CC Form 2022

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FBCAR 001/2022_V1 (updated 17.03.

2022)

Credit Card/-i or Personal Financing/-i Checklist


Customer’s Full Name as per NRIC/Passport Identification No 840717-01-6387
NORKAMARUZZAMAN BIN ABD RAHMAN Application Type Credit Card/-i Personal Financing/-i

APPLICATION DOCUMENT CHECKLIST


Confirmed the following document received. Please tick (√) if document received.
Credit Card/-i Personal Financing/-i
Salaried Salaried Tick
Document Required Self- Commission Self- Commission
Non- Non- (√)
MNCs Govt Employed Earner MNCs Govt Employed Earner
MNCs MNCs
Copy of MyKad or MyPR or Other
Country PR (front and back) /          
Passport copy
Recent 1-month salary slip    
i) Recent 3-month salary slip
ii) Recent 3-month bank statement  
evidenced by salary crediting
i) Recent 6-month salary /
commission slip
 
ii) Recent 6-month bank statement
evidenced by salary crediting
Recent 6-months bank statement  
Latest EPF Statement: Min. 12
   
months contribution
i) Latest Form B/BE
   
ii) Latest Tax Payment Receipt
i) Latest Notice of Assessment;
AND/
 
ii) Latest tax payment receipt
(For working in Singapore)
i) Latest Pension Letter/ Pension
Statement
 *
ii) Recent 3-month bank statement
showing crediting of pension
Letter of Employment / Appointment
(mandatory for employment for < 6        
months)
Copy of Certificate of Incorporation
of Private Company (previously
known as Form 9), Return of
Allotment of Shares (previously
known as Form 24) and Return  
Giving Particulars in Register of
Directors, Managers andSecretaries
and Changes of Particulars
(previously knownas Form 49)
For Supplementary and Upgrade i. Copy of MyKad or MyPR or Other Country PR
Card application (front and back)/ Passport copy
ii. Latest Income Documents (for new card / card
upgrade / additional card application with limit
increase)
Note 1. Minimum age required is 21 years for Principal 1. Salaried Non-MNCs – (salary slip and bank
Card and 18 years for a Supplementary Card. statement) or Latest EPF statement (min. 6
2. For any applicants employed outside Malaysia, a months).
valid work permit is required. 2. Commission Earner Submission –
3. A combined credit limit will be issued for 6 months’ salaryslip or 6 months commission
application of more than one (1) credit card. statement) and (latest 6 months crediting
4. Singapore Credit Bureau is required for bank statement or Latest BE Form).
Malaysian working in Singapore, Singapore 3. For Joy@Work application, submission of
permanent resident and Singaporean. payslip can be replaced with salary crediting
5. For Joy@Work application, submission of into RHB CASA/-i
payslip can be replaced with salary crediting 4. Financing application RM50,000 and above
into RHB CASA/-i required site visit
6. Contract staff, recent 6 months’ salary / 5. Contract staff, recent 6 months’ salary /
commission slip with crediting bank statements, commission slip with crediting bank
OR 12 months EPF statement statements, OR 12 months EPF statement
All documents submitted are non-returnable. All documents submitted are non-returnable.
All documents must be uploaded into dedicated All documents must be uploaded into dedicated
folder in FLASH folder in FLASH
* Applicable as additional income only

Note: Please attach this checklist to the application form. Page 1 of 2


FGROP 002/2022_v1 (Updated on 17.03.2022)
For Bank Use
Referral Staff ID No.
ranch C C E
Region K L
RHB Bank Berhad 196501000373 (6171-M) |
Channel D
RHB Islamic Bank Berhad 200501003283 (680329-V)
Premier Joy@Work

PART A: PRINCIPAL APPLICANT INFORMATION


PERSONAL DETAILS

Salutation Nationality
Dato Datin Mr Mrs Miss Malaysian
Others Non-Malaysian; Country of Origin:

Full Name as per NRIC/Passport Identification


N OR KA MA R UZ Z A MA N B I N Type of Identification
A B D R A HM AN MyKad MyPR MyTentera Passport MyKid

Identification Number
Political Expose Person (PEP) or Close Associate to PEP (CATP)
Yes No
8 4 0 7 1 7 0 1 6 3 8 7

RHB Group Staff Yes No Passport Expiry Date D D / M M / Y Y Y Y

Race Foreign PR: Yes No


Bumiputera - Malay Bumiputera - Non Malay Chinese Foreign PR ID:
Indian Others
Foreign PR Country:
Date of Birth 1D D
7 / M
0 M
7 / Y1 Y9 Y8 Y
4
Residence Status
Gender Male Female
Status Foreign Exchange Notices (FEN)
OKU Visually Impaired Others Declaration

Education Level Resident 1. I am a citizen of Malaysia, without


permanent resident status in any
Primary Secondary Diploma Degree
country or a territory outside Malaysia.
Masters PHD
2. I am a Foreign National with permanent
Marital Status resident status in Malaysia and I am
Single Married Widowed Divorced ordinarily residing in Malaysia.
Separated Non - Resident 1. I am a Foreign National without
permanent resident status in Malaysia.
Number of Children 0 6
2. I am a citizen of Malaysia with
Mother’s Maiden Name permanent resident status of a country
or territory outside Malaysia and I am
MA RE Y A H H J A L I A S residing outside Malaysia.
3. Any person other than a Resident.

PAGE 1 of 2
FGROP 002/2022_v1 (Updated on 17.03.2022)

CONTACT DETAILS EMERGENCY CONTACT (for financing application only)


Name
Home Phone Number
S I T I A I S A H B I NT I
Mobile Phone Number 0 1 3 7 3 0 0 8 2 0 D A UD
Office Phone Number
Relationship WIFE
Email Address [email protected]
Contact Number 0 1 9 7 2 0 0 8 2 0

STATEMENT DELIVERY

e-Statement via RHB Now e-Statement via email

RESIDENCE DETAILS

Residence Type Own Property Mortgaged Employers Rented Parents

Length of Stay in Current Residence 0Y Y6 0 M


M 9 Same as Residential/Permanent Address

Residential / Permanent Address Correspondence Address

L O T 6 4 3 8 0 K G S I N A R A N
B A R U

City S KU D A I City
Postcode 8 1 3 0 0 Postcode
State State
Country M A L A Y S I A Country

EMPLOYMENT DETAILS

Employer Name Nature of Business/Employment Sector


AKZ HARMONY SOLUTION ICT
Occupation Employment Type
ICT COORDINATOR Government Employee Private Employee
RHB Employee Self-employed
Office Address
Unpaid Family Worker Unemployed
N O 5 T A P A K P A S A R
Outside Labor Force (Student, Housewife, Retiree)
M A L A M K G S I N A R A N
B A R U Employment Status
City S K U D A I Permanent Contract
Postcode 8 1 3 0 0 Under Probation Part Time
State Freelance Temporary
Country M A L A Y S I A Source of Wealth
Accumulated Savings Employment Income
RM1500
Monthly Gross Income RM
Inheritance Trust Fund
Other Income RM2500
RM
Retirement Income EPF
Years of Employment 0
Y 3
Y 0
M 2
M Disposal of Assets/Shares Legal Settlement
Return on Investment Insurance/Takaful
Previous Employer Name (if less than 2 years in present employment) Maturity/Surrender
Income From Own Business

Length of Services Y Y M M

PAGE 2 of 2
FBGSV 003/2022_v1 (Updated on 17.03.2022)
PART C: PERSONAL FINANCING/-i APPLICATION FORM
ACCOUNT TYPE

Please tick (√) where applicable Purpose of Account Opening: Personal Loan/Financing
Personal Financing Source of Fund: Credit Facility Approve by FI
Enrolment in Personal Smart Shield (PSS) Yes No
Personal Financing/-i Amount Applied
Personal Financing-i
RM
Civil Sector
Maintain the same monthly payment, in the event of base rate Financing Tenure
(BR) adjustment Yes No
Months
Private Sector/Potongan Gaji Majikan
Pensioners Financing Disbursement Account
Purpose of Application (Please √ one) New Existing;

005 Personal Consumption 037 Booking Fee - Car 038 Debt Consolidation 039 Education
040 Electrical Goods 041 Home Furnishing/Equipment 042 Medical Expenses 043 Online Financing
044 Personal Refinancing 045 Property/House Financing 046 Renovation 047 Travel

SETTLEMENT INSTRUCTION

Personal Financing Account No. Settlement Amount Monthly Instalment


No. Institutions/ Cooperatives
or Credit Card No. (RM) (RM)*

*For settlement of financing account based on CCRIS report


I expressly instruct the Bank to deduct any amount from the approved Facility to settle any outstanding balance on my behalf according to the details as
per compiled in the above instructions and/or as per the outstanding amount reported in the Central Credit Reference Information System (CCRIS) report
with an additional amount of up two (2) months monthly installment. I agree to pay the settlement balance in excess of the approved Facility (if any) after
the Bank has made payment in accordance to my instruction here and pursuant to the settlement letter by the respective institutions that is/are enclosed
herewith. I agree to request for refund or excess amount (if any) directly from the respective institutions pursuant to the settlement made by the Bank in
accordance to my instruction here. I also agree that I will not make or take any claims or actions towards the Bank in acting according to my instruction here-
in, unless such claims or actions arises out of the act, omission, default, negligence and/or misconduct on the part of the Bank and/or any of its employees,
representatives and agents of the Bank.

PART D: CREDIT CARD/-i APPLICATION FORM


REQUEST TYPE

New Card Additional Card Upgrade Card

PRODUCT TYPE

Please tick (√) where applicable Excess Limit Fee Consent


Credit Card I/We hereby agree and consent the Bank may debit my/our card
Credit Card-i account for excess limit transactions, where an excess limit fee of
RM50 may be imposed whenever the Total Outstanding Balance
Card Type VISA MASTERCARD exceeds the combined card limit due to an excess limit transactions.
Yes No
Product Name
For Credit Card
Product Code
Enrolment in Life Credit Shield (by Tokio Marine)
Name on Card (maximum 19 characters) The amount of premium to be paid shall be based on the aggregate
N OR KA MA R UZ Z A MA N outstanding balance of the Life Assured as at the monthly billing
dates at RM0.65 per RM100 outstanding balance.
Card Delivery to: Yes No
Residential/Permanent Address
For Credit Card-i
Office Address
TAKAFUL myCREDIT SHIELD (by Syarikat Takaful)
Correspondence Address
The contribution is to be payable on monthly basis and shall be
SETIA TROPIKA
Card Collection at Branch: ___________________________________________ based on the monthly closing credit card statement at RM0.46 per
(Branch Name) RM100 of the total credit card outstanding balance.
Purpose of Account Opening: Personal Loan/Financing Yes No

Source of Fund: Credit Facility Approve by FI


PAGE 2 of 5
FBGSV 003/2022_v1 (Updated on 17.03.2022)
PART E: DECLARATION & CONSENT BY APPLICANT(S) **
** These declaration and Consent shall apply to all RHB Bank Berhad and/or RHB Islamic Berhad, as the case may be, (“the Bank”) product(s)
which you apply for as stated in the application form(s). The Bank being the licensed financial institution granting the account/loan/financing
product(s) referred to in the application form(s) completed by me/us.
1. FOR ALL PRODUCTS:
i. I/We hereby confirm and declare that all the information provided by me/us is complete, true and correct and I/We authorise
the Bank to verify any information provided and to obtain from any source including Inland Revenue Board as the Bank considers
appropriate any information, which the Bank may require such its discretion and approve or reject my/our application.
ii. I  /We hereby confirm that I/We have received, briefed, read, informed and understood the following applicable documents
governing the operation of the relevant account(s). I/We agree to be bound by them and/or such other terms and conditions of
which the Bank may modify or amend or update from time to time with 21 calendar days’ prior written notice to me/us.
iii. I/We
 am/are aware the below documents of the product(s) that I/We applied for is/are available in RHB Website
www.rhbgroup.com:
a) The Bank’s Terms and Conditions: www.rhbgroup.com/others/terms-conditions/index.html
b) The Bank’s Product Disclosure Sheet: www.rhbgroup.com
c) The Bank’s Privacy Notice: https://www.rhbgroup.com/files/others/personal-data/privacy-notice.pdf
d) Perbadanan Insurans Deposit Malaysia (PIDM) brochure: www.rhbgroup.com
e) Notification of incidental fees/charges that will be incurred at https://www.rhbgroup.com/others/service-charges/index.html
iv. I/We have been informed on the purpose of registration One Time Password (OTP) for RHB Now Internet Banking.
v. I/We agree that by activating, signing on and/or using the card(s) issued by the Bank, I/We agree to be bound by and to comply
with all the Terms and Conditions in relation to such card(s).
vi. Consent
 for cross selling, marketing, promote products and services of strategic partners
Please √ where applicable
I/We
 consent and authorise RHB Bank Berhad to process and disclose any information that I/We have provided for the
purposes of cross selling, marketing, promotions (including administering offers and competitions), and conducting
surveys (to improve the quality of products/services) to RHB Banking Group (which shall include the holding company(s),
its subsidiary(s), any associated company(s) and/or any company/branch as a result of any restructuring, merger, sale or
acquisition, whether in or outside Malaysia), strategic partners, service providers and its agent, servant and/or such persons
or third parties, if applicable.

2. FINANCING TRANSACTIONS AND EXPOSURES WITH CONNECTED PARTIES


Do you have any immediate family or close relatives (including parents, brother, sister, dependent and own/step/adopted child and
their spouses) that are employees of RHB Banking Group?

Yes, Relationship No

3. FOR FINANCING PRODUCTS AND JOY@WORK ENROLMENT


I/We, authorise and consent the Bank to obtain any credit information from CTOS and/or other registered Credit Reporting
Agencies as defined under the Credit Reporting Agencies Act 2010 without further notice to me/us to such extent and for the
purpose of the followings (whichever is applicable):
Credit application processing; Credit limit review; Restructuring; Overlapping; Upgrading application;

4. FOR FINANCING PRODUCTS


Financial obligation self-declaration.
Followings are my/our outstanding debts with financial institutions and/or non-financial institutions in Malaysia.

Type of Facility/
Bank/
Financing Financing Amount Outstanding Balance Monthly Payment
Finance Company/
(Housing/Car/ (RM) (RM) Amount (RM)
Other Banks
Personal/Others)

PAGE 3 of 5
FBGSV 003/2022_v1 (Updated on 17.03.2022)
5. DECLARATION OF TAX RESIDENCY STATUS
Please √ where applicable
I/We have been briefed and I/We hereby confirm I/We understand my/our tax residency/FATCA/CRS requirements. I/We
hereby declare that all statements made in this declaration are, to the best of my/our knowledge and belief, correct and complete:

Foreign Account Tax Compliance Act “FATCA” Common Reporting Standard “CRS”
(For U.S. Only) (Other than U.S.)
I am not a U.S. citizen or resident in the U.S. for tax purposes. I confirm that I am a tax resident in Malaysiai.

I confirm that I was born in the U.S. (or a U.S. territory) but am no I confirm that I am NOT a tax resident in Malaysia or any countriesii.
longer a U.S. citizen as I have voluntarily surrendered my citizenship Please specify reason*: ______________________________________________________________________
as evidenced by the attached documents. I confirm that I am a tax resident in Malaysia and other countriesiii.

I confirm that I am a U.S. citizen and/or resident in the U.S. for tax I confirm that I am a foreign tax residentiv.
purposes (i.e. green card holder or resident under the substantial If you have selected iii and iv, please complete the following table:
presence test). No 1 2
Tax Number Country of Tax
Type SSN Social Security Number Resident
(Please √ one) TIN Taxpayer Identification Number Taxpayer
ID No. (TIN)
Reason, Country does not Country does not
if No TIN issue TIN issue TIN
(Please √ one)
Country does Country does
not require the not require the
collection of TIN collection of TIN
Others*: Others*:
__________________________________ __________________________________
*TIN application in progress | not required to register tax file | housewife
| househusband | minor | student | retiree | foreign diplomat in embassy

6. APPLICANT ACKNOWLEDGEMENT:
i. I/We,
 the undersigned declare that the above information provided by me/us are true and correct and if the Bank subsequently
discovers that any of the information provided are false, incorrect or incomplete, the Bank may cancel or vary the Facility approved.
ii. I/We agree that the emailed copy(ies) of the application form and/or supporting document(s) received by the Bank are deemed
to be the original application form and/or supporting document(s) and I/We am/are to produce the original application form and/
or supporting document(s) to the Bank upon request.
iii. I/We
 have also been advised that I/We may contact RHB Customer Contact Centre by telephone at +603-9206 8118 or by
email at [email protected] or visit any branch of the Bank if I/We do not understand any of the product features,
benefits, product disclosure sheet and/or Terms and Conditions.
Applicant’s Signature Full Name as per NRIC/Passport

NORKAMARUZZAMAN BIN ABD RAHMAN


Identification No.
8 4 0 7 1 7 0 1 6 3 8 7
Date 0D 6D / 1 1 /
M M 2
Y 0
Y 2
Y 2
Y

FOR BANK USE ONLY

I hereby declare that I have sighted the original copies of the documents and all information provided above is truthful and trustworthy.

Attended By: Checked & Verified By:

Name Name

Staff ID Staff ID

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

Personal Financing/-i Campaign Code Credit Card/-i

Product Code Package Code Source Code S H L N


PGM Code Source Code Program Code

PAGE 4 of 5
FBCAR 004/2017_v8 (Updated 6/1/2022)

RHB BANK BERHAD (196501000373 (6171-M)) RHB Bank Berhad


RHB Credit Cards
PRODUCT DISCLOSURE SHEET
Date: __________________
(Read this Product Disclosure Sheet before you
decide to take up the RHB Bank Credit Card. Be sure
to also read the Visa Card / Mastercard Cardholder
Agreement and Terms & Conditions where
applicable)

1. WHAT IS THIS PRODUCT ABOUT?

This is a credit card product issued by RHB Bank Berhad (“RHB Bank”) primarily for payment of goods and
services. Where any amount of the credit utilised by you has not been settled in full on or before the due date,
the unsettled amount will be subject to finance charges.

2. WHAT DO I GET FROM THE PRODUCT?

Credit Limit
RHB Bank offers various types of credit card that suits a customer’s need. RHB Bank credit card’s credit limit
will be determined based on individual credit assessment, annual income and type of credit card applied. The
credit limit for each card entitled by RHB Bank Credit Cardholder subject to RHB Bank’s approval. The
approved credit limit will be made known to you in the credit card welcome pack.

3. WHAT ARE MY OBLIGATIONS?

Minimum Monthly Repayment


a) 5% of Outstanding Balance*;
b) All Monthly Instalments due**;
c) The contracted monthly term loan instalment for any Automatic Balance Conversion if any;
d) Any unpaid minimum payments specified in the preceding month’s statement (if any);
e) Amount in excess of the Card Limit during the statement month (if any), and
f) Card Service Tax and any other value added taxes imposed (if any).
OR
g) A minimum of RM50 from the outstanding balance whichever is higher.

Note:
* Outstanding balance shown on the card statement (the Outstanding Balance)
** Monthly Instalment means an outstanding balance, transaction amount or cash advances that has
converted into monthly instalment that need to be paid in full that form part of the monthly minimum
amount due.

Interest Free Period


a) For retail transactions – 20 days from the statement date, if you pay the balance in full and on time.
b) If you do not pay in full and on time, finance charges on retail transactions will be calculated from the
posting day of the transaction.
c) The interest free period is not applicable to balance transfer, cash advances and other installment plans
available from time to time.

Note:
As the principal card cardholder, you are liable for all transactions incurred by the supplementary card
cardholders.

1
FSHDE 018/2017- Version 11

RHB ISLAMIC BANK BERHAD (Registration No.: 200501003283 (680329-V)


PRODUCT DISCLOSURE SHEET

(Read this Product Disclosure Sheet together with the general RHB Islamic Bank Berhad
terms and conditions governing the Credit Card-i before you Credit Card-i
decide to take this product. Be sure to also read the Visa Card /
Mastercard Cardholder Agreement and Term & Conditions Date: ________________
where applicable. Seek assistance from RHB Islamic Bank
Berhad if you need further clarification on any part of this (To be filled by Branch /
document or the terms) Sales Personnel)

1. WHAT IS THIS PRODUCT ABOUT?


This is an Islamic Credit Card-i product which the usage is subject to its predetermined credit limit. It functions as a
payment medium that offers the convenience and security to make transactions (subject to restricted MCC code) at millions
of Visa/Mastercard merchants worldwide.

2. WHAT IS THE SHARIAH CONCEPT APPLICABLE?


The Shariah concept applicable for this product are:
a) Ujrah : Ujrah concept will entitle the Cardholder for certain services, benefits and privileges in consideration for a
specified fee

b) Qard : The credit limit of the Credit Card-i is provided by the Bank to the Cardholder based on Shariah concept of
Qard which refers to the Bank lending an amount equivalent to a credit limit to the Cardholder and the
Cardholder is bound to repay an equivalent amount to the Bank.

3. WHAT DO I GET FROM THIS PRODUCT?


a) Credit Limit
RHB Islamic Bank offers various types of credit card that suits a customer’s need. RHB Islamic Bank credit card-i’s
credit limit will be determined based on individual credit assessment, annual income and type of credit card applied.
The credit limit for each card entitled by RHB Islamic Bank Credit Cardholder subject to RHB Islamic Bank’s
approval. The approved credit limit will be made known to you in the credit card welcome pack.

b) Management Fee Free Period


• For retail transactions – twenty (20) days from the statement date and is applicable only for retail transactions
and the Cardholders who pay in full on or before the payment due date. No management fee free period on
Balance Transfers or Cash Advances. As the principal card Cardholder, you are liable for all transactions incurred
by the supplementary card Cardholders.

c) 0% Management Fee Installment


0% Management Fee up to twenty four (24) months for RHB Islamic Smart Installment

4. WHAT ARE MY OBLIGATIONS?


a) Minimum Monthly Payment
• 5% of Outstanding Balance*;
• All Monthly Instalments due**;
• The contracted monthly term financing instalment for any Automatic Balance Conversion if any;
• Any unpaid minimum payments specified in the preceding month’s statement (if any);
• Amount in excess of the Card Limit during the statement month (if any); and
• Card Service Tax and any other value added taxes imposed (if any);
OR
• A minimum of RM50 from the outstanding balance whichever is higher.

b) Use the card responsibly, including not to use the card for Shariah non-compliant activity; and

c) Check the monthly statement and report any discrepancy without undue delay

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