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Credit Card Conversion Application Form

Let us know which Citibank Credit Card you would like to convert to, and we will get it done for you!*

Step 1 Complete this application form

2 Send it back to us by mail at : CITIBANK BERHAD (297089-M)

BANKCARD CREDIT INITIATION DEPARTMENT CREDIT CARDS LEVEL 17, MENARA CITIBANK

165, JALAN AMPANG 50450 KUALA LUMPUR

Step

or fax to 603 2383 6666.

* Credit card conversion programme - terms and conditions available on www.citibank.com.my

MY PERSONAL PARTICULARS

Yes, I wish to convert my existing Citibank Credit Card to a ________________________________________________________________. √

Please indicate the Citibank Credit Card account number which you would like converted :

Full name as per NRIC :

NRIC :

Mobile No. :

□ Latest 3 months salary slips

_________________________________

_________________________________

_________________________________

□ Latest EA form (issued within the last 12 months)

□ Latest EPF statement (issued within the last 12 months)

□ Latest Borang B / BE with LHDN receipt or proof of tax paid

DECLARATION OF DEBT OBLIGATIONS WITH NON-BANKS

Type of Debt Obligations Amount of each monthly

Installment / Payment (RM)

Outstanding Balance

(RM)

Capacity

(Self / Joint / Guarantor)

Name of Non-Bank

TOTAL

Important Note :

By converting your existing Citibank Credit Card, your

supplementary card(s) assigned to this account will also be

duly converted.

OPTIONAL : APPLICATION FOR ADDITIONAL CREDIT LIMIT ALONG WITH THE CARD CONVERSION

Should you wish to have a permanent increase in your credit card along with the conversion, please substantiate with one or more of the following

computerized documents :

If you are applying for a permanent increase in your credit card along with the conversion, please provide information on your debt obligations with

non-banks.

Important Note :

All your other principal cards (if any) will also be standardized to the higher credit limit, upon approval.

Important Note :

Conversions are only applicable from a VISA to VISA type

card or a MasterCard to MasterCard type card

Debt obligations include both secured and unsecured financing from non-banks (such as PTPTN & cooperatives) that provide credit facilities.

Any non-disclosure of complete and accurate information may impact the Bank’s decision on your application.

The approval of your application and the amount of credit limit increase is at the Bank’s discretion as we deem fit, subject to credit evaluation.

CITI PRESTIGE ONLY: CONSENT FOR GLOBAL CONCIERGE

By signing below, I hereby (1) authorise Citibank Berhad (“the Bank”) to disclose my personal data, such as my name, address(es), contact num-

bers, e-mail address(es) and information pertaining to this application to TEN Lifestyle Management Ltd (“TEN”) for purposes of providing Citi Pres-

tige Global Concierge services to me, (2) understand that any personal data provided by the Bank to TEN shall also be subject to the TEN’s privacy

policy of which details can be located at http://www.tenlifestyle.com/privacy and to the full extent permitted by law, the Bank shall not be liable for

any unauthorized disclosure of personal data or breach of confidentiality (3) agree to indemnify and hold the Bank harmless against any liability to

the full extent permitted by law arising from the disclosure of my personal data.

For Rewards Platinum card only: Please tick your Rewards categories Shopping Driving Home Travel Entertainment

* Please choose 1 Rewards category or else Shopping will be the default. Annual fee per category is RM100. First category in the first year is waived. T&C apply.

________________________________ Date : Principal Cardmember’s Signature :

_____________________________

http://www.tenlifestyle.com/privacy

By signing below, you agree to the following terms and conditions: The conversion from your Existing Citibank Credit Card to the New Citibank Credit Card shall be subject to the following terms and conditions: 1. The credit limit for your New Citibank Credit Card will be subject to the bank’s approval and policies. Citibank also reserves

the right to approve or reject this application based on its sole discretion. 2. All your outstanding balances, including unbilled installment loans, balance transfer balances, other fees and charges as

well as your Citibank One Bill, Autopay services and Credit Shield Plus services (if any) on your Existing Credit Card will be transferred to your New Citibank Credit Card.

3. You confirm that you are fully aware that your Existing Credit Card will still be active to be used for a period of 90 days after the conversion to the New Citibank Credit Card. Thereafter, Citibank will automatically block your Existing Credit Card from all transactions. Notwithstanding that, you must take precautions to avoid any unauthorised usage of the Existing Credit Card. You may cut the Existing Credit Card into several pieces across the magnetic strip and microchip embedded in the Existing Credit Card to ensure that all those components are completely destroyed.

4. The above terms and conditions shall also apply to the supplementary card(s) to your Existing Credit Card. 5. All Reward Points /Rebates accumulated on your Existing Citibank Credit Card would be transferred to your New Citibank

Credit Card according to the following schedule:

Existing Credit Card New Citibank Credit Card Rewards / Rebates conversion

Category A - Rewards

based card Choice Silver / Silver / Clear / Gold / Platinum / Rewards

Platinum / Prestige / Citibusi-ness Gold

Category A - Rewards based card

Choice Silver / Silver / Clear / Platinum / Rewards Platinum / Prestige / Citibusiness Gold

All Rewards Points will be transferred to my New

Citibank Credit Card at a ratio of 1 Reward Points : 1 Reward Points

Category B - Premier Miles based card

PremierMiles


Citibank Credit Card at a ratio of 6 Reward Points : 1 PremierMiles

Category C - AirAsia Rewards based card

AirAsia Silver / AirAsia Gold / AirAsia Platinum


Citibank Credit Card at a ratio of 10 Reward Points : 7 AirAsia Reward Points

Category D - Rebates based card

Cashback Silver / Cashback Gold / Cashback Platinum / Shell Classic / Shell Gold / Giant / Business Platinum

All Rewards Points will NOT be transferred to my

New Citibank Credit Card. I will redeem all Reward Points prior to conversion, failing which my Reward Points will be forfeited.

Category B - Premier Miles

based card PremierMiles



All PremierMiles will be transferred to my New

Citibank Credit Card at a ratio of 1 PremierMiles: 3 Reward Points



All PremierMiles will NOT be transferred to my

New Citibank Credit Card. I will redeem all PremierMiles prior to conversion, failing which my PremierMiles will be forfeited.

Category C - AirAsia Re-

wards based card AirAsia Silver / AirAsia Gold / AirAsia Platinum



All AirAsia Rewards Points will NOT be

transferred to my New Citibank Credit Card. I will redeem all AirAsia Rewards Points prior to conversion, failing which my AirAsia Rewards

Points will be forfeited. Category B - Premier Miles based card

PremierMiles





All Rebates will NOT be transferred to my New

Citibank Credit Card. All remaining rebates accumulated in my Existing Credit Card which is not redeemed or insufficient for redemption

(whichever applicable) prior to conversion will be forfeited when I convert to my New Citibank Credit Card.

Category D - Rebates based

card Cashback Silver / Cashback Gold / Cashback Platinum /

Shell Classic / Shell Gold / Giant / Business Platinum

Category B - Premier Miles based card

PremierMiles

Category C - AirAsia Rewards based card

AirAsia Silver / AirAsia Gold / AirAsia Platinum



Please sign :

Principal Cardmember’s Signature :

Date : _________________________________

_________________________________

NRIC : _________________________________

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