The MAS American Express Platinum Business Card gives you more Enrich Miles. With Automatic Enrich Gold Status. Apply now and enjoy :

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1 Cash Withdrawals Cash withdrawals are available at all national Maybank ATMs and over 900,000 American Express ATMs worldwide. The MAS American Express Platinum Business Card gives you more Enrich Miles Emergency Card Replacement In the event of a lost or stolen card, a replacement Card will be sent to you in 24 hours when in Malaysia and within 5 days when overseas. Once your Card has been reported lost or stolen you will not be held liable for any transactions made on the Card. Customer Service The Customer Service Hotline is open during business hours for enquiries about your Card account, for advice on Card services, or to request details regarding American Express Travel Offices. For more information, please call or or apply now by returning your completed application form via or fax Apply now and enjoy : With Automatic Enrich Gold Status 10,000 Enrich Miles* * 2,000 Enrich Miles valid on the first transaction and 8,000 Enrich Miles on the first Malaysia Airline ticket purchase. Apply now and enjoy : 10,000 Enrich Miles* Maybankard Centre Commercial Card, 39th Floor, Menara Maybank 100 Jalan Tun Perak, Kuala Lumpur. Terms & Conditions apply

2 Embark On A Journey Of Discovering The MAS American Express Platinum Business Card The MAS American Express Platinum Business Card offers you and your company superior benefits and savings with the ability to earn Enrich Miles faster, together with exclusive airline benefits. Designed to provide convenience anytime, anywhere, you will soon discover the many possibilities that simplify day to day business and travel, regardless of whether you are in Malaysia or abroad. 2,000 Bonus Enrich Miles On First Transaction 8,000 Bonus Enrich Miles On Your First Malaysia Airlines Ticket Purchase 100% Bonus Enrich Miles On Local Spend Of RM10,000 Annually 5% Savings On Malaysia Airlines International Flights Year Round EXCLUSIVE REWARDS AND SAVINGS Earn More Enrich Miles Earn 2,000 Enrich Miles immediately upon your first transaction and an additional 8,000 Enrich Miles for your first Malaysia Airlines ticket purchase with your Business Card. Get 2 Enrich Miles for every RM5 spent overseas and 1 Enrich Mile for local spend. Also, enjoy a 100% bonus for all local Enrich Miles accrued on the anniversary of your Business Card, rewarding you with 2 Enrich Miles for every RM5 spent locally when you spend RM10,000 and above annually. Year Round Savings On Malaysia Airlines International Flights Enjoy exclusive 5% savings 1 on international flights departing from Malaysia when you travel with Malaysia Airlines. These savings will enable you and your carded employees to fly more throughout the year for less. You can obtain these savings through major travel agents, the Malaysia Airlines Call Centre, Malaysia Airlines ticket offices and online via MHdirect % savings apply to MHsmart and above for flights departing from Malaysia. 2 MHdirect will be available to MAS American Express Business Cardmembers by the end of Q Year Round Savings On Business Expenditure Save time negotiating corporate rates with individual suppliers and enjoy savings of up to 20% on everyday business and travel spend through a select group of merchants. TRAVEL SERVICES AND BENEFITS Personal Concierge Whether you are abroad or at home, we can arrange the delivery of flowers, champagne or gifts for your business associates or your family. We will also assist in making special arrangements at world renowned restaurants around the globe for those important business meetings where you want to make the right impression. Complimentary Travel Accident Insurance Coverage 3 Enjoy complimentary Travel Accident Insurance of up to RM1,000,000, as well as Travel Inconvenience coverage for missed connections, luggage delay and luggage loss when airfare is booked through your MAS American Express Platinum Business Card. 3 Subject to the terms and conditions of the Master Policy. Global Assist Be assured that help is at hand should an emergency occur when overseas. Our Global Assist hotline is 24/7 and will source medical and legal support in the event of a natural disaster or crisis such as evacuation or repatriation. This travel line will also provide you information on inoculation and visa requirements, weather forecasts and exchange rates for your destination. FINANCIAL CONTROL FOR YOUR BUSINESS Easy Reconciliation All expenses you charge to the MAS American Express Platinum Business Card are consolidated into a simple monthly statement. This enables you to reconcile your spend with greater ease, having a single document of reference to tie your business receipts or invoices to. Receive a year end summary of charges which consolidates all your expenses for the previous year into one simple report. If you have more than one card tied to your business, it will consolidate all the expenses on each card within the report so you have a single point of reference for your business expenditure. Flexible Credit Limits As your Business Card limit is assessed on your Company s profitability it is not attached to any personal cards you currently hold. Therefore, in most circumstances, you can receive a higher credit limit with the Business Card then you would with an additional personal card. Interest-Free Credit You pay no interest charges on any of your transactions for 20 days from the date of your monthly billing statement if you have paid the previous month s statement in full. This means up to 50 days interest-free on purchases, should you use your 30 days prestatement advantageously. If you opt to pay partial or minimum payment, the finance charges on your transactions will be calculated from the day the transactions are posted to your account. CONVENIENCE AND PEACE OF MIND Access To U.S. Online Shopping With Globaleshop is an online service for MAS American Express Business Cards. Enjoy secure and hassle-free shopping at any U.S. merchant, including those that don t deliver internationally, and have your purchases delivered to your doorstep in Malaysia. Our buy-forme concierge service will also make purchases on your behalf at U.S. sites that do not accept international cards, enabling you to source unique business gifts or accessories to differentiate your business. Convenient Payment Options You can place all your business utility spend on auto bill with your MAS American Express Platinum Business Card ensuring all your important recurring business utility bills are paid on time. In addition, you can earn valuable Enrich Miles for all these charges. You can also conveniently pay your MAS American Express Business Card bills online or at over 400 Maybank branches or at over 2,000 Maybank Kawanku ATMs nationwide with cash or cheque. Saturday banking is also available at some branches. For more information, visit

3 MAS American Express Platinum Business Card Kad Bisnes Platinum MAS American Express Application Form Borang Permohonan Business Owner Information Butiran Pemilik Perniagaan Full Name as in NRIC Nama Penuh mengikut KP (Mr/Mrs/Ms/Dr/Others) Name to Appear on the Card with Surname in full within 19 spaces Nama pada Kad dengan nama keluarga sepenuhnya dalam 19 petak Business Data Data Bisnes Company Name to Appear on the Card within 19 spaces Nama Syarikat dicetak pada Kad dalam 19 petak Address same as previous, if not, please fill in Alamat sama dengan terdahulu, jika tidak, sila isikan Address Alamat MAS American Express Platinum Business Card Kad Bisnes Platinum MAS American Express Annual Fee Yuran Tahunan : RM500 Note : Add-on Cardmembers will be issued with the same Card type as the Principal Cardmember Nota : Jenis Kad yang sama dengan Kad Utama akan dikeluarkan kepada ahli Kad Tambahan. Eligibility : Company turnover RM5 million and above. Kelayakan : Perolehan syarikat RM5 juta dan ke atas. Enrich Membership Keahlian Enrich I am an existing Enrich member Saya merupakan ahli Enrich Card No. No. Kad M H I do not have an Enrich Card, please enrol me as a new Enrich member Saya tidak mempunyai Kad Enrich, sila daftarkan saya sebagai ahli baru Enrich If your Enrich mailing address differs from your current address, please call Enrich at to update your information. Jika alamat surat-menyurat berbeza dengan alamat semasa, sila hubungi Enrich di untuk mengemaskini maklumat anda. Important Information Nota-Nota Penting It is essential that forms are completed in full. All information is required and will be subject to verification before an account can be established, insufficient information may cause unnecessary delays in the processing of your application. All applicants must read the Declaration stated before signing at the signature of applicant column at the end of this application form. Ia penting borang-borang itu disiapkan dalam penuh. Semua maklumat diperlukan dan akan tertakluk kepada pengesahan sebelum satu alasan dapat dimantapkan, maklumat sedikit boleh menyebabkan kelewatan tidak perlu dalam pemprosesan permohonan anda. Semua pemohon wajib membaca Pengakuan yang tertera sebelum menandatangan di petak tandatangan pemohon di penghujung borang permohonan ini. Date of Birth Tarikh Lahir (day/month/year) Male Lelaki NRIC/Passport No. KP/No. Pasport Nationality Kewarganegaraan Female Perempuan Present Residential Address Alamat Kediaman Kini Tel (Home) Tel (Rumah) Mobile No. No. Tel Bimbit Emel Company Name (in full) Nama Syarikat (sepenuhnya) Position Jawatan Gross Annual Salary Gaji Tahunan Kasar (RM) Company Application Permohonan Syarikat This Section is an application to establish an American Express Business Card Account. From this account we will issue Business Cards to qualified members of your company. Seksyen ini adalah satu permohonan untuk mewujudkan akaun Kad Bisnes American Express. Daripada akaun ini, kami akan mengeluarkan Kad Bisnes untuk ahli-ahli yang layak di syarikat anda. Business Premise Premis Perniagaan Tel (Business) Tel (Bisnes) Extension Sambungan Fax No. No. Faks No. of Employees Jumlah Pekerja Own Milik Sendiri Rented Sewa Industry or Nature of Business Industri atau Sifat Perniagaan Registration No. No. Pendaftaran Total Assets Jumlah Aset-Aset (RM) Existing Maybank Company Account Akaun Syarikat Maybank Terkini Yes Ya No Tidak If yes, Maybank Account No. Jika ya, No. Akaun Maybank Other Information Lain-Lain Maklumat I will be the contact for Central Bill Payments and Statement Saya akan menjadi penghubung untuk Bayaran dan Penyata Pusat Bil Yes Ya No Tidak Not Sure Tidak Pasti I will be the contact approver for any Add-on Cards for the Company Saya akan menjadi penghubung untuk pengulusan Kad Tambahan Yes Ya No Tidak Not Sure Tidak Pasti If you have stated No or Not Sure to either of the above statements, Maybank will qualify this information upon receipt of your application form Jika anda telah menyatakan Tidak atau Tidak Pasti untuk salah satu kenyataan-kenyataan di atas, Maybank akan melayakkan maklumat ini atas penerimaan borang permohonan anda

4 To expedite processing, please enclose the following documents (certified true copies): I) Business Registration Form A/B/Form 9, 24 and 49/Trading License II) Last 2 years audited financial statements III) Last 6 months company bank statements IV) Company s memorandum and article of association V) Copy of NRIC (both sides) or passport Vl) SME Bureau consent letter Untuk mempercepatkan pemprosesan, sila sertakan dokumen-dokumen (salinan sebenar diperakui): I) Borang Pendaftaran Perniagaan A/B/Borang 9, 24, 49/Lesen Perniagaan II) 2 tahun terakhir penyata kewangan yang diaudit III) 6 bulan terakhir penyataan bank untuk syarikat IV) Memorandum dan artikel persatuan syarikat V) Salinan Kad Pengenalan (depan dan belakang) atau pasport Vl) Surat kebenaran SME Biro The annual Service Tax of RM50 (Principal Card and Add-on Card) will be imposed on each Card. Cukai Perkhidmatan tahunan sebanyak RM50 (Kad Utama dan Kad Tambahan) akan dikenakan untuk setiap Kad. By signing below, I acknowledge that I have read and agree to the declaration stated / Dengan menandatangani di bawah, saya mengakui yang saya telah membaca dan bersetuju kepada perisytiharan yang dipaparkan Signature of Applicant Tandatangan Permohon Authorised Signatory Tandatangan Rasmi Date Tarikh Date Tarikh Name Nama Position Jawatan Company Stamp Cop Syarikat Declaration I/We declare that the above information given by me/us is true and complete. I/We hereby authorise you to verify information on me/us from whatever source you consider appropriate from any financial institution and the Director General of Inland Revenue Department on any information which Malayan Banking Berhad may require. I/We further agree and authorise the Bank to make the relevant credit references with external parties including but not limited to CCRIS, and any other credit reference agencies and that in so doing 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 confirm that I/we shall read the terms and conditions of the Malayan Banking Berhad Credit Cardholder Agreement which have been displayed on the Malayan Banking Berhad s maybank2u.com website and agree to be bound by them and all future amendments thereto before accepting and receiving the card(s). In the event I/we require a hard copy of the said Malayan Banking Berhad Credit Cardholder Agreement, I/we may request for a copy of the same from the Bank. I/We further agree that the company and I/we will be Jointly & Severally responsible for the liabilities and obligations of all Cardmember(s) applied under the company, for the charges made with the Business Card. 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 understand the Card(s) remain the property of Malayan Banking Berhad and shall be subject to cancellation without notice and would be returned upon request. I/We hereby agree to you disclosing information to Bank Negara Malaysia regarding my/our credit facilities and my/our account with you, as may be required, whether pursuant to law or otherwise. Malayan Banking Berhad shall not be liable whether directly or indirectly to me/us or any other persons for such disclosure. Pengakuan Saya/Kami sesungguhnya berikrar bahawa maklumat yang diberi di atas oleh saya/kami adalah benar dan lengkap. Saya/Kami memberi kuasa kepada anda untuk mengesahkan maklumat tentang saya/kami dan manamana pemohon tambahan dari mana-mana sumber yang difikirkan sesuai, dari mana-mana institusi kewangan dan Ketua Pengarah Lembaga Hasil Dalam Negeri, untuk apa sahaja maklumat yang Malayan Banking Berhad perlukan. Saya/Kami seterusnya bersetuju dan membenarkan Bank membuat rujukan kredit yang berkaitan dengan pihak-pihak luaran termasuk tetapi tidak terhad kepada CCRIS, dan mana-mana agensi rujukan kredit lain dan ketika melaksanakan sedemikian Bank berhak mendedahkan maklumat yang diperlukan agar pihak-pihak luaran dapat menyediakan rujukan/ pengesahan yang diminta oleh Bank. Saya/Kami mengesahkan bahawa saya/kami akan membaca syarat dan peraturan Perjanjian Pemegang Kad Malayan Banking Berhad yang telah dinyatakan di laman web maybank2u. com Malayan Banking Berhad dan bersetuju untuk mematuhinya dan segala pindaan akan datang sebelum menerima dan mengambil kad (kad-kad). Sekiranya saya/kami memerlukan salinan Perjanjian Pemegang Kad Malayan Banking Berhad tersebut, saya/kami boleh meminta salinan tersebut daripada pihak Bank. Saya/Kami seterusnya bersetuju bahawa syarikat serta saya/kami akan menanggu liabiliti bersesama terhadap semua liabiliti dan obligasi ke atas semua Pemegang Kad yang dipohon melalui syarikat, terhadap segala caj yang dilakukan dengan menggunakan Kad Bisnes ini. Bank mempunyai hak mutlak untuk melulus atau menolak permohonan saya/kami sewajarnya tanpa memberikan apa-apa sebab. Saya/Kami faham bahawa kad tersebut masih hakmilik Malayan Banking Berhad dan akan tertakluk kepada pembatalan tanpa pemberitahuan awal dan perlu dikembalikan atas permintaan. Saya/Kami dengan ini memberi kebenaran kepada Malayan Banking Berhad untuk mendedahkan maklumat berhubung kemudahan kad kredit atau akaun saya/kami kepada Bank Negara Malaysia, sepertimana yang ditetapkan oleh undang-undang atau sebaliknya. Malayan Banking Berhad tidak akan bertanggungjawab terhadap sebarang liabiliti, secara langsung atau tidak langsung, yang diakibatkan oleh pendedahan berkenaan, sama ada kepada saya/kami ataupun mana-mana pihak yang lain. I/We hereby expressly irrevocably consent and authorise the Bank to disclose any information that I have provided/disclosed to the Bank for the purpose of cross selling, marketing and promotions with other companies within Maybank Group, its agent (including but not limited to any authorities, merchants and any member of ie Visa International), servants and/or such persons or third parties as the Bank may beem fit. / Saya/Kami mengesahkan bahawa saya/kami memberi kebenaran dan kuasa kepada Bank yang tidak boleh dibatal tanpa kebenaran untuk mendedahkan sebarang maklumat yang telah saya kemukakan kepada Bank bagi tujuan jualan silang ( cross selling ), pemasaran dan promosi dengan syarikat syarikat dalam kumpulan Maybank Berhad, agen (termasuk tetapi tidak terhad kepada mana-mana pihak berkuasa, bank-bank saudagar dan mana-mana ahli institut seperti Visa International), pekerja-pekerjanya dan/atau mana-mana individu atau pihak ketiga yang difikirkan oleh Bank adalah wajar. Please tick ( ) where applicable in relation to the above provision / Sila tanda ( ) pada yang berkenaan berhubung terma yang dinyatakan di atas. Yes Ya No Tidak For Office Use Only Untuk Kegunaan Pejabat Sahaja Name Nama (FE/CSE/RB/DSE/TSE) : PF NO. NO. PF : Branch Cawangan : Branch Code Kod Cawangan : Tel Tel : Fax Faks : Campaign Code Kod Kempen : Introduced by (Lead Generator) Diperkenalkan oleh (Lead Generator) : Maybankard Centre Commercial Card, 39th Floor, Menara Maybank 100 Jalan Tun Perak, Kuala Lumpur. MAS(P)0512

5 Emergency Card Replacement In the event of a lost or stolen card, a replacement Card will be sent to you in 24 hours when in Malaysia and within 5 days when overseas. Once your Card has been reported lost or stolen you will not be held liable for any transactions made on the Card. The MAS American Express Platinum Business Card gives you more Enrich Miles Customer Service The Customer Service Hotline is open during business hours for enquiries about your Card account, for advice on Card services, or to request details regarding American Express Travel Offices. For more information, please call or or apply now by returning your completed application form via or fax Apply now and enjoy : 10,000 Enrich Miles* With Automatic Enrich Gold Status * 2,000 Enrich Miles valid on the first transaction and 8,000 Enrich Miles on the first Malaysia Airline ticket purchase. Apply now and enjoy : 10,000 Enrich Miles* Maybankard Centre Commercial Card, 39th Floor, Menara Maybank 100 Jalan Tun Perak, Kuala Lumpur. Terms & Conditions apply

6 A Card Designed for the Travelling Business Executive The MAS American Express Platinum Business Card offers you exceptional benefits and savings, including a superior Enrich Mile earn rate and exclusive airline benefits. Ensure your business travel provides you with the services you deserve, and arrive at your destination refreshed. 2,000 Bonus Enrich Miles On First Transaction 8,000 Bonus Enrich Miles On Your First Malaysia Airlines Ticket Purchase 100% Bonus Enrich Miles On Local Spend Of RM10,000 Annually 5% Savings On Malaysia Airlines International Flights Year Round EXCLUSIVE REWARDS AND SAVINGS Earn More Enrich Miles Earn 2,000 Enrich Miles immediately upon your first transaction and an additional 8,000 Enrich Miles for your first Malaysia Airlines ticket purchase with your Business Card. Get 2 Enrich Miles for every RM5 spent overseas and 1 Enrich Mile for local spend. Also, enjoy a 100% bonus for all local Enrich Miles accrued on the anniversary of your Business Card, rewarding you with 2 Enrich Miles for every RM5 spent locally when you spend RM10,000 and above annually. Year Round Savings On Malaysia Airlines International Flights Enjoy exclusive 5% savings 1 on international flights departing from Malaysia when you travel with Malaysia Airlines. These savings will enable you to fly more throughout the year for less. You can obtain these savings through major travel agents, the Malaysia Airlines Call Centre and Malaysia Airlines ticket offices. 1 5% savings apply to MHsmart and above for flights departing from Malaysia. TRAVEL SERVICES AND BENEFITS Personal Concierge Whether you are abroad or at home, we can arrange the delivery of flowers, champagne or gifts for your business associates or your family. We will also assist in making special arrangements at world renowned restaurants around the globe for those important business meetings where you want to make the right impression. Complimentary Travel Accident Insurance Coverage 2 Enjoy complimentary Travel Accident Insurance of up to RM1,000,000, as well as Travel Inconvenience coverage for missed connections, luggage delay and luggage loss when airfare is booked through your MAS American Express Platinum Business Card. 2 Subject to the terms and conditions of the Master Policy. Global Assist Be assured that help is at hand should an emergency occur when overseas. Our Global Assist hotline is 24/7 and will source medical and legal support in the event of a natural disaster or crisis such as evacuation or repatriation. This travel line will also provide you information on inoculation and visa requirements, weather forecasts and exchange rates for your destination. FINANCIAL CONTROL FOR YOUR BUSINESS Easy Reconciliation All expenses you charge to the MAS American Express Platinum Business Card are consolidated into a simple monthly statement. This enables you to reconcile your spend with greater ease, having a single document of reference to tie your receipts or invoices to. You will also receive a year end summary of charges which consolidates all your expenses for the previous year into one simple report to give you maximum visibility of annual spend. Interest-Free Credit You pay no interest charges on any of your transactions for 20 days from the date of your monthly billing statement if you have paid the previous month s statement in full. This means up to 50 days interest-free on purchases, should you use your 30 days prestatement advantageously. If you opt to pay partial or minimum payment, the finance charges on your transactions will be calculated from the day the transactions are posted to your account. 0% EzyPay Enjoy 0% interest free installment plans 3 with the MAS American Express Platinum Business Card, freeing up cash flow. 3 Check with the partner merchants on the available options for the installment plans. CONVENIENCE AND PEACE OF MIND Access To U.S. Online Shopping With Globaleshop is an online service for MAS American Express Business Cards. Enjoy secure and hassle-free shopping at any U.S. merchant, including those that don t deliver internationally, and have your purchases delivered to your doorstep in Malaysia. Our buyfor-me concierge service will also make purchases on your behalf at U.S. sites that do not accept international cards, enabling you to source unique gifts or accessories. Convenient Payment Options You can pay your MAS American Express Business Card bills online or at over 400 Maybank branches or at over 2,000 Maybank Kawanku ATMs nationwide with cash or cheque. Saturday banking is also available at some branches. For more information, visit Cash Withdrawals Cash withdrawals are available at all national Maybank ATMs and over 900,000 American Express ATMs worldwide.

7 MAS American Express Platinum Business Card Kad Bisnes Platinum MAS American Express Application Form Borang Permohonan MAS American Express Platinum Business Card Kad Bisnes Platinum MAS American Express Annual Fee Yuran Tahunan : RM500 Enrich Membership Keahlian Enrich I am an existing Enrich member Saya merupakan ahli Enrich Card No. No. Kad M H I do not have an Enrich Card, please enrol me as a new Enrich member Saya tidak mempunyai Kad Enrich, sila daftarkan saya sebagai ahli baru Enrich If your Enrich mailing address differs from your current address, please call Enrich at to update your information. Jika alamat surat-menyurat berbeza dengan alamat semasa, sila hubungi Enrich di untuk mengemaskini maklumat anda. To qualify, applicants must be 21 years old or above. Age limit for applicants is 65. Eligibility : Annual income of RM120,000 and above To expedite processing, please enclose the following documents (certified true copies) : 1. Copy of NRIC (both sides) or passport 2. Latest BE form with official tax receipt or latest EA form 3. Latest 2 months salary slips 4. Latest 3 months savings account activity/current account statements 5. For Self-Employed - copies of your Business Registration and latest 3 months bank statements 6. For Expatriates - letter from employer confirming duration of employment contract in Malaysia and applicant must be a Maybank account holder Note: Documents submitted are non-returnable. Additional documents may be requested (when necessary) upon processing. Approval is subject to the bank s credit assessment and the bank has the right not to disclose reasons for decline. Pemohon mestilah berusia 21 tahun ke atas. Had umur untuk pemohon adalah 65 tahun. Kelayakan : Pendapatan tahunan RM120,000 dan ke atas Untuk mempercepatkan pemprosesan, sila sertakan dokumen-dokumen (salinan sebenar diperakui): 1. Salinan Kad Pengenalan (depan dan belakang) atau pasport. 2. Borang BE terkini serta resit cukai rasmi atau borang EA terkini. 3. Penyata gaji 2 bulan terakhir 4. Aktiviti akaun simpanan/penyata akaun semasa 3 bulan terakhir 5. Untuk yang Bekerja Sendiri - salinan Pendaftaran Perniagaan dan penyata bank 3 bulan terakhir 6. Untuk Pekerja Asing - surat daripada majikan mengesahkan tempoh kontrak pekerjaan di Malaysia dan pemohon mestilah pemegang akaun Maybank Nota: Dokumen yang dihantar tidak akan dikembalikan. Dokumen tambahan mungkin diminta (jika perlu) semasa pemprosesan. Kelulusan tertakluk pada pemeriksaan kredit bank dan berhak untuk tidak mengemukakan alasan penolakan. Personal Data Butiran Peribadi Title Gelaran Mr Encik Mrs Pn Ms Cik Name as in NRIC or Passport Nama mengikut KP atau Pasport NRIC/Passport No. KP/No. Pasport Date of Birth Tarikh Lahir (day/month/year) Name to Appear on the Card with Surname in full within 19 spaces Nama pada Kad dengan nama keluarga sepenuhnya dalam 19 petak Home Address Alamat Rumah Tel (Home) Tel (Rumah) Mobile No. No. Tel Bimbit View my MAS American Express Platinum Business Card Statement on Layari untuk melihat Penyata Akaun anda. ID ID Emel I want my statement to be mailed to me at RM5 per month. Saya ingin Penyata Akaun dikirimkan kepada saya dengan caj RM5 sebulan. Residence Kediaman Own Milik Sendiri Parents Milik Ibubapa Others Lain-lain Rented Sewa Years Spent Tempoh Menetap Relatives Milik Saudara Marital Status Taraf Perkahwinan Mother s Name Nama Ibu Employment Details Butiran Pekerjaan BRN No : Name of Employer Nama Majikan / Firma Office Tel Tel Pajabat Office Fax Faks Pejabat Office Address Alamat Pejabat Business Premise Premis Perniagaan Nature of Business Jenis Perniagaan Designation Jawatan Business Classification Klasifikasi Perniagaan Sole Proprietorship Milik Sendiri Government Kerajaan Own Milik Sendiri Rented Sewa Partnership Perkongsian Sdn Bhd MNC / Public Listed MNC / Senaraian Awam Other Lain-lain Years Employed/In Business Tempoh Perkhidmatan/dalam Perniagaan Banking Reference Butiran Kewangan Bank Account No. Type of Account Date Opened Bank No. Akaun Jenis Akaun Tarikh Dibuka Spouse Pasangan Married Berkahwin Single Bujang (This feature is for your security when verification is required. Ciri ini adalah untuk keselamatan anda jika pengesahan diperlukan.) Name as in NRIC or Passport Nama mengikut KP atau Pasport

8 NRIC/Passport No. KP/No. Pasport Date of Birth Tarikh Lahir (day/month/year) If employed, name and address of employer Jika bekerja, nama dan alamat majikan. Office Tel Tel Pajabat Designation Jawatan Nationality Kewarganegaraan Emergency Contact Rujukan Kecemasan (Parents/immediate family members not living with you. Ibu bapa/ahli keluarga yang tidak tinggal serumah dengan anda). Name Nama Relationship Pertalian Home Address Alamat Rumah House Tel Tel Rumah Office Tel Tel Pejabat HP No No Tel Bimbit Billing Address Alamat Surat-Menyurat Bill to Bil ke House Rumah Office Pejabat Declaration Pengakuan I declare that the above information given by me is true and complete. I hereby authorise you to verify information on me and any from whatever source you consider appropriate from any financial institution and the Director General of Inland Revenue Department on any information which Malayan Banking Berhad may require. I further agree and authorise the Bank to make the relevant credit references with external parties including but not limited to CCRIS, and any other credit reference agencies and that in so doing 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 also confirm that none of my/our spouse(s), parents and/or children are employees of Malayan Banking Berhad or Malayan Banking Group. I confirm that I shall read the terms and conditions of the Malayan Banking Berhad Credit Cardholder Agreement which have been displayed on the Malayan Banking Berhad s maybank2u.com website and agree to be bound by them and all future amendments thereto before accepting and receiving the card(s). In the event I require a hard copy of the said Malayan Banking Berhad Credit Cardholder Agreement, I may request for a copy of the same from the Bank. I further agree that the Cardmember shall be responsible for all liabilities and obligations of the Cardmember. The Bank shall reserve the absolute right to approve or reject my application as the Bank deems fit without assigning any reason. I understand the card(s) remain the property of Malayan Banking Berhad and shall be subject to cancellation without notice and would be returned upon request. I hereby agree to you disclosing information to Bank Negara Malaysia regarding my credit facilities and my account with you, as may be required, whether pursuant to law or otherwise. Malayan Banking Berhad shall not be liable whether directly or indirectly to me or any other persons for such disclosure. Saya sesungguhnya berikrar bahawa maklumat yang diberi di atas oleh saya adalah benar dan lengkap. Saya memberi kuasa kepada pihak Bank untuk mengesahkan maklumat tentang saya dari mana-mana sumber yang difikirkan sesuai, dari mana-mana institusi kewangan dan Ketua Pengarah Lembaga Hasil Dalam Negeri, untuk apa sahaja maklumat yang Malayan Banking Berhad perlukan. Saya seterusnya bersetuju dan membenarkan Bank membuat rujukan kredit yang berkaitan dengan pihak-pihak luaran termasuk tetapi tidak terhad kepada CCRIS, dan mana-mana agensi rujukan kredit lain dan ketika melaksanakan sedemikian Bank berhak mendedahkan maklumat yang diperlukan agar pihak-pihak luaran dapat menyediakan rujukan/ pengesahan yang diminta oleh Bank. Saya juga mengesahkan bahawa tiada pasangan, ibu bapa dan/atau anak-anak saya yang bekerja dengan Malayan Banking berhad atau Kumpulan Malayan Banking. Saya mengesahkan bahawa saya akan membaca syarat dan peraturan Perjanjian Pemegang Kad Malayan Banking Berhad yang telah dinyatakan di laman web maybank2u.com Malayan Banking Berhad dan bersetuju untuk mematuhinya dan segala pindaan akan datang sebelum menerima dan mengambil kad (kad-kad). Sekiranya saya memerlukan salinan Perjanjian Pemegang Kad Malayan Banking Berhad tersebut, saya boleh meminta salinan tersebut daripada pihak Bank. Saya seterusnya bersetuju bahawa Pemegang Kad hendaklah bertanggungjawab terhadap semua liabiliti dan obligasi Pemegang Kad. Bank mempunyai hak mutlak untuk melulus atau menolak permohonan saya sewajarnya tanpa memberikan apa-apa sebab. Saya faham bahawa kad tersebut masih hakmilik Malayan Banking Berhad dan akan tertakluk kepada pembatalan tanpa pemberitahuan awal dan perlu dikembalikan atas permintaan. Saya dengan ini memberi kebenaran kepada Malayan Banking Berhad untuk mendedahkan maklumat berhubung kemudahan kad kredit atau akaun saya kepada Bank Negara Malaysia, sepertimana yang ditetapkan oleh undang-undang atau sebaliknya. Malayan Banking Berhad tidak akan bertanggungjawab terhadap sebarang liabiliti, secara langsung atau tidak langsung, yang diakibatkan oleh pendedahan berkenaan, sama ada kepada saya ataupun mana-mana pihak yang lain. (For External Account Holders Only Untuk Pemegang Akaun Luar Sahaja) I confirm that my borrowings from all sources within Malaysia do not exceed in aggregate RM200,000. Saya mengesahkan bahawa pinjaman saya daripada segala sumber di dalam Malaysia tidak melebihi agregat RM200,000. The annual Service Tax of RM50 will be imposed on each Card. Cukai Perkhidmatan tahunan sebanyak RM50 akan dikenakan untuk setiap Kad. I hereby expressly irrevocably consent and authorise the Bank to disclose any information that I have provided/disclosed to the Bank for the purpose of cross selling, marketing and promotions with other companies within Maybank Group, its agent (including but not limited to any authorities, merchants and any member of ie Visa International), servants and/or such persons or third parties as the Bank may beem fit. / Saya mengesahkan bahawa saya memberi kebenaran dan kuasa kepada Bank yang tidak boleh dibatal tanpa kebenaran untuk mendedahkan sebarang maklumat yang telah saya kemukakan kepada Bank bagi tujuan jualan silang ( cross selling ), pemasaran dan promosi dengan syarikat syarikat dalam kumpulan Maybank Berhad, agen (termasuk tetapi tidak terhad kepada mana-mana pihak berkuasa, bank-bank saudagar dan mana-mana ahli institut seperti Visa International), pekerja-pekerjanya dan/atau manamana individu atau pihak ketiga yang difikirkan oleh Bank adalah wajar. Please tick ( ) where applicable in relation to the above provision / Sila tanda ( ) pada yang berkenaan berhubung terma yang dinyatakan di atas. Yes Ya Signature of Card Applicant Tandatangan Pemohon Kad Date Tarikh : Send your Application Form to Hantarkan Borang Permohonan anda ke : Maybankard Centre Commercial Card, 39th Floor, Menara Maybank, 100 Jalan Tun Perak, Kuala Lumpur, Malaysia. Fax: For Office Use Only Untuk Kegunaan Pejabat Sahaja Name Nama (FE/CSE/RB/DSE/TSE) : No Tidak PF NO. NO. PF : Branch Cawangan : Branch Code Kod Cawangan : Tel Tel : Fax Faks : Campaign Code Kod Kempen : Introduced by (Lead Generator) Diperkenalkan oleh (Lead Generator) : Maybankard Centre Commercial Card, 39th Floor, Menara Maybank 100 Jalan Tun Perak, Kuala Lumpur. MAS(P)IL0512

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