FOR INTERNAL USE ONLY Account No. Date Opened D D M M Y Y Y Y Resident/External Ac. (R/E)

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Transcription:

FOR INTERNAL USE ONLY Account No. Date Opened D D M M Y Y Y Y Resident/External Ac. (R/E) ACCOUNT OPENING APPLICATION FORM (INDIVIDUAL / JOINT) / BORANG PERMOHONAN MEMBUKA AKAUN (INDIVIDU / BERSAMA) Applicant Type / Jenis Pemohon Account Type / Jenis Akaun Purpose of Account Opening / Tujuan Pembukaan Akaun Individual / Individu Joint / Bersama In-Trust / In-Trust Current Account / Akaun Semasa Savings Account / Akaun Simpanan Fixed Deposit / Akaun Simpanan Tetap Foreign Currency Account / Akaun Matawang Asing Others (Please state) / Lain-lain (Sila nyatakan) Saving / Simpanan Business / Perniagaan Investment / Pelaburan SECTION A : PERSONAL INFORMATION / INFORMASI PERIBADI ( Main Account Holder / Pemegang Akaun Utama) Others (Please state) / Lain-lain (Sila nyatakan) Title / Gelaran Mr / Encik Madam / Puan Miss / Cik Others / Lain-Lain Name (as in MyKad/PP/BC) / Nama (seperti dalam MyKad/PP/SB) Gender / Jantina Male / Lelaki Female / Perempuan Race / Bangsa MyKad / Passport No MyKad / No. Pasport Nationality / Warganegara Date of birth / Tarikh Kelahiran Place of Birth / Tempat Kelahiran Permanent Address / Alamat Tetap Correspondence Address / Alamat Surat-Menyurat Home Tel. No. / No. Tel Rumah Mobile Phone No. / No. Tel Bimbit FOR NON MALAYSIAN ONLY / UNTUK BUKAN WARGANEGARA MALAYSIA SAHAJA Office Tel. No. / Email Address / Alamat Emel Are you a Permanent Resident in Malaysia? / Adakah anda mempunyai Taraf Pemastautin Tetap di Malaysia? Yes / Ya No / Tidak Have you stayed in Malaysia more than 182 days? / Adakah anda tinggal di Malaysia melebihi 182 hari? Yes / Ya No / Tidak SECTION B : EMPLOYMENT INFORMATION / INFORMASI PEKERJAAN Employment Status / Status Pekerjaan Occupation / Pekerjaan Employer s Name / Nama Majikan Employed / Berkerja Unemployed / Tidak Berkerja Self-Employed / Berkerja Sendiri Nature of Business / Jenis Perniagaan Retired / Bersara Employer s Address / Alamat Majikan Office Tel.No. / Source of Wealth / Sumber Kekayaan Source of Fund / Sumber Pendapatan Annual Income Range / Pendapatan Tahunan Employment Income / Pendapatan Penggajian Business Ownership / Pemilikan Perniagaan 1. Name and Address of Business Owned / Nama dan Alamat Perniagaan 2. Percentage of Ownership / Peratus Pemilikan % 3. Name of Other Owners / Nama Pemilik-pemilik yang lain Inheritance / Harta Warisan 1. Ancestor s Name / Nama Si Pemberi 2. Country of Probate / Negara yang memberi pengesahan wasiat Investment Income / Pendapatan Pelaburan 1. Nature of Investment Activities / Jenis Aktiviti Pelaburan 2. Where did initial source of funds come from? / Dari manakah sumber dana permulaan diperolehi? Others. Please Describe / Lain-Lain, Sila Nyatakan Employment Income / Pendapatan Penggajian Inheritance / Harta Warisan Business Ownership / Pemilikan Perniagaan Investment Income / Pendapatan Pelaburan Others (Please State) / Lain-Lain (Sila Nyatakan) RM0 - RM24,999 / RM0 - RM24,999 RM250,000 - RM499,999 / RM250,000 - RM499,999 RM25,000 - RM49,000 / RM25,000 - RM49,000 RM500,000 - RM999,999 / RM500,000 - RM999,999 RM50,000 - RM99,999 / RM50,000 - RM99,999 RM1,000,000 or more RM1,000,000 atau lebih RM100,000 -RM249,999 / RM100,000 -RM249,999 Version 27032017 Page 1 of 6

SECTION C : PERSONAL INFORMATION / INFORMASI PERIBADI ( Joint Account Holder / Pemegang Akaun Bersama ) Title / Gelaran Mr / Encik Madam / Puan Miss / Cik Others / Lain-Lain Name / Nama Gender / Jantina Male / Lelaki Female / Perempuan Race / Bangsa MyKad / Passport No MyKad / Pasport No. Nationality / Warganegara Permanent Address / Alamat Tetap Correspondence Address / Alamat Surat-Menyurat Home Tel. No. / No. Tel Rumah Mobile Phone No. / No. Tel Bimbit Relationship with Primary Account Holder / Hubungan Dengan Pemegang Akaun Utama FOR NON MALAYSIAN ONLY / UNTUK BUKAN WARGANEGARA MALAYSIA SAHAJA Date of birth / Tarikh Kelahiran Place of Birth / Tempat Kelahiran Office Tel.No. / Email Address / Alamat Emel Are you a Permanent Resident in Malaysia? / Adakah anda mempunyai Taraf Pemastautin Tetap di Malayisa? Yes / Ya No / Tidak Have you stayed in Malaysia more than 182 days? / Adakah anda tinggal di Malaysia melebihi 182 hari? Yes / Ya No / Tidak SECTION D : EMPLOYMENT INFORMATION / INFORMASI PEKERJAAN Employment Status / Status Pekerjaan Occupation / Pekerjaan Employer s Name / Nama Majikan Employed / Berkerja Unemployed / Tidak Berkerja Self-Employed / Berkerja Sendiri Nature of Business / Jenis Perniagaan Employer s Address / Alamat Majikan Office Tel. No. / Source of Wealth / Sumber Kekayaan Source of Fund / Sumber Pendapatan Annual Income Range / Pendapatan Tahunan Employment Income / Pendapatan Penggajian Retired / Bersara Business Ownership / Pemilikan Perniagaan 1. Name and Address of Business Owned / Nama dan Alamat Perniagaan 2. Percentage of Ownership / Peratus Pemilikan % 3. Name of Other Owners / Nama Pemilik-pemilik yang Lain Inheritance / Harta Warisan 1. Ancestor s Name / Nama Si Pemberi 2. Country of Probate / Negara yang Memberi Pengesahan Wasiat Investment Income / Pendapatan Pelaburan 3. Nature of Investment Activities / Jenis Aktiviti Pelaburan 4. Where did initial source of funds come from? / Dari mana sumber dana permulaan diperolehi? Others (Please State) / Lain-Lain (Sila Nyatakan) Employment Income / Pendapatan Penggajian Inheritance / Harta Warisan Business Ownership / Pemilikan Perniagaan Investment Income / Pendapatan Pelaburan Others (Please State) / Lain-Lain (Sila Nyatakan) RM0 - RM24,999 / RM0 - RM24,999 RM25,000 - RM49,000 / RM25,000 - RM49,000 RM50,000 - RM99,999 / RM50,000 - RM99,999 RM100,000 -RM249,999 / RM100,000 -RM249,999 RM250,000 - RM499,999 / RM250,000 - RM499,999 RM500,000 - RM999,999 / RM500,000 - RM999,999 RM1,000,000 or more RM1,000,000 atau lebih SECTION E : ESTIMATED PRODUCT ACTIVITY INFORMATION / ANGGARAN MAKLUMAT PRODUK AKTIVITI No Product Type / Jenis Produk 1 Current Account / Akaun Semasa 2 Wire Transfers / Tukaran Wang Kiriman 3 Deposit / Simpanan 4 Trade Services / Pembayaran Perdagangan 5 Loans / Pinjaman 6 Others / Lain-lain Monthly Average Volume / Purata Jumlah Angka Bulanan Monthly Average Amount (RM) / Purata Jumlah Nilai Bulanan (RM) Version 27032017 Page 2 of 6

SECTION F : OTHERS / LAIN-LAIN Operation of Account / Pengendalian Akaun Statement Type / Jenis Penyata Any One to Sign / Tandatangan Salah Seorang Pemegang Akaun Via e-mail address (e-statement) / Melalui Alamat e-mel (e-penyata) SECTION G: DECLARATION AND AGREEMENT / PENGISYTIHARAN DAN PERSETUJUAN Both/All to Sign / Tandatangan Kedua-dua/Semua Pemegang Akaun Via Post (as per correspondence address) / Melalui Pos (seperti alamat surat menyurat) 1. I/We agree to abide and be bound by the Terms and Condition governing the Account(s), all other Services including any amendment, supplements and additions hereto made from time to time by the Bank, which terms and conditions are available at all the Bank s branches and at www.bangkokbank.com.my. Saya/Kami bersetuju untuk mematuhi dan terikat dengan Terma-terma dan Syarat-syarat yang mengawal Akaun(-akaun), termasuk apa-apa pindaan, tambahan dan penambahan kepada syarat yang di buat dari semasa ke semasa oleh pihak Bank, yang Terma-terma dan Syarat-syarat yang boleh didapati di mana-mana cawangan-cawangan Bank dan di www.bangkokbank.com.my. 2. I/We hereby declare and confirm that I/we am/are opening the account/taking up the product for myself/ourselves and not on behalf of any other person. Saya/Kami dengan ini mengisytiharkan dan mengesahkan bahawa saya/kami yang membuka Akaun/mengambil produk ini untuk diri sendiri/kami dan bukan untuk pihak lain. 3. I/We hereby declare that I/we have not been adjudged a bankrupt at the time the account(s) was/were opened. Saya/Kami mengisytiharkan bahawa saya/kami tidak pernah diisytiharkan muflis pada masa akaun(-akaun) ini dibuka. 4. I/We declare that a report on bad cheque issuance has not been made against me/us to the Credit Bureau, Bank Negara Malaysia in the last 6 months. Saya/Kami mengisytiharkan bahawa saya/kami tidak pernah dilaporkan berkenaan pengeluaran cek tidaklaku kepada Biro Kredit, Bank Negara Malaysia dalam tempoh 6 bulan yang lepas. 5. I/We hereby apply to open the Account(s) set out in the application form. The information given herein is true and accurate and no material fact has been withheld. Saya/Kami memohon untuk membuka Akaun(-akaun) yang dinyatakan dalam borang permohonan ini. Segala maklumat yang diberikan adalah benar dan tepat dan tiada fakta material disembunyikan. 6. I/We agree that the Bank has the absolute right to approve or reject the application without assigning any reason and the documents accompanying the application shall become and remain the property of the Bank. Saya/Kami bersetuju bahawa Bank mempunyai hak mutlak untuk meluluskan atau menolak permohonan ini tanpa memberikan sebab dan dokumendokumen yang dilampirkan bersama permohonan ini akan menjadi dan kekal hak milik Bank. 7. I/We consent to and authorize the Bank to conduct credit checks, collect and verify information given by me/us with 3 rd parties such as the relevant registrars, credit bureaus, credit reference agencies and credit reporting agencies (as defined in the Credit Reporting Act 2010) and I/we consent to the credit reporting agencies to disclose my/our credit report/information to the Bank for the purpose of applying for the product and services and for the Bank s risk management and review, and the Bank is hereby authorized, but is under no obligation to convey such consent and the purpose of such disclosure to the relevant credit reporting agencies. Saya/Kami bersetuju dan membenarkan Bank menjalankan pemeriksaan kredit, mengumpul dan mengesahkan maklumat yang diberikan oleh saya/kami kepada pihak ketiga seperti pendaftar berkaitan, biro kredit dan agensi-agensi pelaporan kredit (seperti yang diberikan dalam Akta Agensi Pelaporan Kredit 2010) dan saya/kami bersetuju membenarkan agensi-agensi laporan kredit mendedahkan laporan kredit/maklumat saya/kami kepada Bank untuk tujuan memohon akaun dan perkhidmatan dan untuk pengurusan risiko dan semakan pihak Bank, dan Bank dengan ini diberi kuasa tetapi tidak bertanggungjawab untuk menyampaikan persetujuan tersebut dan tujuan pendedahan tersebut kepada agensi pelaporan kredit yang berkaitan. 7.1 In connection with the consent aforementioned, I/we hereby authorize the Bank to provide the aforementioned relevant agencies with my/our personal details, as contained in this application, to enable the agencies to provide me/us with the relevant notification as required under the Credit Reporting Act 2010. Sehubungan dengan persetujuan yang diberikan saya/kami dengan ini memberi kuasa kepada Bank untuk mengemukakan butir-butir peribadi saya/kami seperti yang terkandung di dalam permohonan ini, kepada agensi agensi berkenaan untuk membolehkan agensi berkenaan untuk mengemukakan notis yang berkaitan kepada saya/kami seperti yang ditetapkan oleh Akta Agensi Pelaporan Kredit 2010. 7.2 I/We hereby agree and confirm that I/we shall not hold the Bank liable or responsible for:- a) any statement, misstatement, inaccuracy or omission of any type or manner contained in the credit information, records and/or credit reports provided to the Bank by the relevant agencies b) the Bank s reliance on such credit information records and/or credit reports provided by the relevant agencies to arrive at a decision in relation to my/our application, c) any disclosure of my/our credit information by the relevant agencies to any of the other agencies other subscribers in connection with the credit reporting service provided. Saya/kami dengan ini bersetuju dan mengesahkan bahawa saya/kami tidak akan mempertanggungjawabkan Bank atas:- a) sebarang kenyataan, salah nyata, ketidaktepatan atau peninggalan mana-mana jenis atau cara yang terkandung dalam maklumat kredit, rekod dan/atau laporan kredit yang telah disediakan kepada Bank oleh agensi berkenaan. b) kebergantungan Bank terhadap maklumat kredit, rekod dan/atau laporan kredit yang telah disediakan oleh agensi agensi berkenaan dalam membuat keputusan berhubung dengan permohonan saya/kami, c) sebarang pendedahan maklumat kredit saya/kami oleh agensi agensi berkenaan kepada mana-mana pelanggan agensi yang lain berhubung dengan perkhidmatan pelaporan kredit yang disediakan. Initial for account holder(s) Version 27032017 Page 3 of 6

8. I/We hereby agree the Bank is entitled to reply and act on the instructions of the Authorized Signatory(ies) for the Account until the Bank receives written notice of any changes in such authorization and has a reasonable time to implement such changes. Saya/Kami bersetuju bahawa Bank berhak untuk menjawap dan bertindak atas arahan-arahan yang diberikan oleh penandatangan yang diberikuasa kepada Akaun sehingga Bank menerima notis bertulis untuk perubahan pemberian kuasa dan mempunyai masa yang secukupnya untuk melaksanaan perubahan itu. 9. I/We hereby agree to examine and notify you of any errors, irregularities, discrepancies in the statement of account sent to me/us within 14 days from the receipt of such statement of account and to notify you if I/we fail to receive such monthly statement. Saya/Kami bersetuju untuk memeriksa dan memberitahu pihak Bank akan sebarang kesilapan, kesalahan atau keraguan di dalam penyata akaun yang dihantar kepada saya/kami dalam tempoh 14 hari daripada penerimaan penyata akaun saya dan akan memberitahu pihak Bank sekiranya saya/kami tidak menerima penyata tersebut. 10. For joint account, we confirm that we are jointly and severally liable for the Account and that the mode of termination of the account shall be the same as the mode of Account operation. We agree that upon the decease of any of us, the Bank is authorized to pay or deliver to the other survivor(s) all monies, securities, documents and other properties whatsoever standing to the credit or held by the Bank for any account (in ringgit or any foreign currency) in our joint names. Untuk Akaun bersama, kami mengesahkan bahawa kami bertanggungan secara bersama atau berasingan ke atas Akaun dan mod penamatan Akaun hendaklah sama/selari dengan mod operasi Akaun. Kami bersetuju bahawa jika salah seorang di antara kami meninggal dunia, pihak Bank diberi kuasa untuk membayar atau menyerah kepada pihak yang masih hidup semua wang, sekuriti, dokumen-dokumen dan harta-harta lain apa yang ada pada kredit atau yang dipegang oleh pihak Bank untuk mana-mana akaun (dalam Ringgit atau mana-mana mata wang asing) dalam nama kami. 11. I/We authorize the Bank to debit the Account(s) as the Bank deemed appropriate for any prevailing bank and/or statutory fees, stamp duty, commission or service charge or reimbursement arising incurred on the Account(s). Saya/Kami membenarkan Akaun(-akaun) didebitkan oleh pihak Bank apabila dianggap sesuai untuk apa-apa bayaran bank semasa dan/atau yuran berkanun, duti setem, komisen atau caj servis atau pembayaran balik yang timbul yang dikenakan atas Akaun(-akaun). 12. I/We hereby acknowledge that I/we have been made known of the insurability of the product/accounts; understood the deposit insurance system administered by PIDM and received a copy of the PIDM brochure. Saya/Kami dengan ini mengaku bahawa saya/kami telah dimaklumkan berkenaan produk/akaun ini samada ia diinsurankan atau tidak; memahami system penginsuranan deposits yang ditadbir oleh PIDM dan menerima risalah PIDM. Yes / Ya No / Tidak Anti-Money Laundering, Anti-Terrorism Financing and Proceeds of Unlawful Activities Act 2001 (AMLATFAPUAA2001) Pengisytiharan Akta Pencegahan Pengubahan Wang Haram, Pencegahan Pembiayaan Keganasan dan Hasil daripada Aktiviti Haram 2001. 1. I/We undertake to do the following to enable the Bank to comply with the Anti Money Laundering, Anti-Terrorism Financing and Proceeds of Unlawful Activities Act 2001 (AMLATFAPUAA2001) regulatory requirement/acts that are and that may be imposed from time to time: Saya/Kami bersetuju untuk mengambil tindakan di bawah untuk membolehkan pihak Bank mematuhi Akta Pencegahan Pengubahan Wang Haram,Pencegahan Pembiayaan Keganasan dan Hasil daripada Aktiviti Haram 2001 dan apa-apa akta atau undang-undang yang sedia ada atau bakal berkuatkuasa di masa hadapan: a) Declare that I/we will exercise due care to ensure my/our account(s) is not used in any way to facilitate fraudulent and/or unlawful activities. Mengisytiharkan bahawa saya/kami akan berhati-hati agar akaun saya/kami tidak digunakan dalam apa cara untuk apa-apa kegiatan/aktiviti penipuan/tidak sah. b) Provide the Bank with all relevant information and documents, as and when requested. Bersetuju untuk membekalkan maklumat-maklumat dan dokumen-dokumen yang berkaitan apabila dihendaki oleh pihak Bank. c) If the Bank finds that the operations of the account(s) fails the due diligence (or enhanced due diligence as the case may be) exercise conducted by the Bank, Bank is allowed to : Sekiranya pihak Bank mendapati bahawa operasi akaun/akaun-akaun tersebut tidak mematuhi peraturan-peraturan yang ditetapkan, Bank dibenarkan untuk : i) Reject opening of any new account(s) Menolak permohonan untuk membuka akaun(-akaun) baru; ii) iii) Close the account(s) Menutup akaun(-akaun); Terminate the banking relationship Menamatkan hubungan perbankan Initial for account holder(s) Version 27032017 Page 4 of 6

For Current Account Only / Untuk Akaun Semasa Sahaja 1. I/We confirm that should I/we of us be listed under the 'Dishonoured Information Cheque System' (DCHEQS), the Bank shall have the right to close my/our above Account immediately without notice to me/us. I/We consent the Bank to disclose my/our name(s) and account number to the Bank's printer for the printing of my/our cheque book. Saya/Kami mengesahkan bahawa sekiranya saya/kami yang disenaraikan di bawah Peruntukan Garis Panduan Cek (DCHEQS), pihak Bank berhak menutup akaun saya/kami serta-merta tanpa notis. Saya/kami membenarkan pihak Bank mendedahkan nama dan Akaun nombor saya/kami kepada pencetak Bank untuk mencetak buku cek saya/kami.. 2. Introducer s Declaration / Perakuan Pengenal The Bank reserves the right to close the account in the event that the Bank is unable to verify the identity and credibility of the introducer. Pihak Bank berhak menutup akaun ini jika Pihak Bank tidak dapat mengesahkan identiti dan kredibiliti pengenal. Name (as in MyKad/PP/BC) / Nama (seperti di dalam MyKad/PP/SB): Signature / Tandatangan: NRIC No/Passport No. / No. KP/No. Pasport Date / Tarikh: Consent for Disclosure / Kebenaran Pendedahan Pelanggan As a customer of Bangkok Bank Berhad / Sebagai pelanggan Bangkok Bank Berhad, Consent for Disclosure I / we allow my/our name(s) and contact details (excluding my/our account information) to be disclosed within the Bangkok Bank Group to offer Bangkok Bank Group and third party products /services distributed by Bangkok Bank Group. Saya / kami membenarkan nama(-nama) saya / kami dan butiran perhubungan (kecuali maklumat akaun saya / kami) untuk didedahkan di kalangan Kumpulan Bangkok Bank untuk menawarkan produk-produk / perkhidmatan-perkhidmatan pihak ketiga yang diedarkan oleh Kumpulan Bangkok Bank. I / we do not allow my/our name(s) and contact details to be disclosed within the Bangkok Bank Group and third party products/services not distributed by the Bank. Saya / kami tidak membenarkan nama(-nama) saya / kami dan butiran perhubungan didedahkan di kalangan Kumpulan Bangkok Bank dan produk-produk / perkhidmatan-perkhidmatan oleh pihak ketiga yang bukan diedarkan oleh Kumpulan Bangkok Bank. Main Ac Holder Joint Ac Holder (1) Joint Ac Holder (2) Privacy Policy / Dasar Privasi 2. I/We have read the Bank s Privacy Policy posted at www.bangkokbank.com.my.and confirm that I/we have been informed of the following:- Saya/Kami telah membaca Dasar Privasi Bank di www.bangkokbank.com.my dan mengesahkan bahawa saya/kami telah diberitahu tentang perkara-perkara berikut:- (a) That the bank may collect my/our personal data from me or from other sources; Pihak bank boleh mengumpul data peribadi saya/kami daripada saya atau daripada sumber pihak yang lain; (b) Purpose for which my/our personal data is collected; Tujuan data peribadi saya/kami dikumpulkan; (c) My/our rights to access and correct my personal data; Hak saya/kami untuk mengakses data peribadi saya/kami dan membetulkannya; (d) Classes or persons to whom my/our personal data may be disclosed by the bank; Kelas atau pihak yang bank boleh mendedahkan data peribadi saya/kami; (e) My/our rights as data subject; Hak-hak asas saya/kami sebagai subjek data; (f) Update my/our personal data as soon as there are changes; and Mengemaskinikan data peribadi saya/kami apabila ada pertukaran; dan (g) The bank s contact information if I/we wish to make written inquiries. Butiran hubungan bank jika saya/kami ingin membuat sebarang pertanyaan. 3. I/We have voluntarily provided my/our personal data to the Bank and given consent to the Bank to process my/our personal data to evaluate my/our application for the products and services. Dengan sukarela, saya/kami membekalkan data peribadi saya/kami kepada pihak Bank dan membenarkan Bank memproses data peribadi saya/kami untuk menilai permohonan saya/kami untuk produk dan perkhidmatan. Initial for account holder(s) Version 27032017 Page 5 of 6

4. If my application is successful, the Bank may process my/our personal data as required for the bank customer relationship. If my/our application is unsuccessful, the Bank may retain my data for handling inquiries, audit or legal proceedings. Jika permohonan saya/kami berjaya, pihak bank boleh memproseskan data peribadi saya/kami seperti yang di perlukan untuk hubungan bank dan pelanggan. Jika permohonan saya/kami tidak berjaya, pihak Bank boleh menyimpan data peribadi saya/kami bagi tujuan mengendalikan pertanyaan, audit atau tindakan undang-undang. Signature For All Account Holder / Ditandatangani Oleh Semua Pemegang Akaun: Main Account Holder / Pemegang Akaun Utama Joint Account Holder (1) / Pemegang Akaun Bersama (1) Joint Account Holder (2) / Pemegang Akaun Bersama (2) Name / Nama: NRIC No/Passport No. / No. KP/No. Pasport: Date / Tarikh : Name / Nama: NRIC No/Passport No. / No. KP/No. Pasport: Date / Tarikh : Name / Nama: NRIC No/Passport No. / No. KP/No. Pasport: Date / Tarikh : FOR BANK USE ONLY / UNTUK KEGUNAAN BANK SAHAJA On-site account opening Mode of Payment for initial deposit: MYR by Cash Debit account : Account attended by: Off-site account opening Cheque no: RENTAS/SWIFT Checked / Approved by: Name: Designation: Date: Name: Designation: Date: Version 27032017 Page 6 of 6