Supplementary Card Application Form /Borang Permohonan Kad Tambahan

I/We further agree and authorise the Bank to make relevant credit references with external parties including but not limited to CCRIS, FIS, CTOS, and any other credit reference agencies and that in doing so the Bank shall be entitled to disclose such information as may be necessary in order for the external parties to provide the Bank with the references/confirmation sought. I/We declare that the information given by me/us is true and complete. The Bank shall reserve the absolute right to approve or reject my/our application as the Bank deems fit without assigning any reason. I/We hereby agree to you disclosing information to Bank Negara Malaysia regarding my/our credit facilities and my/our account to you as may be required, whether pursuant by law or otherwise. Malayan Banking Berhad shall not be liable whether directly or indirectly to me/us or any other persons for such disclosure.

Details Of Principal Cardmember /Maklumat Peribadi Pemohon

Supplementary Card / Kad Tambahan

Billing Address And Collecting Branch /AlamatSurat-menyurat Dan Cawangan Pengambilan Kad

Declaration:

Please complete this form in BLOCK LETTERS /Sila isikan borang ini dengan menggunakan HURUF BESAR

FOR BANK STAFF USE / UNTUK KEGUNAAN BANKBranch :Date Received :A / A No. :CIF No. :Campaign Code :

Salutation / GelaranMr / EncikMs / Cik

Nationality / WarganegaraMalaysiaOthers / Lain-lain

Mrs / PuanOthers / Lain-lain(Please specify / Sila nyatakan)

Principal Maybank Credit Card Account No. /Pemegang Kad Utama Nombor Akaun Kad Kredit Maybank

For additional supplementary credit card applications, you can make photocopies of the form or get more forms from your nearest Maybank branch.

or passport.

obligated to disclose reasons for rejecting an application.

Name as in NRIC or Passport /

Contact Details /

House Tel. No. /

HP No. /

Salutation / GelaranMr / Encik

Gender / JantinaMale / Lelaki Female /

Ms / CikMrs / PuanOthers / Lain-lain(Please specify / Sila nyatakan)

Name to appear on card /

Relationship to Principal Cardmember /

Nationality / Warganegara

Religion / Agama

Race / Bangsa

Annual Income /

Designation /

Name as in NRIC or Passport /

- -Date of Birth /

Bill To / Bil Ke

Pengambilan Kad

Home / Office / Pejabat

Residential Address / Alamat Kediaman

NRIC No. / Passport No. /

Postcode / Poskod

City / Bandar

House Tel. No. /

HP No. /

Email / E-Mel

State / Negeri

I would like to assign % or RMof my credit limit to my Supplementary Cardmember.

% atau RM

Credit Limit / Had Kredit

My Supplementary Cardmember will share my credit limit. /

approved credit limit. /

Please courier to my billing address / surat-menyurat saya

Collect at Maybank branch /

Monthly Bill /Bil BulananSeparate statement - Supplementary Cardmember will be sent a personalstatement. /

Duplicate statement - Supplementary Cardmember will be sent a personalstatement with a copy sent to Principal Cardmember. / Penyata

Joint statement - Principal and Supplementary Card activities arecombined and sent to Principal Cardmember. / Penyata bersama -

Note: Delivery of cards by courier is currently applicable to Penisular Malaysia, Sabah and Sarawak, except to P.O.Box addresses /

I/We have read and understood the terms and conditions of the Malayan Banking Berhad Credit Card Agreement and agree to be bound by them and agree that the Principal Cardmember shall be responsible for all liabilities and obligations of the Principal

The Supplementary Cardmember however, shall only be responsible for his/her own liabilities and obligations. / Saya/Kami bersetuju dan membenarkan Bank untuk melaksanakan rujukan kredit yang relavan

liabiliti dan obligasi Pemegang Kad Utama serta Pemegang

Please tick where applicable in relation to the above provision. / Sila

Name / Nama

Date

NoYes / Ya

Name / Nama

Date

Fax to / Faks ke or call /

or e-mail to / maybankardsales@maybank.com.my