CONFIDENTIAL

CIMB BANK BERHAD CIMB ISLAMIC BANK BERHAD

197201001799 (13491-P) 200401032872 (671380-H)
Branch Code
GENERAL CUSTOMER INFORMATION FORM Employee No.

PRODUCTS INTERESTED IN
u Savings/Current/Fixed Deposit/Fixed Return Income Account-i u Credit Card/-i(s) u Auto Financing
u Term Financing-i Secured by ASB u Property Financing u Personal Financing

MY PERSONAL DETAILS
Residency Status (Please one)
Are you an existing customer u Yes u No
Salutation
u Resident u Permanent Residency
u Malaysia My 2nd Home
u Mr u Mrs u Miss u Madam
u Non-Resident, please specify Country of Residence
u Others, please specify
Full Name as per NRIC/Passport
Race
u Malay u Chinese u Indian
NRIC/Passport no. u Others, please specify

Gender u Male u Female

Passport Expiry Date D D / M M / Y Y Y Y
Date of Birth D D / M M / Y Y Y Y
u Other Identification no.
u MyTentera u MyPolis u Old I/C u Birth Certificate Marital Status

Identification no. u Single u Married u Widowed

u Divorced u Separated
Nationality
u MALAYSIAN (Please one) With Dependent Children
u Bumiputra u Non-Bumiputra u No u Yes, please specify how many
u Non-MALAYSIAN, please specify country, visa type and
expiry date of visa Highest Education Level (Please one)
Country u Not applicable u Primary u Secondary
Visa type Code* u Diploma u Professional Qualification
u Bachelor u Masters u Doctorate
Visa document number

Visa expiry date D D / M M / Y Y Y Y

*for Bank use only

GCI V2021.0063.01 [Page 1]

 MY CONTACT DETAILS
Residential Address Please Select Preferred Mailing Address
u Residential Address u Office Address
Note: For credit card, preferred mailing address is defaulted to Residential
Address.
Postcode City
If you prefer an alternative mailing address please indicate below
State Country

Residence Type (Please one)

u Employer’s Quarters u Family Home/Relatives
Postcode City
u Own (Mortgaged) u Own (Not Mortgaged)
State Country
u Rented
Home Phone no.
Office Address
Mobile no.

E-mail Address (required)

Postcode City
State Country

MY EMPLOYMENT/BUSINESS DETAILS
Employer Name Employment Status
u Permanent u Contract u Temporary
Employment Sectors
Code* 1 0 0 0
Office Phone no.
Type of Company (Please one)
Gross Monthly Income Other Monthly Income u CIMB Group u MNC (Non FI)
RM RM u Government Agency u KLSE listed
u Financial Institution (FI) u Private Limited Company
Source of Income
u Public Ltd Company u Sole Proprietorship/
Code* - Not Listed Partnership
u None/Unemployed
Other Source of Income u Others
Code*
Size of Current Employment Company (Please one)
Occupation u <15 employees u 15-50 employees
Code* u >50 employees
Employment Type Length of Service Total Working Experience
Code* Y Y / M M Y Y / M M

*for Bank use only

[Page 2]
 DECLARATION/DISCLOSURE BY APPLICANT(S)/GUARANTOR**
** These declaration shall apply to all CIMB Bank Berhad and/or CIMB Islamic Bank Berhad, as the case may be, (“the Bank”) product(s) which you apply
for as stated in the application form(s). 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 account/loan/financing product(s) referred to in the application form(s) completed by me/us.
FOR ALL PRODUCTS:
1. I/We declare that the information furnished in this application form(s) completed by me/us in relation to the account/loan/financing product(s) applied
for by me/us are true, accurate and complete. I/We have not withheld any information which may prejudice my/our application or have a bearing on the
Bank’s decision.
2. The application forms remain the Bank’s property regardless of whether the facility/account is approved and the Bank reserves the right to reject the
application(s) at its sole discretion without any reasons whatsoever.
3. I/We have not committed any act of bankruptcy and/or been adjudged a bankrupt.
4. I/We confirm that the Bank is authorised to verify and/or make any checks and/or obtain any information and/or confirmation at any time now and/or in
the future, with or from any source, previous, current and future employers and/or any credit reference/reporting agencies, including but not limited to
CCRIS, CTOS, 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/our status for the consideration of the application(s) and thereafter if the application(s) is approved for the
purposes of 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.
5. I/We consent and authorise any credit reporting agency registered under the Credit Reporting Agencies Act 2010 (“CRA”) to process and disclose any
of my/our credit information (as defined in the CRA) in the records of the CRA to the Bank for the purposes of processing or considering the application/
additional application for the Bank’s products including but not limited to credit evaluation, fraud checks, credit reviews, credit monitoring and debt
recovery processes. I/We further consent and authorise the credit reporting agencies to disclose any of my/our credit information to the credit reporting
agencies’ subscribers for purposes of fraud detection and fraud prevention.
6. Anti-Money Laundering (AMLA) - I/We assure the Bank that I/we will exercise due care not to facilitate funds from proceeds of any unlawful activity
to be channeled through my/our account(s) with the Bank and undertake to provide the Bank with all relevant information and documents, as and
when requested, for purposes of my/our identification and/or verification of the source of my/our funds or purpose of transaction under the “Know
Your Client” principle.
7. Subject to the provisions below which (i) prohibit disclosure of information to Group Companies if objected to by me/us; and (ii) require my/our express
consent for disclosure of information to third parties for the stated purposes, I/We 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/us, my/our affairs and/or any accounts maintained by me/us 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/us 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/us): Tel No.: +603 6204 7788.
Further, where the Bank intends to share my/our information (excluding information relating to my/our affairs or account) with third parties for strategic
alliances, marketing and promotional purposes,
u I/We hereby give my/our consent to the above disclosure to third parties.
u I/We do not consent to the giving of the above disclosure to third parties.
8. Taxes
I/We am/are aware that the facility/account may be subject to taxes (including but not limited to indirect taxes or withholding taxes), where applicable,
as may be imposed by the Government of Malaysia or by any other government in any jurisdiction and I/we hereby further agree that I/we shall be
liable for any taxes payable in connection with or arising out of facility/account and I/we hereby authorised the Bank to debit my/our account with
the Bank for the same.
9. Declaration On Foreign Account Tax Compliance Act (FATCA)

Joint Applicant/Supplementary Card Joint Applicant/Supplementary Card

Principal Applicant Applicant/Guarantor/Registered Applicant/Guarantor/Registered
Owner (where applicable) Owner (where applicable)

Please select Yes or No for each of the following questions

1. Are you a U.S. Resident? u Yes u No u Yes u No u Yes u No

(including a current work If yes, Tax Number If yes, Tax Number If yes, Tax Number
permit)

u Yes u No u Yes u No u Yes u No

2. Are you a U.S. Citizen or a
Citizen of a U.S. Territory? If yes, Tax Number If yes, Tax Number If yes, Tax Number

3. Do you hold a U.S. u Yes u No u Yes u No u Yes u No

Permanent Resident Card If yes, Tax Number If yes, Tax Number If yes, Tax Number
(Green Card)?

Passport/ID No. (please

include the 8-digit/letter U.S.
VISA, where applicable)

I/We hereby confirm the information provided in the table above is true, accurate and complete. Subject to the applicable local laws, I/we 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/our information with domestic or overseas regulators or tax authorities where necessary to establish my/our tax liability in any/or the relevant
jurisdiction. Where required by domestic or overseas regulators or tax authorities, I/we also understand and agree that CIMB may be required to obtain
additional documents and/or forms, which I/we will sign, if I/we am/are subject to the relevant jurisdiction’s requirements. Where required by domestic
or overseas regulators or tax authorities, I/we understand and agree that CIMB may withhold, and pay out, from my/our account(s) such amounts
as may be required according to applicable laws, regulations, directives, and/or agreements with and/or from domestic or overseas governmental,
supervisory or regulatory authorities. I/We also agree and undertake to notify CIMB (within 30 calendar days), or provide the information if requested by
the Bank, if there is a change in any information which I/we have provided to CIMB.

[Page 3]
 DECLARATION/DISCLOSURE BY APPLICANT(S)/GUARANTOR**... CONTINUED
10. Declaration on Politically Exposed Person1 (“PEP”)
I declare that I am/used to be formerly a Politically Exposed Person (“PEP”)1/Family Member2 of the PEP/Close Associates3 of the PEP.

Joint Applicant/Supplementary Card Joint Applicant/Supplementary Card

Principal Applicant Applicant/Guarantor/Registered Owner Applicant/Guarantor/Registered Owner
(where applicable) (where applicable)

u Yes u No u Yes u No u Yes u No

If “YES” has been selected for any of the above, please tick () on the appropriate boxes in the table below.
For further clarification please refer to the “Notes”.

Joint Applicant/Supplementary Card Joint Applicant/Supplementary Card

Principal Applicant Applicant/Guarantor/Registered Applicant/Guarantor/Registered
Owner (where applicable) Owner (where applicable)

1. I am/We are a PEP1. u u u

u u u
2. I am/We are a Family Code*: Code*: Code*:
Member2 of the PEP.
Please find the respective Please find the respective Please find the respective
codes under Notes. codes under Notes. codes under Notes.

u u u
Code*: Code*: Code*:

3. I am/We are Close Please find the respective Please find the respective Please find the respective
Associate3 of the PEP. codes under Notes. codes under Notes. codes under Notes.
For “Others”, please specify For “Others”, please specify For “Others”, please specify
(mandatory) (mandatory) (mandatory)

Notes:
1
Politically Exposed Person (“PEP”) - a person who is or has been entrusted with a prominent public function. For example, Heads of State or of
government, senior politicians, senior government, judicial or military officials, senior executives of state owned corporations, important political
party officials.
*2
Family Member of the PEP: 002 - Spouse, 003 - Child, 004 - Parents, 005 - Parents-in-law, 006 - Siblings, 007 - Relative/Extended Family.
*3
Close Associates of the PEP: 008 - Work Colleague, 009 - Close Friend, 010 - Driver, 011 - Bodyguard, 012 - Secretary, 013 - Political Adviser,
014 - Guarantor, 015 - Business Associate, 016 - Business Partner, 017 - Lawyer, 018 - Person Acting on Behalf, 099 - Others (it is mandatory
to specify).

11. Privacy Notice Acknowledgement

I/We hereby acknowledge that I/we 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.cimb.com.my or has otherwise been made available to me/us) and confirm my/our agreement
to the same.

[Page 4]
 DECLARATION/DISCLOSURE BY APPLICANT(S)/GUARANTOR**... CONTINUED
DECLARATIONS FOR FINANCING PRODUCTS: FOR TERM FINANCING-i SECURED BY ASB CERTIFICATE, AUTO FINANCING, CASH PLUS
PERSONAL LOAN/XPRESS CASH FINANCING-i, CREDIT CARD/CREDIT CARD-i, PROPERTY FINANCING PRODUCT(S)
1. I/We also acknowledge that it is a requirement by Bank Negara Malaysia (“BNM”) that all information relating to the application(s), whether successful
or otherwise must be updated and/or transmitted to the Central Credit Reference Information System (“CCRIS”), a database maintained by BNM.
2. I/We declare that I/we have received, read and understood the Bank’s Rule and/or Terms and Conditions governing the operation and/or conduct of the
facility/account, and agree to comply with and be bound by the same and any amendments to the same which the Bank may subsequently introduce
from time to time upon giving adequate prior notice to me/us.
3. I/We declare that I/we have/do not have outstanding debt payment obligation from non-banks (e.g. cooperative building societies, credit companies
and merchants that provide credit sales). Particulars of the main applicant’s outstanding debt payment obligation are as follows (no declaration from the
main applicant denotes that this declaration is not applicable) :
No. Name of Entity Amount of Outstanding Debt (RM) Monthly Instalment Amount (RM)

2
Particulars of the joint-applicant’s/guarantor (if applicable) outstanding debt payment obligation are as follows (no declaration from the joint-applicant/
guarantor denotes that this declaration is not applicable):
No. Name of Entity Amount of Outstanding Debt (RM) Monthly Instalment Amount (RM)

2
4. In connection with the Bank Negara Guidelines on Credit Transactions and Exposures with Connected parties, I/we hereby declare that (no declaration
from the applicant(s) denotes that this declaration is not applicable):
u I am a staff of the CIMB Group1;
u To the best of my knowledge, I have close relative(s)2 employed under the CIMB Group or who have acted as my guarantor.
Particulars of my close relatives in CIMB Group and whether they have acted as my guarantor:
Name I/C/Passport No. Relationship 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 or persons who may influence/be influenced by the staff.
5. If my/our credit facility application is declined, I/we agree and consent to the Bank disclosing the reason(s) for the decline to Agensi Kaunseling dan
Pengurusan Kredit (“AKPK”), if requested by AKPK.
PRODUCT SPECIFIC DECLARATIONS FOR CREDIT CARD/CREDIT CARD-i
I/We hereby request the Bank to issue, upon approval of this application, the credit card/credit card-i(s) which I/we have indicated. I/We acknowledge that the credit
card(s) issued to me/us shall be subject to the Bank’s Credit Card Terms and Conditions which is available in the Bank’s website at www.cimb.com.my , and I/we
further agree to be bound by the terms and conditions set forth in the Bank’s Credit Card Terms and Conditions upon activation of the credit card(s). I, the Principal
Applicant further agree to accept joint and several liability for all amounts incurred arising from the use of the Principal and/or Supplementary credit card/credit card-
i(s) issued pursuant to this application or at any time thereafter at my and/or the Supplementary Applicant’s request. I/We further understand that the Bank shall not
hold the Supplementary Applicant jointly and severally liable for the debts or amounts incurred by the Principal Applicant or other Supplementary Applicant(s). I/We
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/We further
agree to accept liability for all amount incurred arising from the use of my/our credit card(s) issued pursuant to this application or at any time thereafter at my/our
request. I/We agree to be bound by the Bank’s E-Mail Statement Delivery Terms and Conditions and Statement Accessed Via CIMB Clicks Terms and Conditions
available at the Bank’s website – www.cimb.com.my in respect of all my/our statements sent to me/us by e-mail and/or viewed by me/us via CIMB Clicks.
PRODUCT SPECIFIC DECLARATIONS FOR SAVINGS ACCOUNT/SAVINGS ACCOUNT-i, CURRENT ACCOUNT/CURRENT ACCOUNT-i, FIXED
DEPOSIT/FIXED RETURN INCOME ACCOUNT-i
1. I/We confirm having read, understood and retained a copy of the Terms and Conditions in respect of ATM and Debit Card (where debit card is
applicable)/Phone Banking and agree to be bound by them.
2. I/We acknowledge and agree the Bank reserves the right to close my/our account at its absolute discretion if my/our account does not comply with the
Bank’s requirements.
3. For Current Account/Current Account-i, I/We declare that no account(s) in my/our name(s) has/have been previously reported to the Dishonoured
Cheque Information System of Bank Negara Malaysia.
4. For Joint Account - The joint account shall be operated by anyone of us, including any deposit, withdrawal or closure, unless specified otherwise.
Any one of us is authorised to deposit any instruments for payments of money payable to the individual orders of any of us without the personal
endorsement of the payee. In the event of the death of either/any of us, the Bank is authorised to pay any credit balance of the account to the survivor(s)
subject to compliance (if required) with the relevant statutory legislation, the Bank’s internal policy and/or in the case of an account opened with CIMB
Islamic Bank Berhad, Shariah principle.
5. I/We confirm that my/our personal account shall only be used for my/our personal non-business purposes (such as savings, investment, education and
personal or living expenses). I/We undertake to open, maintain or establish a separate business or non-personal account for business, association,
society, or trading purposes.
6. (a) Where the application is with CIMB Bank Berhad (Authorisation to CIMB Islamic Bank Berhad to Debit Account) To CIMB Islamic Bank Berhad
I/We acknowledge and agree that CIMB Islamic Bank Berhad shall be entitled to debit or cause to be debited any of my/our accounts maintained
with CIMB Islamic Bank Berhad, for any charges payable to it and in addition, I/we authorise CIMB Islamic Bank Berhad to debit any of my/our
accounts held with CIMB Islamic Bank Berhad upon instructions from CIMB Bank Berhad and remit the moneys to CIMB Bank Berhad for the
payment of fees and charges in relation to any account(s) and/or banking products and/or services and/or facilities granted by the CIMB Bank
Berhad to me/us.
(b) Where the application is with CIMB Islamic Bank Berhad (Authorisation to CIMB Bank Berhad to Debit Account) To CIMB Bank Berhad
I/We acknowledge and agree that CIMB Bank Berhad shall be entitled to debit or cause to be debited any of my/our accounts maintained with CIMB Bank
Berhad, for any charges payable to it and in addition, I/we authorise CIMB Bank Berhad to debit any of my/our accounts held with CIMB Bank Berhad
upon instructions from CIMB Islamic Bank Berhad and remit the moneys to CIMB Islamic Bank Berhad for the payment of fees and charges in relation to
any account(s) and/or banking products and/or services and/or facilities granted by the CIMB Islamic Bank Berhad to me/us.
APPOINTMENT OF CIMB ISLAMIC BANK AS AGENT (APPLICABLE ONLY FOR SAVINGS ACCOUNT-i, CURRENT ACCOUNT-i & FIXED RETURN
INCOME ACCOUNT-i)
For Savings Account-i, Current Account-i and Fixed Return Income Account-i (collectively referred to as “the Accounts”) under the Tawarruq concept, I/we
hereby appoint CIMB Islamic Bank to act as my/our agent to negotiate, execute and do all acts for the sale and purchase of the Commodity in accordance
with the applicable Terms and Conditions (“Terms and Conditions”) of the Accounts. The agency shall commence from the date the Accounts is opened until
the closure of the Accounts either by me/us or by the Bank in accordance with the applicable Terms and Conditions of the Accounts.

[Page 5]
CIMB BANK BERHAD CIMB ISLAMIC BANK BERHAD
197201001799 (13491-P) 200401032872 (671380-H)

PROPERTY FINANCING APPLICATION FORM

PERSONAL DETAILS (JOINT APPLICANT/GUARANTOR)

Are you an existing customer u Yes u No Date of Birth D D / M M / Y Y Y Y

Salutation Marital Status

u Mr u Mrs u Miss u Madam u Single u Married u Widowed
u Others, please specify u Divorced u Separated
Full Name as per NRIC/Passport With Dependent Children
u No u Yes, please specify how many

NRIC/Passport no. Highest Education Level

u Not applicable u Primary u Secondary
u Diploma u Professional Qualification
Passport Expiry Date D D / M M / Y Y Y Y u Bachelor u Masters u Doctorate
u Other Identification no. Residential Address
u MyTentera u MyPolis u Old I/C u Birth Certificate
Identification no.
Postcode City
Nationality
State Country
u MALAYSIAN (Please one)
u Bumiputra u Non-Bumiputra Mailing Address (If different from Residential Address)

u Non-MALAYSIAN, please specify country, visa type and

expiry date of visa
Country Postcode City
Visa type Code* State Country

Visa document number Home Phone no.

Visa expiry date D D / M M / Y Y Y Y Mobile no.

Residency Status (Please one) E-mail Address (required)

u Resident u Permanent Residency

u Malaysia My 2nd Home Residence Type (Please one)
u Non-Resident, please specify Country of Residence u Employer’s Quarters u Family Home/Relatives
u Own (Mortgaged) u Own (Not Mortgaged)
Race u Rented
u Malay u Chinese u Indian Relationship with Main Applicant
u Others, please specify u Spouse u Child u Relative
u Business Partner u Sibling u Parent
Gender u Male u Female u Others
*for Bank use only

V2023.0063.01 [Page 6]
 EMPLOYMENT DETAILS (JOINT APPLICANT/GUARANTOR)
Employer Name Employment Type
Code*

Employment Status
u Permanent u Contract u Temporary
Office Phone no.
Employment Sectors
Office Address Code* 1 0 0 0

Type of Company (Please one)

Postcode City
u CIMB Group u MNC (Non FI)
u Government Agency u KLSE listed
State Country
u Financial Institution (FI) u Private Limited Company
Gross Monthly Income Other Monthly Income u Public Ltd Company u Sole Proprietorship/
- Not Listed Partnership
RM RM
u None/Unemployed
Source of Income u Others
Code*
Size of Current Employment Company (Please one)
Other Source of Income u <15 employees u 15-50 employees
Code* u >50 employees
Occupation Length of Service Total Working Experience
Code* Y Y / M M Y Y / M M

*for Bank use only

FACILITY DETAILS
Purpose of Facility Product Name
u Purchase u Refinance
u Top-up/Enhancement u Cash-out First Time Property Purchase u Yes u No
Owner Occupied u Yes u No Reason for Top-up/Enhancement/Cash-out
u Renovation u Personal use/Education

PROPERTY VALUE
Purchase Price Indicative Market Value
RM RM

FACILITY AMOUNT
Housing/Term Loan/Home/Term Financing Other (GMRTA/GMRTT, Legal and Valuation fees)
RM RM

Margin of Finance % Term Y Y

[Page 7]
 INSURANCE/TAKAFUL (PLEASE SELECT OPTION)

u I wish to apply for GMRTA/GMRTT insurance/takaful policies underwritten by SunLife Malaysia/Sun Life Malaysia Takaful Berhad
Insured/Covered Applicant Insured/Covered Amount (RM) Term Insured/Covered (years)

PROPERTY DETAILS
Property Type
Title Type u Individual u Strata u Master
u Residential u Commercial u Land
Title Status u Freehold u Leasehold
Property Description
Specify Expiry Date of Lease D D / M M / Y Y Y Y

Land Area Built up Area Property Address

Construction Status (if applicable)

Postcode
u Completed u Under Construction
Title Number Lot Number
% of completion

Source of Property
Sub-district District
u Developer u Vendor u Auctioned u Refinancing
u Others State

OWNER’S DETAILS (FOR THIRD PARTY ONLY)

Owner’s Name 1 Owner’s Name 2

NRIC/Passport no. NRIC/Passport no.

Passport Expiry Date D D / M M / Y Y Y Y Passport Expiry Date D D / M M / Y Y Y Y

Relationship with Main Applicant Relationship with Main Applicant

FOR COMPANIES WHO ACT AS REGISTERED OWNER, KINDLY FILL IN THE INFORMATION BELOW
Company Name Company Registered Number

Industry Sector
Code*
*for Bank use only

[Page 8]
 UNDER CONSTRUCTION PROPERTY
Project Name Developer’s Name

Phase

REFINANCING PROPERTY
Current Financier (if applicable) Bank Account Number with Current Financier (if applicable)
u Master Account Number
Outstanding Amount Financial Institution Code
RM u Sub Account Number

SECONDARY MARKET PROPERTY

Vendor Name u Other Identification no.
u Passport u Army/Police
u Others, please specify
Vendor’s NRIC
Specify Number

Passport Expiry Date D D / M M / Y Y Y Y

AS FINANCING EXTENDS BEYOND MY/OUR RETIREMENT AGE, I/WE PROPOSE TO SETTLE/REDUCE THE
FINANCING VIA THE FOLLOWING:

u Withdrawal from EPF u Proceeds from investment

u Pension provisions or contracted annuity payments u Refinancing to be undertaken by children
u Proceeds from Insurance/Takaful policy cash value u Other manner, please specify

DOCUMENTS ENCLOSED
Which of the following documents are you providing with this form?

ALL APPLICANTS
u Copy of applicant’s NRIC/Passport u Latest EA Form/Form B with proof of tax payment/EPF Statement
u Latest 3 months’ bank statements u Sale and Purchase Agreement OR booking receipt OR copy of Title Deed
u Valuation report (if available) u Latest loan/financing statement (if refinancing)
SALARIED APPLICANTS SELF-EMPLOYED APPLICANTS
u Latest 3 months’ salary slip u Profit and loss statement
u Employment letter u Business registration A & D OR Forms 24 & 49

u Duly completed US IRS form, when applicable as requested by the bank

Note: To use the latest form, download from US IRS website (http://www.irs.gov/Businesses/Corporations/FATCA-Current-Alerts-and-Other-News) >>
Forms and Publications (PDF) section for the form and instructions. W-8 forms (http://apps.irs.gov/app/picklist/list/formsPublications.html;jse
ssionid=HWBdbXB4i5kwMZvndb6Fog__?value=w-8&criteria=formNumber&submitSearch=Find), W-9 form (http://apps.irs.gov/app/picklist/list/
formsPublications.html;jsessionid=55K-+0VI1PmJE5z-FUjoNw__?value=w-9&criteria=formNumber&submitSearch=Find)

[Page 9]
 Conventional Branch Code
Employee No.
CIMB BANK BERHAD CIMB ISLAMIC BANK BERHAD Campaign Code
197201001799 (13491-P) 200401032872 (671380-H)

CREDIT CARD/CREDIT CARD-i APPLICATION FORM (MAIN APPLICANT)

Please tick () where applicable
u New Card u Additional Card u Supplementary Card

Important Notes:
For Additional Card: ONLY fill in your Full Name, NRIC/Passport/Other ID numbers, Nationality, My Employment/Business Details & Declaration/Disclosure
by applicant(s) in the General Customer Information section. Please select the card(s) that you wish to apply below. Where applicable, please complete
the Monthly Repayment/Payment Section (Mandatory for Non-Malaysian) and/or Insurance Coverage.
For Supplementary Card: ONLY fill in Full Name, My Employment/Business Details & NRIC/Passport/Other ID numbers of the Principal Cardholder &
Declaration/Disclosure by applicant(s) in the General Customer Information section. Please select the card(s) that you wish to apply and complete the
supplementary card details.

REQUIREMENTS

Age Principal Card : 21 years old Supplementary Card : 18 years old

Travel World Elite Travel Visa Infinite World Mastercard Visa Signature Platinum
Minimum
World Mastercard
Income
Per Annum RM250,000 RM100,000 RM120,000 RM90,000 RM60,000 RM24,000

I WISH TO APPLY FOR THE FOLLOWING CARD (PLEASE CHOOSE A MAXIMUM OF 3 CARD PRODUCTS ONLY)

A. CIMB BANK CREDIT CARD

u CIMB Travel World Elite u CIMB Visa Infinite u CIMB Visa Platinum
u CIMB Travel World Mastercard u CIMB World Mastercard u CIMB Cash Rebate Platinum
u CIMB Travel Platinum u CIMB Visa Signature u CIMB e Credit Card

B. CIMB ISLAMIC CREDIT CARD-i

u CIMB PETRONAS Visa Infinite-i u CIMB PETRONAS Visa Platinum-i u CIMB Platinum-i
Important Note: (1) Additional credit card-i/credit card will share a combined credit limit. (2) Please sign within the signature box.

MY PERSONAL DETAILS
Note: Credit Card Statement will be sent to the e-mail address provided above. For existing cardholders, your other statements will also be sent to this
e-mail address.
Name to Appear on Card (Not more than 19 letters) Mother’s Maiden Name

MY EMERGENCY CONTACT
Name Relationship to Principal Cardholder/Applicant

Contact no.

[Page 10]
 SUPPLEMENTARY CARD DETAILS
Salutation Mobile no.
u Mr u Mrs u Miss u Madam
u Home Phone no. u Office Phone no.
u Others, please specify
Full Name as per NRIC/Passport Race
u Malay u Chinese u Indian
u Others, please specify
NRIC/Passport no.
Nationality
u MALAYSIAN (Please one)
*For Passport holders please indicate your passport expiry date
u Bumiputra u Non-Bumiputra
D D / M M / Y Y Y Y
u Non-MALAYSIAN, please specify country, visa type and
expiry date of visa
u Other Identification no.
Country
u MyTentera u MyPolis u Old I/C u Birth Certificate
Visa type Code*
Identification no.
Visa document number
Occupation
Visa expiry date D D / M M / Y Y Y Y
Code*

Employment Sectors Name to Appear on Card (Not more than 19 letters)

Code* 1 0 0 0

E-mail Address (required) u Yes I would like to nominate a credit limit for this supplementary
application of :
RM
Relationship to Principal Cardholder/Applicant
Note: The total combined credit limits cannot exceed the principal
cardholders current approved credit limit. If no nomination is made
specifically, the supplementary card will share the principal credit limit.
Mother’s Maiden Name (for verification purposes)

*for Bank use only

SIGNATURE
By signing here, I acknowledge and confirm making the declaration/disclosure appearing under the caption of ‘For All Products’, ‘Declarations for
Financing Products’ and ‘Product Specific Declarations For Credit Card/Credit Card-i’.

Principal Credit Card-i/Credit Card Applicant’s Signature : Supplementary Credit Card-i/Credit Card Applicant’s Signature :

Full Name as per NRIC / Passport Full Name as per NRIC / Passport

NRIC/Passport no. NRIC/Passport no.

Date D D / M M / Y Y Y Y Date D D / M M / Y Y Y Y

[Page 11]
 Conventional Branch Code
Employee No.
CIMB BANK BERHAD CIMB ISLAMIC BANK BERHAD Campaign Code
197201001799 (13491-P) 200401032872 (671380-H)

CREDIT CARD/CREDIT CARD-i APPLICATION FORM (JOINT APPLICANT)

Please tick () where applicable
u New Card u Additional Card u Supplementary Card

Important Notes:
For Additional Card: ONLY fill in your Full Name, NRIC/Passport/Other ID numbers, Nationality, My Employment/Business Details & Declaration/Disclosure
by applicant(s) in the General Customer Information section. Please select the card(s) that you wish to apply below. Where applicable, please complete
the Monthly Repayment/Payment Section (Mandatory for Non-Malaysian) and/or Insurance Coverage.
For Supplementary Card: ONLY fill in Full Name, My Employment/Business Details & NRIC/Passport/Other ID numbers of the Principal Cardholder &
Declaration/Disclosure by applicant(s) in the General Customer Information section. Please select the card(s) that you wish to apply and complete the
supplementary card details.

REQUIREMENTS

Age Principal Card : 21 years old Supplementary Card : 18 years old

Travel World Elite Travel Visa Infinite World Mastercard Visa Signature Platinum
Minimum
World Mastercard
Income
Per Annum RM250,000 RM100,000 RM120,000 RM90,000 RM60,000 RM24,000

I WISH TO APPLY FOR THE FOLLOWING CARD (PLEASE CHOOSE A MAXIMUM OF 3 CARD PRODUCTS ONLY)

A. CIMB BANK CREDIT CARD

u CIMB Travel World Elite u CIMB Visa Infinite u CIMB Visa Platinum
u CIMB Travel World Mastercard u CIMB World Mastercard u CIMB Cash Rebate Platinum
u CIMB Travel Platinum u CIMB Visa Signature u CIMB e Credit Card

B. CIMB ISLAMIC CREDIT CARD-i

u CIMB PETRONAS Visa Infinite-i u CIMB PETRONAS Visa Platinum-i u CIMB Platinum-i
Important Note: (1) Additional credit card-i/credit card will share a combined credit limit. (2) Please sign within the signature box.

MY PERSONAL DETAILS
Note: Credit Card Statement will be sent to the e-mail address provided above. For existing cardholders, your other statements will also be sent to this
e-mail address.
Name to Appear on Card (Not more than 19 letters) Mother’s Maiden Name

MY EMERGENCY CONTACT
Name Relationship to Principal Cardholder/Applicant

Contact no.

[Page 12]
 SUPPLEMENTARY CARD DETAILS
Salutation Mobile no.
u Mr u Mrs u Miss u Madam
u Home Phone no. u Office Phone no.
u Others, please specify
Full Name as per NRIC/Passport Race
u Malay u Chinese u Indian
u Others, please specify
NRIC/Passport no.
Nationality
u MALAYSIAN (Please one)
*For Passport holders please indicate your passport expiry date
u Bumiputra u Non-Bumiputra
D D / M M / Y Y Y Y
u Non-MALAYSIAN, please specify country, visa type and
expiry date of visa
u Other Identification no.
Country
u MyTentera u MyPolis u Old I/C u Birth Certificate
Visa type Code*
Identification no.
Visa document number
Occupation
Visa expiry date D D / M M / Y Y Y Y
Code*

Employment Sectors Name to Appear on Card (Not more than 19 letters)

Code* 1 0 0 0

E-mail Address (required) u Yes I would like to nominate a credit limit for this supplementary
application of :
RM
Relationship to Principal Cardholder/Applicant
Note: The total combined credit limits cannot exceed the principal
cardholders current approved credit limit. If no nomination is made
specifically, the supplementary card will share the principal credit limit.
Mother’s Maiden Name (for verification purposes)

*for Bank use only

SIGNATURE
By signing here, I acknowledge and confirm making the declaration/disclosure appearing under the caption of ‘For All Products’, ‘Declarations for
Financing Products’ and ‘Product Specific Declarations For Credit Card/Credit Card-i’.

Principal Credit Card-i/Credit Card Applicant’s Signature : Supplementary Credit Card-i/Credit Card Applicant’s Signature :

Full Name as per NRIC / Passport Full Name as per NRIC / Passport

NRIC/Passport no. NRIC/Passport no.

Date D D / M M / Y Y Y Y Date D D / M M / Y Y Y Y

[Page 13]
 DECLARATION/DISCLOSURE BY APPLICANT/GUARANTOR
PRODUCT SPECIFIC DECLARATIONS FOR PROPERTY FINANCING
I/We hereby consent and authorise the bank to disclose my/our loan/financing application status and any other relevant loan/financing details to Property
Developer and/or Real Estate Agent or any of their authorised agents. I/We agree to be bound by the Bank’s Terms and Conditions for E-Mail Statement
Delivery available at the Bank’s website - www.cimb.com.my in respect of all my/our statements requested to be sent to me/us by e-mail. Where I/we have
a CIMB Clicks Internet Banking (“CLICKS”) and have requested to view all my/our CIMB Bank/CIMB Islamic facility/account statement via CLICKS. I/We
agree to be subject to the Terms and Conditions for e-statement accessed via CIMB Clicks published on CIMB Bank/CIMB Islamic Bank website. I/We agree
that I/we will not receive hardcopy Statements nor will I/we receive Statement(s) via E-mail.
If I/we am/are applying for property financing and if this application is approved, I/we agree that the Bank may conduct subsequent check(s) on me/us
prior to disbursement of the loan/financing, and if the Bank finds that I/we have submitted applications to other institutions to finance the purchase of
different property(ies) which have been approved and accepted by myself/ourselves, which in turn affects my/our ability to service and/or repay/pay the
loan/financing, the Bank is at liberty to withdraw its offer even if it has been accepted by me/us and/or the loan/financing documents have all been signed.
For Fire or Houseowner Insurance/Takaful
I/We acknowledge and understand that fire or houseowner insurance/takaful is required to be taken up to cover the Property against the risk of fire and other
risks determined by the Bank up to the full insurable/coverage value.
For the purpose of the facilitating the fire or houseowner insurance/takaful coverage over the Property from the Bank’s panel insurance company/takaful
provider and other services to me/us, I/we consent and authorise the Bank to (i) disclose the information provided in this form to the Bank’s panel insurance
company/takaful provider, (ii) take up and maintain the fire or houseowner insurance/takaful coverage over the Property on my/our behalf; and (iii) debit all
insurance premium/contribution to my/our Facility account(s) with the Bank.
I/We acknowledge and understand that if I/We wish to use my/our own fire or houseowner insurance/takaful coverage, I/we shall extend a copy of the
insurance policy/ takaful certificate to the Bank (at email: [email protected]) with the sum insured/covered acceptable by the Bank, and with the
Bank’s interest endorsed on the insurance policy/takaful certificate as assignee and/or loss payee, prior to disbursement (for completed properties) and
upon vacant possession (for under construction properties).
For GMRTA/GMRTT (Underwritten by Sun Life Malaysia/Sun Life Malaysia Takaful Berhad) (referred to singly or collectively as the case may be
as “the Insurance Company/Takaful Operator”)
I/We declare that the information furnished in this form is completely true and accurate. I/We hereby consent to the Bank sharing the information contained
in this application form with the Insurance Company/Takaful Operator selected by me/us which upon receipt of my/our information herein will then consider
my/our application for the same.
For Withdrawal From Employee Provident Fund (“EPF”)
I/We hereby irrevocably consent to the Bank disclosing any information pertaining to my/our facility and all matters relating thereto to the EPF, whenever
requested by EPF, to facilitate my/our application for withdrawal of monies from the EPF.
For Property Financing under the Special PR1MA End Financing (“SPEF”) Scheme with or without Employee Provident Fund withdrawal
I/We hereby irrevocably consent to the Bank disclosing any information pertaining to my/our facility and all matters relating thereto to PR1MA Corporation
Malaysia and/or the Government of Malaysia and/or any other bodies, authorities and/or agencies in relation to the PR1MA programme.
For Property Financing under Corporate Employer Scheme (“CES”)
I/We hereby irrevocably consent to the Bank disclosing any information pertaining to my/our facility and all matters relating thereto to my/our employer in
relation to the CES from time to time during my/our facility tenure.
I/We confirm that a copy of the relevant Product Disclosure Sheet(s) was provided to me/us and the key contract terms affecting my/our
obligations have been adequately explained to me/us.

Main Applicant’s Signature Joint Applicant’s Signature

Main Applicant’s Name Joint Applicant’s Name

NRIC/Passport no. NRIC/Passport no.

Date D D / M M / Y Y Y Y Date D D / M M / Y Y Y Y

Note: Be sure to read and understand the terms and conditions in the letter of offer and to discuss further with the Bank’s staff if there are any terms that
you do not understand before signing the letter of offer.

[Page 14]
 DECLARATION/DISCLOSURE BY APPLICANT/GUARANTOR... CONTINUED
Declaration/Disclosure by Guarantor and Registered Owner
I/We hereby irrevocably confirm, consent and authorise the Bank
(i) to be provided information as may be required by the Bank for processing pursuant to the Personal Data Protection Act 2010 including for use
in accordance and in connection with the applicant’s application or request for accounts, products, banking facilities and/or services (collectively
“Facilities”);
(ii) to carry out the necessary reference checks at any time and from time to time now and/or in the future including but not limited to credit reference/
reporting checks with 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/our status as
may be required by the Bank for the purposes of considering the Facilities and thereafter (if applicable) for the grant and/or continued maintenance
of the Facilities; and/or recovery of debts owing under the Facilities; and/or any purpose related to or in connection with the Facilities applied for by
the applicant; and/or for any other purposes that is required or permitted by law, regulations, guidelines and/or relevant regulatory authorities;
at the Bank’s sole discretion, without further reference to me/us. I/We undertake to update the Bank in writing should there be any change to my/our
personal and financial, credit information.
By signing below, I/we acknowledge and confirm making the declaration/disclosure appearing under the caption of ‘For All Products’ and ‘Declarations
for Financing Products for Property Financing’.

Guarantor’s/Registered Owner’s Signature Guarantor’s/Registered Owner’s Signature

Full Name Full Name

NRIC/Passport no. NRIC/Passport no.

Date D D / M M / Y Y Y Y Date D D / M M / Y Y Y Y

DISCLOSURE TO PROPERTY DEVELOPER AND/OR REAL ESTATE AGENT AND/OR AUTHORISED PARTY (OPTIONAL)
Please fill in name of your Property Developer/Real Estate Agent/Authorised Party to receive information of your loan/financing application status and any
other relevant loan/financing details.

BANK USE ONLY

For Property Financing
Salesperson Name
Fire Insurance/Takaful u Home Safe Plus u Houseowner
GMRTA/GMRTT
Salesperson I/D u Yes - Self finance u Yes - Bank financed u No
Sales Team/Branch Code Free Moving Costs u Yes u No
Referrer Name Differently Abled u Main Applicant u Joint Applicant
Referrer I/D Regional Customer u Main Applicant u Joint Applicant
Applicant Name Verified by SD Doc No.

NRIC No. Name of Manager*

*Confirmed the required forms are duly completed and signed

[Page 15]