan semula: We require / Kami memerlukan cheque books / buku cek. If the number of cheque books to be re-ordered is not indicated, it will be defaulted to 2 cheque books for each re-order. / Jika bilangan buku cek yang akan dipesan semula tidak dinyatakan, ianya akan ditetapkan kepada 2 buku cek bagi setiap pesanan semula. Note / Nota : 1. Automated re-ordering of cheque books is only triggered when 60 of existing cheques have been presented to the Bank for payment. / 1. Pesanan semula otomatik buku cek hanya dicetuskan apabila 60 cek yang sedia ada telah dikemukakan kepada Bank untuk pembayaran. 2. Your account will be debited with the stamp duty and courier charges relating to the cheque book re-ordering. / 2. Akaun anda akan didebitkan dengan duti setem dan caj kurier berkaitan kepada pesanan semula buku cek. 3. All cheque books will be couriered to your mailing address. Please ensure that your mailing address is not a P.O. Box. / 3. Semua buku cek akan dikurier ke alamat surat-menyurat anda. Sila pastikan alamat surat-menyurat anda adalah bukan P.O Box. 4
Audit Confirmation of Balance Request / Permintaan Pengesahan Audit Baki Please mail to my/our auditor, an audit confirmation of my/our balances. / Sila hantarkan kepada juruaudit saya/kami, satu pengesahan audit bagi baki saya/kami. With effect from / Bermula daripada: Auditor s name and address / Nama dan alamat juruaudit: Financial year end / Tahun Kewangan berakhir: Frequency required / Kekerapan diperlukan Yearly / Tahunan Half yearly / Setengah tahun Quarterly / Suku tahun : Note: Charges of 10.60* for Automail and 53* for Manual are applicable for Audit Confirmation of Balance Request. *Inclusive of Goods and Services Tax (GST). / Nota: Caj 10.60* untuk Automail dan 53* untuk Manual adalah dikenakan untuk Permintaan Pengesahan Audit Baki. *Termasuk Cukai Barang dan Perkhidmatan (CBP). Account Services / Perkhidmatan Akaun I/We would like to subscribe to the following services / Saya/Kami ingin melanggan perkhidmatan berikut Business Connect Business Express Note: Please approach your Relationship Manager to enquire more about our HSBCnet service. 5
IMPORTANT NOTE / NOTA PENTING Please cancel all unused portion(s) on this page to prevent any tampering / Sila batalkan semua bahagian yang tidak digunakan di halaman ini untuk mengelakkan apa-apa pengubahsuaian. Entity Set Up [For BTB] / Penetapan Entiti [Untuk BTB] Please set your entity's overall daily limits / Sila tetapkan had keseluruhan entiti harian anda Maximum Daily Limit set by HSBC Amanah () Had Maksimum Harian yang ditetapkan oleh HSBC Amanah () 500,000 Transfer to your own account / Pindahan kepada akaun anda sendiri Your Entity's Maximum Daily Limit () Had Maksimum Harian Entiti Anda () Transfer to pre-designated payee / Pindahan 500,000 kepada penerima pra-ditetapkan Note: Please note that your entity s Maximum Daily Limit must not exceed the Maximum Daily Limit set by HSBC Amanah. If your entity s Maximum Daily Limit is left blank or is not clearly stated or if it exceeds the Maximum Daily Limit set by HSBC Amanah, it will be defaulted to the highest Delegate Maximum Daily Limit applicable to each type of transactions, provided that each of such delegate limits shall not exceed the corresponding Maximum Daily Limit set by HSBC Amanah. If any of the delegate limits for any type of transactions exceeds the corresponding Maximum Daily Limit set by HSBC Amanah for that transaction, it would be defaulted to the Maximum Daily Limit set by HSBC Amanah or your entity s Maximum Daily Limit for that transaction, whichever is the lower. Please also note that if no amount is stated for both entity and delegate limits, then the default entity limit will be set as Zero (0)." Nota: Sila ambil perhatian bahawa Had Maksimum entiti Harian anda mestilah tidak melebihi Had Maksimum Harian yang ditetapkan oleh HSBC Amanah. Jika Had Maksimum entiti Harian anda dibiarkan kosong atau tidak jelas dinyatakan atau jika ianya melebihi Had Maksimum Harian yang ditetapkan oleh HSBC Amanah, ia akan diletakkan ke Had Maksimum Wakil Harian tertinggi yang terpakai kepada setiap jenis transaksi, dengan syarat bahawa setiap had wakil sedemikian hendaklah tidak melebihi Had Maksimum Harian sepadan yang ditetapkan oleh HSBC Amanah. Jika mana-mana had wakil bagi apa-apa jenis transaksi melebihi Had Maksimum Harian sepadan yang ditetapkan oleh HSBC Amanah bagi transaksi tersebut, ia akan diletakkan kepada Had Maksimum Harian yang ditetapkan oleh HSBC Amanah atau Had Maksimum Harian entiti anda bagi transaksi tersebut, yang mana lebih rendah. Sila juga ambil perhatian bahawa jika tiada jumlah yang dinyatakan bagi kedua-dua had entiti dan wakil, maka had entiti asal akan ditetapkan sebagai Sifar (0). Delegates/Users / Wakil/Pengguna Please provide details on page 6 & 7 / Sila berikan butiran di halaman 6 & 7 (i.e. persons nominated and authorised by the customer to use the Services) / (iaitu orang yang dilantik dan diberikuasa oleh pelanggan untuk menggunakan Perkhidmatan) Full Name as per NRIC/Passport / Nama Penuh seperti di dalam Kad Pengenalan/Pasport: BTB enquiry only / Pertanyaan BTB sahaja Transact via BTB* / Urusniaga melalui BTB* BSA Complete the below section if transaction via BTB is required / Lengkapkan bahagian di bawah jika transaksi melalui BTB diperlukan: Type of Transactions / Jenis Transaksi Maximum Daily Limit / Had Maksimum Harian Transfer to own account / Pindahan kepada akaun sendiri *** Transfer to pre-designated payee / Pindahan kepada penerima pra-ditetapkan *** Transactions of 5,000 and above will be advised to you via SMS. If you wish to set a different threshold, please indicate the amount. / Transaksi sebanyak 5,000 dan ke atas akan dimaklumkan kepada anda melalui SMS. Jika anda ingin menetapkan ambang yang berbeza, sila nyatakan jumlah BCR Email Address to receive BCR / Alamat emel untuk menerima BCR: Mobile phone number to receive SMS / Nombor telefon mudahalih untuk menerima SMS Note : Only one (1) nominated user is allowed for access to BSA Nota : Hanya seorang (1) pengguna yang dilantik dibenarkan untuk mengakses kepada BSA. BAC Maximum daily cash withdrawal limit /Had maksimum pengeluaran wang tunai harian Note:Maximum limit allowed is 5,000 and limit must be stated in multiple of thousands. If no amount is stated, the default limit is 5,000. Nota: Had maksimum yang dibenarkan adalah 5,000 dan had mestilah dinyatakan dalam gandaan seribu. Jika tiada jumlah yang dinyatakan, had asal adalah 5,000. 6
Delegates/Users / Wakil/Pengguna Please provide details on page 6 & 7 / Sila berikan butiran di halaman 6 & 7 (i.e. persons nominated and authorised by the customer to use the Services) / (iaitu orang yang dilantik dan diberikuasa oleh pelanggan untuk menggunakan Perkhidmatan) Full Name as per NRIC/Passport / Nama Penuh seperti di dalam Kad Pengenalan/Pasport: BTB enquiry only / Pertanyaan BTB sahaja Transact via BTB* / Urusniaga melalui BTB* BSA Complete the below section if transaction via BTB is required / Lengkapkan bahagian di bawah jika transaksi melalui BTB diperlukan: Type of Transactions / Jenis Transaksi Maximum Daily Limit / Had Maksimum Harian Transfer to own account / Pindahan kepada akaun sendiri *** Transfer to pre-designated payee / Pindahan kepada penerima pra-ditetapkan *** Transactions of 5,000 and above will be advised to you via SMS. If you wish to set a different threshold, please indicate the amount. / Transaksi sebanyak 5,000 dan ke atas akan dimaklumkan kepada anda melalui SMS. Jika anda ingin menetapkan ambang yang berbeza, sila nyatakan jumlah BCR Email Address to receive BCR / Alamat emel untuk menerima BCR: Mobile phone number to receive SMS / Nombor telefon mudahalih untuk menerima SMS Note : Only one (1) nominated user is allowed for access to BSA. Nota : Hanya seorang (1) pengguna yang dilantik dibenarkan untuk mengakses kepada BSA. BAC Maximum daily cash withdrawal limit / Had maksimum pengeluaran wang tunai harian Note:Maximum limit allowed is 5,000 and limit must be stated in multiple of thousands. If no amount is stated, the default limit is 5,000. Nota: Had maksimum yang dibenarkan adalah 5,000 dan had mestilah dinyatakan dalam gandaan seribu. Jika tiada jumlah yang dinyatakan, had asal adalah 5,000 Please note that transfer of funds made via BTB for any purpose, between (i) an external account and a resident account or (ii) an external account and another external account belonging to a different account holder, is subject to a maximum daily limit of 10,000-00 per account per day. / Sila ambil perhatian bahawa pindahan dana yang dibuat melalui BTB untuk apa-apa tujuan, di antara (i) akaun luar dan akaun pemastautin atau (ii) akaun luar dan akaun luar lain yang dimiliki oleh pemegang akaun yang berbeza, adalah tertakluk kepada had maksimum harian sebanyak 10,000-00 per akaun sehari. BAC (Business ATM Card) Would you like to open another account solely for BAC? / Adakah anda ingin membuka akaun lain semata-mata untuk BAC? * Yes/Ya No/Tidak BTB (Business Telephone Banking) We recommend all customers to activate the BTB for your business banking convenience. For security reasons, the Delegate s Personal Banking Number (PBN) and Personal Identification Number (PIN) are required to access BTB. Please note that the Authorised Signatory(ies) is/are required to acknowledge receipt of PIN on behalf of the Delegate. Otherwise the Delegate is unable to conduct payment/transfer although he/she has been authorised to do so. Payment/transfer limits will be activated within three (3) banking days after our receipt of the acknowledgement of the relevant PIN If more Delegates are required to be nominated for BTB services, please use the Business Connect Amendment Request Form. *** Please note that if no amount is stated, the default limit will be set at Zero (0). Delegates with Zero limit assigned to all types of transaction above can perform enquiry services only. Please also note that the maximum daily limit for each transaction should not exceed the corresponding limit set by you under the Entity Set Up [for BTB] section. * BTB (Business Telephone Banking) Kami mengesyorkan semua pelanggan untuk mengaktifkan BTB bagi kemudahan perbankan perniagaan anda. Bagi tujuan keselamatan, Nombor Perbankan Peribadi Wakil (PBN) dan Nombor Pengenalan Peribadi (PIN) adalah diperlukan untuk mengakses BTB. Sila ambil perhatian bahawa Penandatangan Yang Diberikuasa adalah dikehendaki untuk mengaku terima PIN bagi pihak Wakil. Jika tidak, Wakil tidak berupaya untuk membuat pembayaran/pindahan walaupun dia telah diberikuasa untuk berbuat demikian. Had pembayaran/pindahan akan diaktifkan dalam masa tiga (3) hari perbankan selepas kami menerima pengakuterimaan PIN berkenaan. Jika lebih ramai Wakil yang perlu dilantik untuk perkhidmatan BTB, sila gunakan Borang Permintaan Pindaan Menghubung Perniagaan. *** Sila ambil perhatian bahawa jika tiada jumlah yang dinyatakan, had asal akan ditetapkan pada Sifar (0). Wakil dengan had Sifar yang diberikan kepada semua jenis transaksi di atas boleh melaksanakan perkhidmatan pertanyaan sahaja. Sila juga ambil perhatian bahawa had maksimum harian bagi setiap transaksi seharusnya tidak melebihi had sepadan yang ditetapkan oleh anda di bawah bahagian Penetapan Entiti [bagi BTB]. 7
Declaration 1. I/We confirm that the information given in this application is true, complete and not misleading, and authorise the Bank to confirm this from any source the Bank may choose. I/We will furnish such identification and/or supporting documents as may be required by the Bank for its due diligence. 2. I/We confirm that I am/we are not insolvent, no statutory demand has been served on me/us and no legal proceedings or regulatory investigations have been commenced against me/us at the time of this application. 3. I/We have not had any financial institution close my/our account with them. 4. I/We have access to and have read the latest version of the Bank s Generic Terms & Conditions and Specific Terms & Conditions for Commercial Banking (available at www.hsbc.com.my or www.hsbcamanah.com.my) and I/we agree to be bound by the same (including all amendments thereto from time to time) should the Bank accept my/our application for account opening. 5. I/We have been given a copy of the Notice to Customers relating to the Personal Data Protection Act 2010 ( the Notice ). I/We hereby confirm that I/we have read and agree to the terms of the Notice. I/We understand that I/we can also download a copy of the Notice at www.hsbc.com.my or www.hsbcamanah.com.my 6. I/We understand that acceptance of this application is at the Bank s sole discretion and the Bank need not furnish any reason for rejecting this application. 7. I/We understand that the Bank reserves the right to close the account(s) if any documents requested by the Bank are not received within the stipulated timeframe; and that pending such receipt, the Bank is at liberty to suspend/restrict usage of the account(s) including but not limited to, restricting transfer of monies to third parties; and in event of closure, the Bank is at liberty to remit the monies in the account(s) to the source from where it came. 8. *I/We hereby certify that our company is Resident Non-Resident Controlled in accordance with the definition in the Exchange Control Regulation and undertake to notify the Bank immediately of any change in this status. 9. If I/we have stated in this application that I am/we are acting on behalf of 3rd party(ies), I/we confirm that I am/we are properly authorised by our principal(s) to do so in respect of this application. 10. Unless otherwise stated in this application, I/we confirm that I am/we are not acting on behalf of undisclosed 3rd party(ies). 11. I/We confirm that all documents furnished to the Bank in support of this application are up-to-date, correct, true and valid under applicable laws and in accordance with all relevant constitutional documents. 12. I/We have been informed that the account(s) which I/we am/are applying for herein is/are eligible for protection by Perbadanan Insurans Deposit Malaysia (PIDM). 13. I/We have been provided with a copy of the Perbadanan Insurans Deposit Malaysia (PIDM) brochure. 14. We confirm and warrant that neither our company nor shareholder (whether direct or indirect, legal or beneficial) has issued any bearer shares and further undertakes that neither our company nor such shareholder will issue or convert any of its shares or such shareholder s shares (as the case may be) to bearer form without the prior written consent of the Bank, failing which the Bank reserves the right to terminate the banking relationship with us. *Applicable to limited company only Definition of a Non-Resident Controlled Company (NRCC) A company which is resident in Malaysia is deemed to be non-resident controlled (i.e. controlled, directly or indirectly, by non-resident) where: More than 50 of its shareholding is held by non-residents and/or NRCCs; It is a branch of a company which is incorporated outside Malaysia; The majority shareholding is held by residents, but the ultimate right of control is held by non-residents and/or NRCCs; or Although the ultimate right of control is held by residents, the majority shareholding is held by non-residents and/or NRCCs. Definition of a Small Medium Enterprise (SME) An enterprise in Manufacturing sectors with sales turnover not exceeding 50 million or full-time employees not exceeding 200; OR An enterprise in Services & Other sectors (including Primary Agriculture, Construction, Mining and Quarrying) with sales turnover not exceeding 20 million or full-time employees not exceeding 75; OR Other SME definition provided by the National SME Development Council, which may be amended from time to time. The economic activities of each sector are classified based on the Malaysian Standard Industrial Classification (MSIC) 2008 codes. Pengakuan 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Saya/Kami mengesahkan bahawa maklumat-maklumat yang diberikan di dalam permohonan ini adalah benar, lengkap dan tidak mengelirukan, dan memberi kuasa kepada Bank untuk mengesahkan perkara ini daripada mana-mana sumber yang Bank boleh pilih. Saya/Kami akan membekalkan pengenalan sedemikian dan/atau dokumen-dokumen sokongan sebagaimana yang dikehendaki oleh Bank untuk penelitian yang sewajarnya. Saya/Kami mengesahkan bahawa saya/kami tidak muflis, tiada tuntutan berkanun telah disampaikan kepada saya/kami dan tiada prosiding undang-undang atau siasatan berperaturan telah dimulakan terhadap saya/kami pada masa permohonan ini. Saya/Kami tidak mempunyai mana-mana institusi kewangan yang menutup akaun saya/kami dengan mereka. Saya/Kami telah mengakses kepada dan telah membaca versi terkini Terma-terma & Syarat-syarat Generik dan Terma-terma dan Syarat-syarat Khusus bagi Perbankan Komersial Bank (boleh didapati di www.hsbc.com.my atau www.hsbcamanah.com.my) dan saya/kami bersetuju untuk terikat dengan yang sama (termasuklah semua pindaan padanya dari semasa ke semasa) jika Bank menerima permohonan saya/kami untuk pembukaan akaun. Saya/Kami telah diberikan sesalinan Notis kepada Pelanggan berkaitan Akta Perlindungan Data Peribadi 2010 ( Notis ). Saya/Kami dengan ini mengesahkan bahawa saya/kami telah membaca dan bersetuju dengan terma-terma Notis tersebut. Saya/Kami memahami bahawa saya/kami boleh juga memuat turun sesalinan Notis tersebut di www.hsbc.com.my atau www.hsbcamanah.com.my Saya/Kami memahami bahawa penerimaan permohonan ini adalah tertakluk kepada budi bicara mutlak Bank dan Bank tidak perlu memberikan apa-apa alasan bagi penolakan permohonan ini. Saya/Kami memahami bahawa Bank merizabkan hak untuk menutup akaun(-akaun) jika apa-apa dokumen yang diminta oleh Bank tidak diterima dalam tempoh masa yang ditetapkan; dan sementara menunggu penerimaan tersebut, Bank adalah bebas untuk menggantung/menyekat penggunaan akaun(-akaun) termasuklah tetapi tidak terhad kepada, menyekat pemindahan wang kepada pihak ketiga; dan sekiranya penutupan, Bank adalah bebas untuk menghantar balik wang di dalam akaun(-akaun) kepada sumber daripada mana ia datang. *Saya/Kami dengan ini mengesahkan bahawa syarikat kami adalah Dikawal Pemastautin Bukan Dikawal Pemastautin selaras dengan definisi di dalam Peraturan Pertukaran Kawalan dan mengakujanji untuk memberitahu Bank serta-merta mengenai apa-apa perubahan dalam status ini. Sekiranya saya/kami telah menyatakan dalam permohonan ini bahawa saya/kami bertindak bagi pihak pihak ke-3, saya/kami mengesahkan bahawa saya/kami telah dibenarkan oleh prinsipal kami untuk berbuat demikian berkenaan permohonan ini. Melainkan dinyatakan sebaliknya di dalam permohonan ini, saya/kami mengesahkan bahawa saya/kami tidak bertindak bagi pihak pihak ke-3 yang tidak didedahkan. Saya/Kami mengesahkan bahawa segala dokumen yang dibekalkan kepada Bank bagi menyokong permohonan ini adalah dikemaskini, benar, betul dan sah di bawah undang-undang yang terpakai dan selaras dengan semua dokumen-dokumen perlembagaan yang berkaitan. Saya/Kami telah dimaklumkan bahawa akaun(-akaun) yang saya/kami memohon di sini adalah layak dilindungi oleh Perbadanan Insurans Deposit Malaysia (PIDM). Saya/Kami telah disediakan dengan sesalinan risalah Perbadanan Insurans Deposit Malaysia. Kami mengesahkan dan menjamin bahawa tidak syarikat mahupun pemegang saham kami (sama ada secara langsung atau tidak langsung, undang-undang atau benefisial) telah menerbitkan apa-apa saham pembawa dan seterusnya mengakujanji bahawa tidak syarikat kami mahupun pemegang saham tersebut akan menerbitkan atau menukar mana-mana sahamnya atau saham-saham pemegang saham tersebut (seperti mana yang berkenaan) kepada bentuk pembawa tanpa kebenaran bertulis daripada Bank terlebih dahulu, jika gagal Bank berhak untuk menamatkan hubungan perbankan dengan kami. *Terpakai kepada syarikat berhad sahaja 8
Definisi Syarikat Bukan-Kawalan Pemastautin (NRCC) Sebuah syarikat yang bermastautin di Malaysia disifatkan bukan kawalan pemastautin (iaitu dikawal, secara langsung atau tidak langsung, oleh bukan-pemastautin) di mana: Lebih daripada 50 pemegang sahamnya dipegang oleh bukan-pemastautin dan/atau NRCC; Ianya adalah cawangan sebuah syarikat yang diperbadankan di luar Malaysia; Majoriti pemegang saham dipegang oleh pemastautin, tetapi hak kawalan utama adalah dipegang oleh bukan-pemastautin dan/atau NRCC; atau Walaupun hak kawalan utama dipegang oleh pemastautin, majoriti pemegang saham adalah dipegang oleh bukan-pemastautin dan/atau NRCC. Definisi Perusahaan Kecil Sederhana (SME) Sebuah perusahaan dalam sektor-sektor Pembuatan/Perkilangan dengan perolehan jualan tahunan tidak melebihi 50 juta atau dengan pekerja-pekerja sepenuh masa yang tidak melebihi 200 orang; ATAU Sebuah perusahaan dalam sektor Perkhidmatan & sektor-sektor lain (termasuk sektor-sektor Pertanian Utama, Pembinaan dan Perlombongan dan Kuari) dengan perolehan jualan tahunan tidak melebihi 20 juta atau pekerja-pekerja sepenuh masa yang tidak melebihi 75 orang; ATAU Definisi SME lain yang disediakan oleh National SME Development Council yang boleh dipinda dari semasa ke semasa. Aktiviti-aktiviti ekonomi bagi setiap sektor berdasarkan Malaysian Standard Industrial Classification (MSIC) 2008 codes. SIGNED FOR AND ON BEHALF OF THE APPLICANT ** / DITANDATANGANI UNTUK DAN BAGI PIHAK PEMOHON** 1. Full name in BLOCK LETTERS / Nama penuh dalam HURUF BESAR Please provide details on page 10/11 / Sila berikan butir-butir di halaman 10/11 Relationship with the Applicant / Hubungan dengan Pemohon director / partner / sole proprietor / office-bearer pengarah / rakan kongsi / pemilik tunggal / pemegang jawatan company secretary / employee / setiausaha syarikat / pekerja (please specify) / (sila nyatakan) S.W. Signature / Tandatangan 2. Full name in BLOCK LETTERS / Nama penuh dalam HURUF BESAR Please provide details on page 10/11 / Sila berikan butir-butir di halaman 10/11 Relationship with the Applicant / Hubungan dengan Pemohon director / partner / sole proprietor / office-bearer pengarah / rakan kongsi / pemilik tunggal / pemegang jawatan company secretary / employee / setiausaha syarikat / pekerja (please specify) / (sila nyatakan) S.W. Signature / Tandatangan 3. Full name in BLOCK LETTERS / Nama penuh dalam HURUF BESAR Please provide details on page 10/11 / Sila berikan butir-butir di halaman 10/11 Relationship with the Applicant / Hubungan dengan Pemohon director / partner / sole proprietor / office-bearer pengarah / rakan kongsi / pemilik tunggal / pemegang jawatan company secretary / employee / setiausaha syarikat / pekerja (please specify) / (sila nyatakan) S.W. Signature / Tandatangan ** To be signed by / **Untuk ditandatangani oleh: Dated this / Bertarikh pada day of / haribulan,20 - the Sole Proprietor / Pemilik Tunggal For Partnership / Bagi Perkongsian - the Partner(s) authorised by the partnership resolution / Rakan Kongsi yang diberikuasa oleh resolusi perkongsian For Limited Liability Partnership / Bagi Perkongsian Liabiliti Terhad - the Partner(s) authorised by the Limited Liability Partnership resolution / Rakan kongsi yang diberikuasa oleh resolusi Perkongsian Liabiliti Terhad For Limited Company / Bagi Syarikat Berhad - the person(s) authorised by a Board resolution / orang(-orang) yang diberikuasa oleh resolusi Lembaga Pengarah For Registered Club/Society/Association / Bagi Kelab/Pertubuhan/Persatuan - the Office-Bearer(s) authorised by the governing body resolution / Pemegang Jawatan yang diberikuasa oleh resolusi badan pentadbir For Sole Proprietorship / Bagi Perniagaan Tunggal 9
Information of Directors/Partners/Sole Proprietor/Signatories/Office Bearers/Users / Maklumat Pengarah/Perkongsian/Pemilik Tunggal/Penandatangan/Pemegang Jawatan/Pengguna Registered Name / Nama Berdaftar: Note / Nota: All personal details of person(s) mentioned in the Business Account Application Form and Signature Cards must be completed in this section / Segala butir-butir peribadi mengenai orang(-orang) yang disebutkan di dalam Borang Permohonan Akaun Perniagaan dan Kad Tandatangan mesti dilengkapkan di bahagian ini. * Signature only required for Delegate or User who is not an Authorised Signatory. / *Tandatangan hanya diperlukan untuk Wakil atau Pengguna yang bukan seorang Penandatangan Diberikuasa. # For Sole Proprietor, please complete details in the next page. / Untuk Pemilik Tunggal, sila lengkapkan butiran di halaman seterusnya. Director / Pengarah Full Name as per NRIC/Passport / Nama Penuh seperti di dalam K/P/Pasport: Previous Occupation/Business background / Pekerjaan Dahulu/latarbelakang Pernigaan Source of Wealth/Income/ Sumber Kekayaan/ Pendapatan: Partner / Rakan Kongsi Sole Proprietor/ Pemilik Tunggal Date of Birth / Tarikh Lahir: NRIC/Passport no. / No. K/P/Pasport: Residential address / Alamat kediaman (please provide street address) / (sila berikan alamat jalan): Permanent address / Alamat tetap (if different from Residential address) / (jika berbeza daripada alamat Kediaman): Signatory / Penandatangan Nationality / Warganegara: Office Bearers / Pemegang Jawatan Contact Number (home, office or mobile) / No. telefon (rumah, pejabat atau mudah alih): Name of Employer / Nama majikan: Delegate/ Primary User / Wakil/Pengguna Utama Signature* / Tandatangan* Director / Pengarah Full Name as per NRIC/Passport / Nama Penuh seperti di dalam K/P/Pasport: Previous Occupation/Business background / Pekerjaan Dahulu/latarbelakang Pernigaan Source of Wealth/Income/ Sumber Kekayaan/ Pendapatan: Partner / Rakan Kongsi Sole Proprietor/ Pemilik Tunggal Date of Birth / Tarikh Lahir: NRIC/Passport no. / No. K/P/Pasport: Residential address / Alamat kediaman (please provide street address) / (sila berikan alamat jalan): Permanent address / Alamat tetap (if different from Residential address) / (jika berbeza daripada alamat Kediaman): Signatory / Penandatangan Nationality / Warganegara: Office Bearers / Pemegang Jawatan Contact Number (home, office or mobile) / No. telefon (rumah, pejabat atau mudah alih): Name of Employer / Nama majikan: Delegate/ Primary User / Wakil/Pengguna Utama Signature* / Tandatangan* Director / Pengarah Full Name as per NRIC/Passport / Nama Penuh seperti di dalam K/P/Pasport: Previous Occupation/Business background / Pekerjaan Dahulu/latarbelakang Pernigaan Source of Wealth/Income/ Sumber Kekayaan/ Pendapatan: Partner / Rakan Kongsi Sole Proprietor/ Pemilik Tunggal Date of Birth / Tarikh Lahir: NRIC/Passport no. / No. K/P/Pasport: Residential address / Alamat kediaman (please provide street address) / (sila berikan alamat jalan): Permanent address / Alamat tetap (if different from Residential address) / (jika berbeza daripada alamat Kediaman): Signatory / Penandatangan Nationality / Warganegara: Office Bearers / Pemegang Jawatan Contact Number (home, office or mobile) / No. telefon (rumah, pejabat atau mudah alih): Name of Employer / Nama majikan: Delegate/ Primary User / Wakil/Pengguna Utama Signature* / Tandatangan* Director / Pengarah Partner / Rakan Kongsi Sole Proprietor/ Pemilik Tunggal Signatory / Penandatangan Office Bearers / Pemegang Jawatan Delegate/ Primary User / Wakil/Pengguna Utama Checked by / Disemak oleh: Dated this / Bertarikh pada day of / haribulan, 20 /BB/CSB/FGS Full Name as per NRIC/Passport / Nama Penuh seperti di dalam K/P/Pasport: Date of Birth / Tarikh Lahir: NRIC/Passport no. / No. K/P/Pasport: Nationality / Warganegara: Contact Number (home, office or mobile) / No. telefon (rumah, pejabat atau mudah alih): Name of Employer / Nama majikan: Signature* / Tandatangan* Previous Occupation/Business background / Pekerjaan Dahulu/latarbelakang Pernigaan Residential address / Alamat kediaman (please provide street address) / (sila berikan alamat jalan): Source of Wealth/Income/ Sumber Kekayaan/ Pendapatan: Permanent address / Alamat tetap (if different from Residential address) / (jika berbeza daripada alamat Kediaman): 10
Additional Information of Sole Proprietor (As Applicable) / Maklumat tambahan Pemilik Tunggal (jika berkenaan) Your details (Mandatory) / Butiran Anda (Wajib) Full Name as per NRIC/Passport / Nama Penuh seperti di dalam K/P/Pasport: NRIC/Passport no. / No. K/P/Pasport: Multiple Nationalities / Pelbagai Kewarganegaraan: Yes / Ya No / Tidak Passport Details / Butiran Pasport Nationality 1 / Warganegara 1: Country of Issue / Negara Dikeluarkan: Nationality 1 / Warganegara 1: Date of Issue / Tarikh Dikeluarkan: Expiry Date / Tarikh Luput: Country of Issue / Negara Dikeluarkan: Nationality 1 / Warganegara 1: Date of Issue / Tarikh Dikeluarkan: Expiry Date / Tarikh Luput: Country of Issue / Negara Dikeluarkan: Country of birth / Negara kelahiran: Date of Issue / Tarikh Dikeluarkan: Expiry Date / Tarikh Luput: Previous address, if the present residential address is less than 3 years / Butir-butir alamat terdahulu sekiranya alamat kediaman terkini kurang dari 3 tahun: Source of Wealth Sole Proprietors only / Sumber Kekayaan Pemilik Tunggal sahaja [you can select more than 1 item below / anda boleh memilih lebih daripada 1 perkara di bawah] For sole proprietors only / Untuk pemilik tunggal sahaja: Principal source of wealth / Sumber kekayaan utama: profession / Profesion pelanggan Business ownership/ Pemilikan perniagaan Inheritance / Warisan Pension lump sum payment / Bayaran pencen sekaligus Redundancy payment / Bayaran pemberhentian Active wealth / investment / Kekayaan aktif / pelaburan-pelaburan Family loan/financing / Pinjaman/Pembiayaan keluarga Sale of property / assets / Jualan harta / aset Real estate development / investment / Pembangunan hartanah / pelaburan Lottery / Casino / Gaming win / Loteri / Kasino / Menang dalam permainan Current or former government official / Pegawai kerajaan semasa atau bekas Pegawai kerajaan External investment / Pelaburan luar Others / Lain-lain: (please specify / sila nyatakan) Is actual or projected annual revenue more than US$1,000,000? / Adakah hasil tahunan sebenar atau yang dijangka lebih daripada US$1,000,000? Yes / Ya No / Tidak Is the expected source of funds more than US$150,000? / Adakah sumber dana yang dijangka lebih daripada US$150,000? Yes / Ya No / Tidak The country(ies) in which the sole proprietor attained the initial and on-going source of wealth / Negara(-negara) yang mana pemilik tunggal mencapai sumber kekayaan yang awal dan berterusan: 11
Information of Beneficial Owner*/Principal Shareholder / Maklumat Pemilik Benefisial*/ Pemegang Saham Utama Registered Name / Nama Berdaftar: Note / Nota: All personal details of person(s) mentioned in the Business Account Application Form and Signature Cards must be completed in this section/ Segala butir-butir peribadi mengenai orang(-orang) yang disebutkan di dalam Borang Permohonan Akaun Perniagaan dan Kad Tandatangan mesti dilengkapkan di bahagian ini. Beneficial Owner*/ Pemilik Benefisial* Full Name as per NRIC/Passport / Nama Penuh seperti di dalam K/P/Pasport: Date of Birth / Tarikh Lahir: Occupation/Nature of Business / Pekerjaan /Jenis Perniagaan Source of Wealth/Income/ Sumber Kekayaan/ Pendapatan: Ownership / Pemilikan NRIC/Passport no. / No. K/P/Pasport: Nationality / Warganegara: Residential address / Alamat kediaman (please provide street address) / (sila berikan alamat jalan): Permanent address / Alamat tetap (if different from Residential address) / (jika berbeza daripada alamat Kediaman): Principal Shareholder / Pemegang Saham Utama Ownership / Pemilikan Contact Number (home, office or mobile) / No. telefon (rumah, pejabat atau mudah alih): Name of Employer / Nama majikan: Signature* / Tandatangan* Beneficial Owner*/ Pemilik Benefisial* Full Name as per NRIC/Passport / Nama Penuh seperti di dalam K/P/Pasport: Date of Birth / Tarikh Lahir: Occupation/Nature of Business / Pekerjaan /Jenis Perniagaan Source of Wealth/Income/ Sumber Kekayaan/ Pendapatan: Ownership / Pemilikan NRIC/Passport no. / No. K/P/Pasport: Nationality / Warganegara: Residential address / Alamat kediaman (please provide street address) / (sila berikan alamat jalan): Permanent address / Alamat tetap (if different from Residential address) / (jika berbeza daripada alamat Kediaman): Principal Shareholder / Pemegang Saham Utama Ownership / Pemilikan Contact Number (home, office or mobile) / No. telefon (rumah, pejabat atau mudah alih): Name of Employer / Nama majikan: Signature* / Tandatangan* Beneficial Owner*/ Pemilik Benefisial* Full Name as per NRIC/Passport / Nama Penuh seperti di dalam K/P/Pasport: Date of Birth / Tarikh Lahir: Occupation/Nature of Business / Pekerjaan /Jenis Perniagaan Source of Wealth/Income/ Sumber Kekayaan/ Pendapatan: Ownership / Pemilikan NRIC/Passport no. / No. K/P/Pasport: Nationality / Warganegara: Residential address / Alamat kediaman (please provide street address) / (sila berikan alamat jalan): Permanent address / Alamat tetap (if different from Residential address) / (jika berbeza daripada alamat Kediaman): Principal Shareholder / Pemegang Saham Utama Ownership / Pemilikan Contact Number (home, office or mobile) / No. telefon (rumah, pejabat atau mudah alih): Name of Employer / Nama majikan: Signature* / Tandatangan* Beneficial Owner*/ Pemilik Benefisial* Full Name as per NRIC/Passport / Nama Penuh seperti di dalam K/P/Pasport: Date of Birth / Tarikh Lahir: Occupation/Nature of Business / Pekerjaan /Jenis Perniagaan Source of Wealth/Income/ Sumber Kekayaan/ Pendapatan: Ownership / Pemilikan NRIC/Passport no. / No. K/P/Pasport: Nationality / Warganegara: Residential address / Alamat kediaman (please provide street address) / (sila berikan alamat jalan): Permanent address / Alamat tetap (if different from Residential address) / (jika berbeza daripada alamat Kediaman): Principal Shareholder / Pemegang Saham Utama Ownership / Pemilikan Contact Number (home, office or mobile) / No. telefon (rumah, pejabat atau mudah alih): Name of Employer / Nama majikan: Signature* / Tandatangan* * Beneficial Owners in relation to a company (if fulfils any of the following criteria) means an individual who: owns or controls, directly or indirectly, including through a trust or bearer shares holding, not less than 10 of the issued share capital of the company; or is directly or indirectly, entitled to exercise or control the exercise of not less than 10 of the voting rights at general meetings of the company; or exercises ultimate control over the management of the company; or if the company is acting on behalf of another person, means the other person. * Pemilik Benefisial berkaitan dengan sesebuah syarikat (jika memenuhi mana-mana kriteria di bawah) bermaksud seseorang individu yang:- Memiliki atau mengawal, secara langsung atau tidak langsung, termasuklah melalui satu amanah atau pemegang saham pembawa, tidak kurang daripada 10 daripada modal saham terbitan syarikat itu; atau Adalah secara langsung atau tidak langsung, berupaya menjalankan atau mengawal perjalanan yang tidak kurang daripada 10 hak mengundi pada mesyuarat agung syarikat itu; atau Menjalankan kawalan mutlak ke atas pengurusan syarikat itu; atau Jika syarikat itu bertindak bagi pihak orang lain, bermaksud orang lain tersebut. Checked by / Disemak oleh: Dated this / Bertarikh pada day of / haribulan, 20 /BB/CSB/FGS 12
NOTICE RELATING TO THE PERSONAL DATA PROTECTION ACT 2010 (THE "PDPA") HSBC BANK MALAYSIA BERHAD / HSBC AMANAH MALAYSIA BERHAD ("the Bank") 1. The Bank views your personal data and privacy seriously. This Notice is issued pursuant to the requirements of the Personal Data Protection Act 2010. 2. Individuals may have supplied and may continue from time to time, supply the Bank with their personal data and information ( data ) in connection with the opening or continuation of accounts and the establishment or continuation of banking facilities or provision of banking services or compliance with any laws, guidelines or requests issued by regulatory or other authorities. The Bank may also verify or source personal information about you from third party sources (both public and private) such as credit reporting agencies, Companies Commission and Insolvency Department. Your visit to our public website may be recorded for analysis on the number of visitors to the site and general usage patterns. Some of this information will be gathered through the use of "cookies". 3. Such data may include information concerning your personal details (such as name, age, gender, identity card number, passport number, date of birth, education, race, ethnic origin, nationality, citizenship), contact details (such as address, email, phone numbers), family information (such as marital status, name of spouse or child or immediate family), occupation details (such as employer name, income range, job title, job responsibilities, employer s contact information and address) and other information such as financial reference (in respect of other bank facilities used by you). In addition, the Bank may from time to time request for certain other personal information that may be relevant for the Bank to consider your request for any other products or banking facility of the Bank. 4. Failure to supply such data may result in the Bank being unable to open, establish, continue or provide the banking accounts, services or facilities or comply with any laws or guidelines issued by regulatory or other authorities. 6. The purposes for which data may be used and/or processed are as follows: a) considering applications and the processing of applications for banking accounts, services and/or facilities provided to customers; b) the daily operation of the banking accounts, services and/or facilities provided to customers; c) conducting credit checks (including but not limited to upon an application for credit and upon periodic or special review of the credit which normally will take place one or more times each year); d) creating and maintaining the Bank's credit and risk related models and/or any purpose relating to risk management functions; e) assisting other financial institutions to conduct credit checks and collect debts; f) updating customers records; g) ensuring ongoing credit worthiness of customers; h) designing financial services or related products for customers' use; i) marketing services or products of the Bank and/or selected companies (in respect of which the Bank may or may not be remunerated) including but not limited to: i. financial, insurance/takaful, credit card, banking, wealth management and related services and products; ii. reward, loyalty or privileges programmes and related services and products; iii. services and products offered by the Bank s co-branding partners (the names of such co-branding partners will be provided during the application of the relevant services and products, as the case may be); j) determining the amount of indebtedness owed to or by customers; k) collection of amounts outstanding from customers and those providing security for customers' obligations; l) for fraud or crime prevention, audit and debt collection and in order that services may be processed by the Bank; m) for investigating, reporting, preventing or otherwise in relation to breach of banking secrecy/confidential information, fraud, money laundering, terrorist financing and criminal activities generally; n) meeting obligations, requirements or arrangements, whether compulsory or voluntary, of the Bank or any of its branches and any member of the HSBC Group to comply with, or in connection with; i. any law, regulation, judgment, court order, voluntary code, sanctions regime, within or outside Malaysia existing currently and in the future ( Laws ); ii. any guidelines, guidance or requests given or issued by any legal, regulatory, governmental, tax, law enforcement or other authorities, or self-regulatory or industry bodies or associations of financial services providers within or outside Malaysia existing currently and in the future and any international guidance, internal policies or procedures; iii. any present or future contractual or other commitment with local or foreign legal, regulatory, judicial, administrative, public or law enforcement body, or governmental, tax, revenue, monetary, securities or futures exchange, court, central bank or other authorities, or self-regulatory or industry bodies or associations of financial service providers or any of their agents with jurisdiction over all or any part of the HSBC Group (together the Authorities and each an Authority ) that is assumed by, imposed on or applicable to the Bank or any of its branches or any member of the HSBC Group; or iv. any agreement or treaty between Authorities; o) complying with any obligations, requirements, policies, procedures, measures or arrangements for sharing data and information within the HSBC Group and/or any other use of data and information in accordance with any programmes for compliance with sanctions or prevention or detection of money laundering, terrorist financing or other unlawful activities; p) conducting any action to meet obligations of the Bank or any member of the HSBC Group to comply with Laws or international guidance or regulatory requests relating to or in connection with the detection, investigation and prevention of money laundering, terrorist financing, bribery, corruption, tax evasion, fraud, evasion of economic or trade sanctions and/or any acts or attempts to circumvent or violate any Laws relating to these matters; q) meeting any obligations of the Bank or any member of the HSBC Group to comply with any demand or request from the Authorities; r) enabling an actual or proposed assignee of the Bank, or participant or sub-participant of the Bank's rights in respect of the customer to evaluate the transaction intended to be the subject of the assignment, participation or sub-participation; s) market research and statistical analysis and surveys with the aim of improving our products and services; t) for any purpose required by law or regulation; u) for the purpose of enforcing its legal rights and/or obtaining legal advice; v) to support the Group s business, financial and risk monitoring, planning and decision making; w) for making enquiries or investigations as to whether or not the customer or person whose data is collected, used and/or processed by the Bank is actually a sanctioned person, or is otherwise howsoever related to, or associated with, a sanctioned person or entity; and also for the reporting or the taking of any remedial or preventive action in relation thereto; x) for all ancillary purposes relating to the provision of facilities including the provision of computer, telecommunications and technology services; y) for internal operational requirements of the Bank or the HSBC Group (including, without limitation, credit and risk management, system or product development and planning, insurance/takaful, audit and administrative purposes), and/or z) purposes relating thereto. 7. Data held by the Bank or a member of the HSBC Group relating to an individual will be kept confidential but the Bank or a member of the HSBC Group may provide or disclose such information to the following parties (whether within or outside Malaysia) for the purposes set out in paragraph 6 (who may also subsequently process, transfer and disclose such data for the purposes set out in paragraph 6): a) any HSBC Group Member; b) any agent, contractor, sub-contractors, service providers, lawyers, auctioneers, valuers or associates of the HSBC Group (including their employees, directors, officers, agents, contractors, service providers and professional advisers); 5. It is also the case that data are collected from (i) customers and other sources in the ordinary course of the continuation of the banking relationship, for example, when customers write cheques, deposit money or apply for credit, (ii) a person acting on behalf of the individual whose data are provided, and (iii) other sources (for example, information obtained from any bureaus or agencies established or to be established by Bank Negara Malaysia or any of its subsidiaries, or by any other authorities, the Association of Banks in Malaysia (ABM) or the Association of Islamic Banking Institutions Malaysia (AIBIM) whichever is applicable, any registered credit reporting agencies or any debt collection agencies that may be appointed by the Bank, and with any authority, central depository or depository agent in relation to the securities industry). Data may also be generated or combined with other information available to the Bank or any member of the HSBC Group ( HSBC Group means HSBC Holdings plc, its affiliates, subsidiaries, associated entities and any of their branches and offices (together or individually) and member of the HSBC Group has the same meaning). 13