Cash Plus Personal Loan Application Form Sales Source FOR BANK USE ONLY u BRANCH u CSC u MSF u AFS Centre / Branch Code - - - MSF-MSC Code Staff ID - Staff Name Campaign Code - - - - - 1 LOAN APPLICATION AMOUNT Amount : RM, 0 0 Please tick (3) Tenure (Years) : 5 4 3 2 2 MY PERSONAL DETAILS Full Name As In NRIC : Date Of Birth (DD/MM/YYYY) : / / Nationality : M A L A Y S I A N Old I/C No. : Sex : u Male u Female New I/C No. : u MyKad u MyTentera u MyPolis u Passport Residence Is : u Owned - No Loan u Owned - With Loan u Rented u Others u Parents / Relatives Residential Address : Race : u Malay u Chinese u Indian u Others Marital Status : u Single u Married u Widowed u Divorced Highest Education Level : u Primary u Secondary u College u University u Others Mobile Tel : City : Correspondence Address : u Home Postcode : u Office E-mail : 3 MY EMPLOYMENT / BUSINESS DETAILS Employment Status : u Permanent u Temporary Occupation : u Contract u Self Employed / Business Owner Nature of Business : u Retail u Education u Manufacturing u Information Technology & Telecommunication u Land Transport, Logistic & Warehousing Employer : u Financial Institutions u Professional Services u Real Estate Construction u Government & Quasi-Government u F&B, Restaurant, Hotel & Tourism u Wholesale (excluding Construction) u Others Office Address : Office Tel : Date Joined (DD/MM/YYYY) : / / City : Postcode : 4 MY EMERGENCY CONTACT (NOT LIVING WITH ME) Name : Relationship With Applicant : Mobile Tel : Version 6.0 (2015) [1/5]
CIMB Islamic Credit Card Application Form CIMB Bank Credit Card Application Form 5 I WISH TO APPLY FOR THE FOLLOWING CARD : u CIMB Islamic PETRONAS Gold MasterCard u CIMB Islamic Platinum MasterCard u CIMB Cash Rebate Platinum MasterCard u CIMB PETRONAS Platinum MasterCard u CIMB Platinum MasterCard u CIMB Visa Platinum (Basic) u CIMB Visa INFINITE u CIMB WORLD MasterCard u CIMB Visa SIGNATURE Notes : 1. Additional credit cards will share a combined credit limit. 2. Minimum annual income per annum for Gold/Platinum (RM24,000), Visa SIGNATURE/WORLD MasterCard (RM100,000) and Visa INFINITE (RM150,000). Card Applicant s Signature : 6 MY PERSONAL DETAILS Name To Appear On Card (Not More Than 19 Letters) : Mother s Maiden Name : 7 MY BILLING DELIVERY INSTRUCTIONS E-mail : Customers with e-mail address will be enrolled for e-statement automatically. u Paper Statement : No, I prefer paper statement to be sent to my mailing address u CIMB CLICKS Internet Banking : No, I prefer to receive my statement via CIMB Clicks Internet Banking 8 CIMB TOUCH N GO ZING AUTOMATIC RELOAD AMOUNT CIMB Touch n Go Zing Card (Touch n Go card linked to CIMB Bank/CIMB Islamic Credit Card) u I would like to have the CIMB Touch n Go Zing Card with the following automatic reload amount Principal Card u RM100 u RM200 u RM300 Note : If the auto reload amount is not specified, CIMB Bank/CIMB Islamic Bank will automatically set the default reload amount to RM100. 9 PRIVACY NOTICE ACKNOWLEDGEMENT I hereby acknowledge that I have accessed and/or read the Privacy Notice issued by CIMB Group (which is available at all CIMB branches as well as at the CIMB website at www.cimbbank.com.my or www.cimbislamic.com.my or has otherwise been made available to me) and confirm my agreement to the same. [2/5]
DECLARATION/DISCLOSURE BY APPLICANT** ** This declaration shall apply to all CIMB Bank Berhad and/or CIMB Islamic Bank Berhad, as the case may be, ( the Bank ) products(s) which you apply for as stated in the above completed application form. The Bank refers to CIMB Bank Berhad and/or CIMB Islamic Bank Berhad, as the case may be, being the licensed financial institution granting the loan/financing product(s) referred to in the above application form. FOR ALL PRODUCTS : (i) I hereby declare that I have/do not have any monies owing to any other lenders. Particulars (if applicable) of my debt payment obligation are as follows : No. Name of Entity Amount of Debt Owing (RM) Monthly Instalment Amount (RM) 1. 2. (ii) I declare that the information furnished in this form are completely true and accurate and I have not withheld any information which may prejudice my financing/loan application or have a bearing on your financing decision. (iii) I hereby authorize you or your representative to obtain information relating to this information from any source. (iv) I agree that the above completed application form shall belong to and remain as the property of the Bank regardless of whether the above facilities is or are approved and the Bank reserves the right to reject any of the above application(s) at its sole discretion without any reasons whatsoever. (v) I have not committed any act of bankruptcy and/or been adjudged a bankrupt. (vi) I shall comply with the Bank s requirements in respect of my loan/financing application and understand that the Bank s offer of the loan/ financing shall be subject to the Bank performing any necessary verification. (vii) I confirm that the Bank is authorized to verify and/or make any checks and/or obtain any information and/or confirmation at any time and from time to time now and/or in the future, with or from any credit reference/reporting agencies, including but not limited to CCRIS, FIS and/or any other agencies and/or from any financial institution and to provide to such aforesaid party(s) with the required information requested to enable the Bank to ascertain my status and/or any other person, individual and/or entity related to and/or associated with me as may be required by the Bank for the purpose of the consideration of this application and thereafter if this application is approved for the purposes of the grant and/ or continued maintenance of the facility/account; and/or recovery of debts owing under the facility/account; and/or any purpose related to or in connection with the facility/account applied for; and/or for any other purpose that is required or permitted by any law, regulations, guidelines and/or relevant regulatory authorities. (viii) Where applicable in connection with the Guidelines on Credit Transactions and Exposures with Connected Parties issues by Bank Negara Malaysia, I hereby declare that : u I am a staff of the CIMB Group 1 u To the best of my knowledge, I have close relative(s) 2 who are presently employed under the CIMB Group and/or who have acted as my guarantor (particulars of which are as follows): Name of close relative employed under the CIMB Group I/C / Passport No. Relationship with applicant Acted As Guarantor (Indicate Yes or No) u Yes u No u Yes u No 1 CIMB Group means CIMB Bank Berhad or CIMB Islamic Bank Berhad or CIMB Investment Bank Berhad or other subsidiaries or companies controlled by the aforesaid respective banking institutions. 2 Close relative(s) include parents / spouse of staff including the spouse s dependents / children / spouse of the children / brother and sister / spouse of brother / sister and any other dependents and persons who may influence / be influenced by the staff. (ix) Subject to the provisions below which (i) prohibit disclosure of information to Group Companies if objected to by me; and (ii) require my express consent for disclosure of information to third parties for the stated purposes, I hereby agree and authorise the Bank to disclose to any of its agents, service providers, auditors, legal counsel, professional advisors, security providers and guarantors in or outside Malaysia and to companies within the group of the Bank as well as companies within the group of CIMB Group Holdings Berhad, the Bank s ultimate holding company ( the Group Companies ) whether such Group Companies are residing, situated, carrying on business, incorporated or constituted within or outside Malaysia any information relating to me, my affairs and/or any accounts maintained by me with the Bank for facilitating the business, operations, facilities and services of or granted or provided by the Bank and/or the Group Companies to their customers. Disclosure to Group Companies shall be for facilitating the operations, businesses, cross-selling and other purposes of the Bank and/or the Group Companies provided always that disclosure for cross selling purposes shall not be effected if such disclosure is objected by me by contacting the Bank at the following telephone number or address (which may be changed by the Bank from time to time by notice to me): 19th Floor, Menara Bumiputra Commerce, 11 Jalan Raja Laut, 50350 Kuala Lumpur, Tel No.: 1 300 880 900. Further, where the Bank intends to share my information (excluding information relating to my affairs or account) with third parties for strategic alliances, marketing and promotional purposes, u I hereby give my consent to the above disclosure to third parties. u I do not consent to the giving of the above disclosure to third parties. (x) I also acknowledge that it is a requirement by Bank Negara Malaysia ( BNM ) that all information relating to this application, whether successful or otherwise must be updated and/or transmitted to the Central Credit Reference Information System ( CCRIS ), a database maintained by BNM. [3/5]
DECLARATION/DISCLOSURE BY APPLICANT***... CONTINUED (xi) CIMB Touch n Go Zing Card In addition to the declaration where I have confirmed that any credit card issued to me shall be subject to the Bank s Cardholder Agreement, I also agree to abide by the terms and conditions of the Touch n Go Zing Card ( the Card ) and any other terms and conditions imposed by Touch n Go Sdn. Bhd. ( TNGSB ) and/or the Bank from time to time in respect of the use of the Touch n Go features of the Card. I am aware the Card has an automatic reload amount of RM100, RM200 or RM300 and that the automatic reload fee of RM1.59, RM2.12 or RM3.18 respectively is payable. I confirm and irrevocably authorize the Bank to debit my Credit Card account linked to the Card, for each reload and automatic reload fee (where chargeable) whenever the account balance drops to RM50 and below. In the event that I cancel my Card and my Card has an account balance at the point of cancellation, such balance will be refunded, upon request, to my Credit Card account after deducting the processing fee of RM5.30. In the event that my Card does not have any account balance when I cancel my Card, no processing fee will be charged. A RM10.00 fee is also chargeable for new Card replacements. By signing and/or using the Card I agree to be bound by the terms and conditions imposed on the Card and other variations or amendments thereof. I understand that the Card remains the property of TNGSB and must be returned to TNGSB upon request. (xii) For Credit Card I hereby request the Bank to issue, upon approval of my above completed application, the credit card(s) which I have indicated. I acknowledge that the use of the credit card(s) issued to me shall be subject to the Bank s Cardholder Terms and Conditions ( Cardmember Agreement ) which will be sent to me with the credit card(s) upon the approval of this application, and I further agree to be bound by the terms and conditions set forth in the Cardmember Agreement upon issuance or use of the credit card(s). I understand that the credit card(s) when issued shall at all times remain the property of the Bank and must be duly returned upon request by the Bank. I further agree to accept liability for all amount incurred arising from the use of my credit card(s) issued pursuant to this application or at any time thereafter at my request. (xiii) For Email Statement Delivery I agree to be bound by CIMB Bank/CIMB Islamic Bank Terms & Conditions for E-mail Statement Delivery available at CIMB Bank s/ CIMB Islamic Bank s respective website at www.cimbbank.com.my and www.cimbislamic.com in respect of all my credit card statements requested to be sent to me by e-mail. (xiv) For View/Receive Statements By CIMB CLICKS Internet Banking Where I have a CIMB Clicks Internet Banking account ( CLICKS ) and have requested to view all my CIMB Bank/CIMB Islamic Bank credit card Statement(s) via CLICKS. I agree to be subject to the Terms and Conditions for Credit Card e-statement accessed via CIMB Clicks published on CIMB Bank s/cimb Islamic Bank s website. I agree that I will not receive hardcopy Statements nor will I receive Statement(s) via E-mail. (xv) For Goods & Services Tax (GST) (Effective 1 April 2015) I am aware that the published fees/charges are inclusive of Goods and Services Tax (GST), where applicable and I hereby further agree that I shall be liable for all GST payable in connection with or arising out of the products applied for under this application form or any account or any services in connection therewith and you shall be authorised to debit my account for the same. (xvi) For FOREIGN ACCOUNT TAX COMPLIANCE ACT (FATCA) Please complete in BLOCK LETTERS Nationality / Country of Birth : MALAYSIAN Residency / Alternate Nationality : Please check ( 3 ) Yes or No for each of the following questions : Yes / No 1. Are you a U.S. Resident? (including a current work permit) u u If yes, Tax Number 2. Are you a U.S. Citizen or a Citizen of a U.S. Territory? u u If yes, Tax Number 3. Do you hold a U.S. Permanent Resident Card (Green Card)? u u If yes, Tax Number I hereby confirm the information provided above is true, accurate and complete. Subject to the applicable local laws, I hereby consent for CIMB Group, its parent or ultimate holding company or any of its affiliates (including branches) (collectively known as CIMB ) to share my information with domestic or overseas regulators or tax authorities where necessary to establish my tax liability in any/or the relevant jurisdiction. Where required by domestic or overseas regulators or tax authorities, I also understand and agree that CIMB may be required to obtain additional documents and/or forms, which I will sign, if I am subject to the relevant jurisdiction s requirements. Where required by domestic or overseas regulators or tax authorities, I understand and agree that CIMB may withhold, and pay out, from my account(s) such amounts as may be required according to applicable laws, regulations, guidelines and/or agreements with regulators or authorities and directives. I also agree and undertake to notify the Bank (within 30 calendar days), or provide the information if requested by the Bank, if there is a change in any information which I have provided to the Bank. Passport / ID No. : Passport / ID expiration date : (please include the 8-digit / letter U.S. VISA, where applicable) (please include the Passport / ID expiration date, where applicable) (xvii) I hereby confirm having read, understood and retained a copy of Product Disclosure Sheet that explains the benefits and my duties in relation to my application for the Product(s) that I applied for. I am aware the full terms and conditions of the product(s) that I applied for is/are available in : Cash Plus Personal Loan : www.cimbbank.com.my 1 300 880 900 CIMB Islamic Credit Card : www.cimbislamic.com.my 03 6204 7788 CIMB Credit Card : www.cimbbank.com.my 03 6204 7788 [4/5]
DECLARATION/DISCLOSURE BY APPLICANT***... CONTINUED (xviii) For Cash Plus Personal Loan ( Facility ) The Bank is hereby expressly authorized to discuss with my previous, current and future employers regarding my above application and/or my payment record. I hereby declare that I am not a bankrupt and there is no on-going legal action against me presently. I have read and understood the Terms and Conditions ( Terms ) of the Cash Plus Personal Loan ( Facility ) which are attached to my above application form and hereby make my offer to the Bank for grant of the Facility to me upon the Terms. My above completed Application Form, the Disbursement Notice and the Terms shall govern the Facility. I acknowledge that the Bank is deemed to have accepted my offer when the Facility applied for is credited to my personal account maintained (or to be opened by me) with the Bank. If the Bank does not accept my offer but instead offers me the Facility of a different amount, interest rate and/or tenure, as the case may be, I may accept the Bank s counter offer verbally or by utilizing the Facility offered by the Bank which has been credited to my personal account, whichever happens earlier. Any difference between the Facility amount, interest rate or tenure applied for and the amount, interest rate or tenure finally approved and offered by the Bank shall not affect the validity of the Terms. I agree that any agreement, confirmation, declaration, consent or undertaking given by me verbally or by any electronic method shall be legal and binding on me. I hereby authorize the Bank to debit or cause to be debited the monthly instalments or charges or outstanding amount due under the Facility ( the Authorization ) from my account number ( the Account ) :- I undertake to ensure that sufficient funds are kept in the Account to meet the above mentioned payments. Where the Account is a Current Account, I hereby understand and agree that it shall be my responsibility to ensure that there is sufficient funds at all times in the Account to honour cheques deposited for payment. I further acknowledge and agree that the Bank and or CIMB Islamic Bank Berhad will not be liable for defamation and or for breach of contract and or for any losses, damages, expenses, costs or charges whatsoever which may be claimed against the Bank and or CIMB Islamic Bank Berhad arising from remarks place on the return cheque(s) by the Bank and or CIMB Islamic Bank Berhad, as the case may be, and or upon the grounds that cheque(s) issued under the Account was returned due to insufficient funds in the Account as a result of the Bank debiting or causing to be debited the Account pursuant to the Authorization. I further agree to be bound by the terms and conditions for standing instructions as stated hereunder in relation to my Authorization. Terms and Conditions For Standing Instruction : 1. Although the Bank will endeavour to effect such periodical payments, it shall not be liable or responsible for effecting such periodical payments if such failure is due to reasons not attributable to the Bank or which are beyond the Bank s reasonable control or by virtue of any of the Bank s operational and/or system error or malfunctioning unless they arise from and are caused directly by the Bank s gross negligence or willful default. 2. The Authorization is subject to any arrangement now subsisting or which may hereafter subsist between myself and the Bank in relation to the Account or any banking accommodation afforded to me. 3. The Bank may, in its absolute discretion, conclusively determine the order of priority of payment by it of any money pursuant to this or any other order or cheque which I have heretofore or may hereafter give to the Bank or drawn on my account. 4. The Bank may, at its absolute discretion, terminate the Authorization as to future payments at any time by notice in writing to me without assigning any reason therefore. 5. The Authorization will remain effective for the protection of the Bank in respect of payments made in good faith notwithstanding my death or bankruptcy or the revocation of the Authorization by any other means until notice of my death or bankruptcy or of such revocation is received by the Bank. 6. In the event that payment cannot be made due to insufficient funds in the Account, the Bank shall not effect payment for the payment date concerned. Further payments shall only be made on the next subsequent payment date. The customer is required to make alternative arrangements to effect the payment concerned. 7. In consideration of the Bank accepting the Authorization, I undertake to indemnify the Bank against all losses, cost in damages, expenses, claims and demands which the Bank may be subjected to as a result from the Bank carrying out the Authorization. 8. Loan payments are accepted without prejudice to any recovery action, pending or contemplated, for the full outstanding amount(s). *Note : All alterations and cancellations should be notified two (2) weeks before payment date. Signature of Applicant Name of Applicant : Signature of Bank Staff Name of Bank Staff : I/C No. : I/C No. : [5/5]