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FGROP 002/2022_v1 (Updated on 17.03.2022)

For Bank Use
Referral Staff ID No.
Branch
Region
RHB Bank Berhad 196501000373 (6171-M) |
Channel
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

Type of Identification
MyKad MyPR MyTentera Passport MyKid

Identification Number
Political Expose Person (PEP) or Close Associate to PEP (CATP)
Yes No

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 D D / M M / Y Y Y Y
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
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
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

Mobile Phone Number

Office Phone Number

Relationship
Email Address
Contact Number

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 Y Y M M Same as Residential/Permanent Address

Residential / Permanent Address Correspondence Address

City City
Postcode Postcode
State State
Country Country

EMPLOYMENT DETAILS

Employer Name Nature of Business/Employment Sector

Occupation Employment Type

Government Employee Private Employee
RHB Employee Self-employed
Office Address
Unpaid Family Worker Unemployed
Outside Labor Force (Student, Housewife, Retiree)

Employment Status
City Permanent Contract
Postcode Under Probation Part Time
State Freelance Temporary
Country Source of Wealth
Monthly Gross Income RM Accumulated Savings Employment Income
Inheritance Trust Fund
Other Income RM
Retirement Income EPF
Years of Employment Y Y M 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
 Print Clear Save As
FBGSV 003/2022_v1 (Updated on 17.03.2022)
PART B: DEPOSITORY ACCOUNT/-i OPENING APPLICATION FORM
ACCOUNT TYPE

Individual Account

Joint Account; Signing Condition:

Joint Applicant Name (s):
Joint Applicant MyKad/Passport No.:

Minor Account (aged 12 years old - below 18 years old)

PRODUCT TYPE

Current / Saving Account Please refer to the Appendix on the last page and select one option.
Current Account/-i Savings Account/-i Purpose of Account Opening:
Product Name: Source of Fund:

Multi Currency Account Please refer to the Appendix on the last page and select one option.
Multi Currency Account Purpose of Account Opening:
Qard Multi Currency Account-i Source of Fund:

Please tick (√) where applicable

Product Name Product Specific Declarations

INDA - Individual Account Currently I/We DO NOT have any Domestic Ringgit Borrowing/Financing with
any financial institutions in Malaysia and in the event I/We have any Domestic
Ringgit Borrowing/Financing, I/We undertake to inform the Bank immediately; or
I/We have Domestic Ringgit Borrowing/Financing with one or more financial
institutions in Malaysia, and my/our total investment abroad and onshore in
foreign currency asset is within the stipulated aggregate threshold* per calendar
year under Foreign Exchange Notices;
RM:_____________________________
I/We have Domestic Ringgit Borrowing/Financing with one or more financial
institutions in Malaysia, and my/our total investment abroad and onshore in
foreign currency asset have exceeded the stipulated aggregate threshold* per
calendar year under Foreign Exchange Notices. I/We hereby furnish the approval
letter from BNM (Ref:_______________________________ ) as supporting document;

EDEA - Education and Employment Account I/We hereby submit the documentary evidence and justification for education/
employment abroad to comply with the requirements set out by Bank Negara
Malaysia.

INEX - Individual Export Proceed Account I/We hereby confirm:

a) The proceeds credited into the account are strictly from exports.
b) To provide documentary evidence, as and when it is required by the Bank.
Note: The Bank may request from the Customer(s) additional supporting document(s) to verify the transaction(s) from the above account(s).
*Up to RM1 million for individual under Foreign Exchange Notices

Debit Card Please tick (√) where applicable

Debit Card Debit Card-i Overseas Transactions
Debit Card Type Card Not Present Transaction

Safe Deposit Box

Please tick (√) where applicable Please refer to the Appendix on the last page and select one option.
I am keen to subscribe the *Safe Deposit Box (SDB) Purpose of Account Opening:
* Subject to the availability of vacant box at SDB branches.
Source of Fund:
Please visit your preferred RHB branch to complete the opening
of Safe Deposit Box.

PAGE 1 of 5
 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
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
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

Identification No.

Date D D / M M / Y Y Y 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

PGM Code Source Code Program Code

PAGE 4 of 5
 FBGSV 003/2022_v1 (Updated on 17.03.2022)

APPENDIX

Purpose of Account Opening

■ Payroll/Salary ■ Standing Instruction
■ Savings/Fixed Deposits ■ EPF Withdrawals
■ Remittance (Local/Foreign) ■ Personal Loan/Financing
■ Household/Family Expenses ■ Administration of Estate Acct
■ Investment ■ Loan Repayment/Financing Payment/Drawdown

Source of Funds
■ Income/Salary ■ Return on Investment
■ Own Bank Transfer (within RHB) ■ FD Placement Roll Over/Renewal
■ EPF/SOCSO/Pension/Gratuity ■ Insurance/Takaful Maturity/Surrender
■ Savings/Investment ■ Legal Settlement
■ Scholarship/Allowance/Edu Loan ■ Credit Facility Approve by FI
■ Trust Funds ■ Trf Frm Own Acct with Oth FI
■ Divorce Sett/Compensation ■ Spouse/Parents/Children
■ Sale of Inves/Shares/Prop/Land ■ Financial/Aid/Subsidies
■ Dividends/Profits ■ Part-time Income
■ Rental Proceeds ■ Inheritance
■ Commission ■ Gift/Donation
■ Directors Fee/Salary ■ Winning-legal Gambling/Contest
■ Welfare Allowance

PAGE 5 of 5
 Cetak Padam Simpan
FGROP 003/2022_v1 (Updated 17.03.2022)
Untuk Kegunaan Bank
No. ID Pekerja Rujukan
Cawangan
Daerah
RHB Bank Berhad 196501000373 (6171-M) |
Saluran
RHB Islamic Bank Berhad 200501003283 (680329-V)
Premier Joy@Work

BAHAGIAN A: MAKLUMAT PEMOHON UTAMA

BUTIRAN PERIBADI

Gelaran Warganegara
Dato Datin Encik Puan Cik Malaysia
Lain-lain Bukan Malaysia; Negara Asal:

Name Penuh seperti Kad Pengenalan/Pasport Pengenalan

Jenis Pengenalan
MyKad MyPR MyTentera Pasport MyKid

Nombor Pengenalan
Individu Berkaitan Politik (PEP) atau Kenalan-kenalan yang
Berkait Rapat dengan PEP
Ya Tidak
Tarikh Tamat Pasport H H / B B / T T T T
Staf RHB Group Ya Tidak
Pemastautin Asing: Ya Tidak
Bangsa
ID Pemastautin Asing:
Bumiputera - Melayu Bumiputera - Bukan Melayu
Cina India Lain-lain Negara Pemastautin Asing:

Tarikh Lahir H H / B B / T T T T
Status Pemastautin
Jantina Lelaki Perempuan Status Deklarasi Notis Pertukaran Asing (FEN)

OKU Cacat Penglihatan Lain-lain Pemastautin 1. Saya warganegara Malaysia, tanpa

status pemastautin tetap di mana-mana
Tahap Pendidikan negara atau wilayah di luar Malaysia.
Sekolah Rendah Sekolah Menengah Diploma 2. Saya seorang Warganegara Asing
dengan status pemastautin tetap di
Sarjana Muda Sarjana Ijazah Kedoktoran
Malaysia dan saya biasa menetap di
Status Perkahwinan Malaysia.
Bujang Kahwin Janda/Duda Bercerai Bukan 1. Saya Warganegara Asing tanpa status
Pemastautin pemastautin tetap di Malaysia.
Bilangan Anak
2. Saya warganegara Malaysia dengan
status pemastautin tetap di negara
Nama Ibu
atau wilayah di luar Malaysia dan saya
menetap di luar Malaysia.
3. Mana-mana pihak selain daripada
Pemastautin.

MUKA SURAT 1 daripada 2

 FGROP 003/2022_v1 (Updated 17.03.2022)

MAKLUMAT BERHUBUNG TALIAN KECEMASAN (untuk permohonan pembiayaan sahaja)

Nama
No. Telefon Rumah

No. Telefon Bimbit

Telefon Pejabat
Hubungan
Alamat E-mel
Nombor Telefon

PENGHANTARAN PENYATA

e-penyata melalui RHB Now e-penyata melalui e-mel

MAKLUMAT KEDIAMAN

Jenis Kediaman Milik Sendiri Pembiayaan/Pinjaman Majikan Sewa Ibu Bapa

Tempoh Menginap di Kediaman Sekarang T T B B Sama Seperti Alamat Kediaman/Alamat Kekal

Alamat Kediaman/Alamat Kekal Alamat Surat Menyurat

Bandar Bandar
Poskod Poskod
Negeri Negeri
Negara Negara

BUTIRAN PEKERJAAN

Nama Majikan Jenis Perniagaan/Sektor Pekerjaan

Pekerjaan Jenis Pekerjaan

Pekerja Kerajaan Pekerja Swasta
Pekerja RHB Bekerja Sendiri
Alamat Pejabat
Pekerja Keluarga Tidak Bergaji Tidak Bekerja
Di Luar Tenaga Buruh (Pelajar, Suri Rumah, Pesara)

Status Pekerjaan
Bandar Tetap Kontrak
Poskod Dalam Tempoh Percubaan Sambilan
Negeri Bebas Sementara
Negara Sumber Kekayaan
Pendapatan Kasar Bulanan RM Simpanan Terkumpul Pendapatan Pekerjaan
Warisan Dana Amanah
Pendapatan Lain RM
Pendapatan Persaraan KWSP
Tempoh Bekerja T T B B Pelupusan Aset/Saham Penyelesaian
Pulangan Pelaburan Undang-undang
Nama Majikan Terdahulu Kematangan/Penyerahan
(jika bekerja kurang daripada 2 tahun dari tempoh bekerja terkini) Pendapatan Daripada
Perniagaan Sendiri Insurans/Takaful

Tempoh Perkhidmatan T T B B

MUKA SURAT 2 daripada 2

 Cetak Padam Simpan
FBGSV 004/2022_v1 (Updated on 17.03.2022)
BAHAGIAN B: BORANG PERMOHONAN PEMBUKAAN AKAUN DEPOSIT/-i
JENIS AKAUN

Akaun Individu

Akaun Pemohon Bersama; Syarat Tandatangan:

Nama Pemohon Bersama:
No. MyKad/Pasport Pemohon Bersama:

Akaun Minor (berumur antara 12 tahun dan 18 tahun sahaja)

JENIS PRODUK

Akaun Semasa / Simpanan Sila rujuk ke Lampiran di muka surat akhir dan nyatakan satu pilihan.
Akaun Semasa/-i Akaun Simpanan/-i Tujuan Pembukaan Akaun:
Nama Produk: Sumber Kewangan:

Multi Currency Account Sila rujuk ke Lampiran di muka surat akhir dan nyatakan satu pilihan.
Multi Currency Account Tujuan Pembukaan Akaun:
Qard Multi Currency Account-i Sumber Kewangan:

Sila tanda (√) di mana berkenaan

Nama Produk Deklarasi Produk Khusus

INDA – Akaun Individu Pada masa ini Saya/Kami TIDAK mempunyai sebarang Pinjaman/Pembiayaan
Domestik Ringgit dengan mana-mana institusi kewangan di Malaysia dan sekiranya
Saya/Kami mempunyai sebarang Pinjaman/Pembiayaan Domestik Ringgit, Saya/
Kami berjanji untuk memaklumkan kepada Bank dengan serta-merta; atau
Saya/Kami mempunyai Pinjaman/Pembiayaan Domestik Ringgit dengan satu atau
lebih institusi di Malaysia, dan jumlah pelaburan Saya/Kami di luar negara dan dalam
negeri dalam aset mata wang asing adalah dalam ambang agregat yang ditetapkan*
setiap tahun kalendar di bawah Notis Pertukaran Asing; RM:___________________________
Saya/Kami mempunyai Pinjaman/Pembiayaan Domestik Ringgit dengan satu atau
lebih institusi di Malaysia, dan jumlah pelaburan Saya/Kami di luar negara dan
dalam negeri dalam aset mata wang asing adalah melebihi ambang agregat yang
ditetapkan* setiap tahun kalendar di bawah Notis Pertukaran Asing. Dengan ini
Saya/Kami memberikan surat kelulusan dari BNM (Ruj:______________________________ )
sebagai dokumen sokongan;

EDEA – Akaun Pendidikan dan Pekerjaan Saya/Kami dengan ini mengemukakan bukti dokumentasi dan justifikasi untuk tujuan
pendidikan/pekerjaan di luar negara untuk mematuhi kehendak yang ditetapkan
oleh Bank Negara Malaysia.

INEX – Akaun Pelaburan Eksport Individu Saya/Kami mengesahkan bahawa:

a) Hasil yang dikreditkan ke dalam akaun adalah dari eksport.
b) Untuk memberikan keterangan dokumentasi, apabila dikehendaki oleh Bank.

Note: Bank boleh meminta dokumen sokongan tambahan daripada pelanggan-pelanggan untuk mengesahkan transaksi-transaksi dari
akaun-akaun di atas.
*Sehingga RM1 juta untuk individu di bawah Notis Pertukaran Asing

Kad Debit Sila tanda (√) di mana berkenaan

Kad Debit Kad Debit/-i Transaksi Luar Negara
Jenis Kad Debit Transaksi Kad Tidak Hadir

Peti Simpanan Keselamatan

Sila tanda (√) di mana berkenaan Sila rujuk ke Lampiran di muka surat akhir dan nyatakan satu pilihan.
Saya berminat untuk memohon *Peti Simpanan Keselamatan Tujuan Pembukaan Akaun:
(PSK)
* Tertakluk kepada ketersediaan kotak kosong di cawangan PSK. Sumber Kewangan:
Sila kunjungi cawangan RHB pilihan anda untuk melengkapkan
pembukaan Peti Simpanan Keselamatan.

MUKA SURAT 1 daripada 5

 FBGSV 004/2022_v1 (Updated on 17.03.2022)
BAHAGIAN C: BORANG PERMOHONAN PEMBIAYAAN PERIBADI/-i
JENIS AKAUN

Sila tandakan (√) di mana berkenaan Tujuan Pembukaan Akaun: Pinjaman/Pembiayaan Peribadi
Pembiayaan Peribadi Sumber Kewangan: Kemudahan Kredit Diluluskan oleh FI
Pendaftaran Masuk Personal Smart Shield (PSS) Ya Tidak
Jumlah Pembiayaan Peribadi Yang Dipohon
Pembiayaan Peribadi-i
RM
Sektor Awam
Kekalkan bayaran bulanan yang sama, sekiranya berlaku Tempoh Bayaran Balik
pelarasan kadar asas (BR) Ya Tidak
Bulan
Sektor Swasta/Potongan Gaji Majikan
Pesara Akaun Kredit Pembiayaan
Tujuan Permohonan (Sila √ satu) Baharu Sedia Ada;

005 Kegunaan Peribadi 037 Bayaran Tempahan – Kenderaan 038 Penyatuan Hutang 039 Pendidikan
040 Barangan Elektrik 041 Kelengkapan/Peralatan Rumah 042 Perbelanjaan Perubatan 043 Pembiayaan Dalam Talian
044 Pembiayaan Semula Peribadi 045 Pembiayaan Hartanah/Rumah 046 Pengubahsuaian 047 Melancong

ARAHAN PENYELESAIAN

No. Akaun Pembiayaan Peribadi Jumlah Penyelesaian Ansuran Bulanan

No. Institusi/Koperasi
atau No. Kad Kredit (RM) (RM)*

*Untuk penyelesaian akaun pembiayaan berdasarkan laporan CCRIS

Saya dengan nyata mengarahkan Bank untuk memotong sebarang amaun daripada Kemudahan yang diluluskan untuk menyelesaikan sebarang baki tertunggak
bagi pihak saya mengikut butiran seperti yang disusun dalam arahan di atas dan/atau mengikut jumlah tertunggak yang dilaporkan dalam laporan Sistem
Maklumat Rujukan Kredit Pusat (CCRIS) dengan jumlah tambahan sehingga dua (2) bulan ansuran bulanan. Saya bersetuju untuk membayar baki penyelesaian
yang melebihi Kemudahan yang diluluskan (jika ada) selepas Bank membuat pembayaran mengikut arahan saya di sini dan menurut surat penyelesaian
oleh institusi masing-masing yang dilampirkan bersama-sama ini. Saya bersetuju untuk meminta bayaran balik atau lebihan amaun (jika ada) terus daripada
institusi masing-masing menurut penyelesaian yang dibuat oleh Bank mengikut arahan saya di sini. Saya juga bersetuju bahawa saya tidak akan membuat atau
mengambil sebarang tuntutan atau tindakan terhadap Bank dalam bertindak mengikut arahan saya di sini, melainkan tuntutan atau tindakan tersebut timbul
daripada perbuatan, peninggalan, keingkaran, kecuaian dan/atau salah laku di pihak Bank dan/atau mana-mana pekerja, wakil dan ejen Bank.

BAHAGIAN D: BORANG PERMOHONAN KAD KREDIT/-i

JENIS PERMINTAAN

Kad Baharu Kad Tambahan Naik Taraf Kad

JENIS PRODUK

Sila tandakan (√) di mana berkenaan Persetujuan Yuran Melebihi Had

Kredit Kad Saya/Kami dengan ini bersetuju dan membenarkan pihak Bank
Kredit Kad-i mendebitkan akaun kad Saya/Kami untuk transaksi melebihi had,
di mana yuran melebihi had RM50 boleh dikenakan apabila Jumlah
Jenis Kad VISA MASTERCARD Baki Tertunggak melebihi gabungan had kad yang disebabkan oleh
transaksi melebihi had.
Nama Produk
Ya Tidak
Kod Produk
Untuk Kad Kredit
Nama pada Kad (maksimum 19 huruf) Pendaftaran Untuk Life Credit Shield (oleh Tokio Marine)
Amaun premium yang perlu dibayar berdasarkan agregat baki
tertunggak dari Hayat Yang Diinsuranskan pada tarikh bil bulanan
Penghantaran Kad ke: pada RM0.65 bagi setiap RM100 baki tertunggak.
Alamat Kediaman/Alamat Kekal Ya Tidak
Alamat Pejabat
Untuk Kad Kredit -i
Alamat Surat Menyurat
Pendaftaran Untuk TAKAFUL myCREDIT SHIELD (oleh Syarikat
Pengambilan Kad di Cawangan: ______________________________________ Takaful)
(Nama Cawangan) Caruman hendaklah dibayar secara bulanan dan berdasarkan
Tujuan Pembukaan Akaun: Pinjaman/Pembiayaan Peribadi penutup bulanan penyata kad kredit pada RM0.46 bagi setiap
RM100 daripada jumlah baki tertunggak kad kredit.
Sumber Kewangan: Kemudahan Kredit Diluluskan oleh FI Ya Tidak
MUKA SURAT 2 daripada 5
 FBGSV 004/2022_v1 (Updated on 17.03.2022)
BAHAGIAN E: PERAKUAN & KEBENARAN OLEH PEMOHON/PENJAMIN **
** Perakuan dan Kebenaran ini akan digunapakai untuk semua produk RHB Bank Berhad dan/atau RHB Islamic Berhad, yang mana
berkaitan, produk (“Bank”) yang anda mohon sebagaimana dinyatakan dalam borang permohonan ini. Bank sebagai institusi kewangan
berlesen yang memberi produk akaun/pinjaman/pembiayaan yang dirujuk mengenainya dalam borang permohonan ini yang dilengkapkan
oleh Saya/Kami.
1. UNTUK SEMUA PRODUK:
i. Saya/Kami mengesahkan dan menyatakan bahawa semua maklumat yang diberikan oleh Saya/Kami adalah lengkap, benar
dan tepat dan Saya/Kami memberi kuasa kepada pihak Bank untuk mengesahkan sebarang maklumat yang diberikan serta
mendapatkan dari mana-mana sumber termasuk Lembaga Hasil Dalam Negeri yang difikirkan sesuai oleh pihak Bank,
maklumat dimana mungkin diperlukan oleh Bank dan memerlukan budi bicara mutlaknya dan meluluskan atau menolak
permohonan Saya/Kami.
ii. Saya/Kami
 mengesahkan bahawa Saya/Kami telah menerima, diberi penerangan, membaca, dimaklumkan dan memahami
dokumen-dokumen tersenarai di bawah yang mengawal pengendalian akaun-akaun yang berkenaan. Saya/Kami bersetuju untuk
terikat dengannya dan/atau terma dan syarat yang di mana pihak Bank boleh mengubahsuai atau meminda atau mengemaskini
dari semasa ke semasa dengan memberikan 21 hari kalendar notis bertulis kepada Saya/Kami terlebih dahulu.
iii. Saya/Kami sedia maklum bahawa produk dokumen di bawah yang Saya/Kami mohon adalah/tersedia dalam Laman Web RHB
www.rhbgroup.com:
a) Terma & Syarat Bank: www.rhbgroup.com/others/terms-conditions/index.html
b) Lembaran Maklumat Produk Bank: www.rhbgroup.com
c) Notis Privasi Bank: https://www.rhbgroup.com/files/others/personal-data/privacy-notice.pdf
d) Risalah Perbadanan Insurans Deposit Malaysia (PIDM): www.rhbgroup.com
e) Notis maklumat mengenai caj-caj/bayaran-bayaran sampingan di https://www.rhbgroup.com/others/service-charges/index.html
iv. Saya/Kami telah diberitahu mengenai tujuan pendaftaran Kata Laluan Sekali (OTP) bagi Perbankan Atas Talian RHB Now.
v. Saya/Kami
 bersetuju dengan mengaktifkan, menandatangani dan/atau menggunakan kad yang dikeluarkan oleh Bank, Saya/
Kami bersetuju untuk terikat dan mematuhi semua Terma dan Syarat berhubung dengan kad tersebut.
vi. Kebenaran
 Untuk penjualan silang, pemasaran, promosi produk dan perkhidmatan daripada rakan kongsi strategik
Sila tandakan √ di mana berkenaan
 aya/Kami membenarkan dan memberi kuasa kepada RHB Bank Berhad untuk memproses dan mendedahkan sebarang
S
maklumat yang Saya/Kami telah berikan untuk tujuan penjualan silang, pemasaran, promosi (termasuk untuk menjalankan
tawaran dan pertandingan), dan menjalankan tinjauan (untuk meningkatkan kualiti produk/ perkhidmatan) kepada RHB
Banking Group (yang termasuk syarikat induk, anak syarikatnya, mana-mana syarikat bersekutu dan/atau mana-mana
syarikat/cawangan hasil daripada sebarang penstrukturan semula, penggabungan, penjualan atau pemerolehan, sama ada
di dalam atau di luar Malaysia), rakan kongsi strategik, penyedia perkhidmatan dan ejennya, pekhidmat dan/atau orang atau
pihak ketiga tersebut, jika berkenaan.

2. TRANSAKSI PEMBIAYAAN DAN PENDEDAHAN DENGAN PIHAK BERKAITAN

Adakah anda mempunyai ahli keluarga atau saudara terdekat (termasuk ibu bapa, saudara lelaki, saudara perempuan tanggungan
anak sendiri/tiri/angkat dan pasangan mereka) yang merupakan kakitangan RHB Banking Group?
Ya, Hubungan Tidak

3. UNTUK PRODUK PEMBIAYAAN DAN PENDAFTARAN JOY@WORK

Saya/Kami, memberi kuasa dan persetujuan kepada Bank untuk mendapatkan maklumat kredit dari CTOS dan/atau Agensi
Pelaporan Kredit berdaftar lain seperti yang ditentukan di bawah Akta Agensi Pelaporan Kredit 2010 tanpa pemberitahuan lebih
lanjut kepada Saya/Kami dan untuk tujuan yang berikut (mana-mana yang berkenaan):
Pemprosesan permohonan kredit; Kajian semula had kredit; Penyusunan semula; Pertindihan; Naik taraf permohonan;

4. UNTUK PRODUK PEMBIAYAAN

Akuan diri obligasi kewangan.
Berikut ialah hutang tertunggak Saya/Kami dengan institusi kewangan dan/atau institusi bukan kewangan di Malaysia.

Jenis Kemudahan/
Jumlah Bayaran
Bank/Syarikat Pembiayaan Jumlah Pembiayaan Baki Belum Jelas
Bulanan
Kewangan/Lain-lain (Rumah/Kereta/ (RM) (RM)
(RM)
Peribadi/Lain-lain)

MUKA SURAT 3 daripada 5

 FBGSV 004/2022_v1 (Updated on 17.03.2022)
5. DEKLARASI STATUS CUKAI PEMASTAUTIN
Sila tandakan √ di mana berkenaan
Saya/Kami telah dimaklumkan dan Saya/Kami dengan ini mengesahkan bahawa Saya/Kami memahami keperluan cukai pemastautin/FATCA/CRS
Saya/Kami. Saya/Kami dengan ini mengisytiharkan bahawa semua maklumat yang telah Saya/Kami berikan, adalah mengikut pengetahuan dan
kepercayaan Saya/Kami yang terbaik, betul dan lengkap:
Akta Pematuhan Cukai Akaun Asing “FATCA” Standard Pelaporan Biasa “CRS”
(Untuk A.S. Sahaja) (Selain A.S.)
Saya bukan warganegara Amerika Syarikat atau pemastautin di Saya mengesahkan bahawa saya pemastautin bercukai di Malaysiai.
Amerika Syarikat untuk tujuan pencukaian. Saya mengesahkan bahawa saya BUKAN pemastautin bercukai
Saya mengesahkan bahawa saya dilahirkan di Amerika Syarikat di Malaysia atau di mana-mana negaraii. Sila nyatakan sebab*:
(atau Wilayah Amerika Syarikat) tetapi tidak lagi memegang ____________________________________________________________________________________________________________
kewarganegaraan Amerika Syarikat kerana saya telah menyerahkan Saya mengesahkan bahawa saya pemastautin bercukai di Malaysia
kewarganegaraan saya secara sukarela seperti yang dibuktikan dan di negara lainiii.
pada dokumen yang dilampirkan. Saya mengesahkan bahawa saya pemastautin bercukai asingiv.
Saya mengesahkan bahawa saya warganegara Amerika Syarikat Jika anda memilih iii dan iv, sila lengkapkan jadual di bawah:
dan/atau pemastautin di Amerika Syarikat untuk tujuan pencukaian No. 1 2
(seperti pemegang kad hijau atau pemastautin yang memenuhi
ujian kehadiran). Negara
Pemastautin
Nombor Cukai Cukai
Jenis Nombor Keselamatan Sosial SSN No.
(Sila √ satu) Nombor Pengenalan Pembayar Cukai TIN Pendaftaran
Cukai (TIN)
Sebab, Negara tidak Negara tidak
jika tiada TIN mengeluarkan TIN mengeluarkan TIN
(Sila √ satu)
Negara tidak Negara tidak
memerlukan memerlukan
pengumpulan TIN pengumpulan TIN
Lain-lain*: Lain-lain*:
________________________ ________________________
*Permohonan TIN sedang dikeluarkan | tidak perlu mendaftar fail cukai
|suri rumah | suami suri rumah | minor | pelajar | pesara | diplomat asing
di kedutaan
6. PENGAKUAN PEMOHON:
i. Saya/Kami, yang bertandatangan di bawah mengisytiharkan bahawa maklumat yang diberikan oleh Saya/Kami di atas adalah benar dan betul dan
jika pihak Bank kemudiannya mendapati bahawa mana-mana maklumat yang diberikan adalah palsu, tidak betul atau tidak lengkap, pihak Bank
boleh membatalkan atau mengubah Kemudahan yang diluluskan.
ii. Saya/Kami bersetuju bahawa salinan e-mel borang permohonan dan/atau dokumen sokongan yang diterima oleh pihak Bank adalah dianggap
sebagai borang permohonan asal dan/atau dokumen sokongan dan Saya/Kami harus mengemukakan borang permohonan asal dan/atau
dokumen sokongan kepada pihak Bank atas permintaan.
iii. Saya/Kami juga telah dinasihatkan bahawa Saya/Kami boleh menghubungi Pusat Perhubungan Pelanggan RHB melalui telefon di +603-9206
8118 atau melalui e-mel di [email protected] atau melawat mana-mana cawangan Bank jika Saya/Kami tidak faham mana-mana
ciri produk, faedah, helaian pendedahan produk dan/atau Terma dan Syarat.
Tandatangan Pemohon Name Penuh seperti Kad Pengenalan/Pasport

No. Pengenalan

Tarikh H H / B B / T T T T

UNTUK KEGUNAAN BANK SAHAJA

Saya dengan ini menyatakan bahawa saya telah melihat salinan asal dokumen dan semua maklumat yang diberikan di atas adalah benar dan boleh dipercayai.
Dihadiri Oleh: Disemak & Disahkan Oleh:

Nama Nama

No. ID Pekerja No. ID Pekerja

Tarikh H H / B B / T T T T Tarikh H H / B B / T T T T

Pembiayaan Peribadi/-i Kod Kempen Kad Kredit/-i

Kod Produk Kod Pakej Kod Sumber

Kod PGM Kod Sumber Kod Program

MUKA SURAT 4 daripada 5

 FBGSV 004/2022_v1 (Updated on 17.03.2022)
LAMPIRAN

Tujuan Pembukaan Akaun

■ Gaji ■ Arahan Tetap
■ Simpanan/Simpanan Tetap ■ Pengeluaran KWSP
■ Kiriman Wang (Tempatan/Asing) ■ Pinjaman/Pembiayaan Peribadi
■ Perbelanjaan Isi Rumah/Keluarga ■ Pentadbiran Akaun Estet
■ Pelaburan ■ Bayaran Balik/Pengeluaran Pinjaman

Sumber Kewangan
■ Pendapatan/Gaji ■ Pulangan Pelaburan
■ Pindahan Bank Sendiri (dalam RHB) ■ Roll Over/Pembaharuan Penempatan FD
■ KWSP/SOCSO/Pencen/Ganjaran ■ Kematangan/Penyerahan Insurans
■ Simpanan/Pelaburan ■ Penyelesaian Undang-Undang
■ Biasiswa/Elaun/Pinjaman Pendidikan ■ Kemudahan Kredit Diluluskan oleh FI
■ Dana Amanah ■ Pindahkan dari Akaun Sendiri dengan FI Lain
■ Penyelesaian Perceraian/Pampasan ■ Pasangan/Ibu Bapa/Anak-anak
■ Penjualan Pelaburan/Saham/Harta Tanah/Tanah ■ Bantuan Kewangan/Subsidi
■ Dividen/Keuntungan ■ Pendapatan Sambilan
■ Hasil Sewa ■ Warisan
■ Komisen ■ Hadiah/Sumbangan
■ Yuran Pengarah/Gaji ■ Perjudian/Pertandingan Berjaya Yang Sah
■ Elaun Kebajikan

MUKA SURAT 5 daripada 5

 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
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

 FBCAR 001/2022_V1 (updated 17.03.2022)

FOR PREMIER CREDIT CARD/-i

I hereby confirm that the applicant of this credit card/-i is an RHB Premier Banking customer and he/she is eligible for the offer as chosen above.

AUM Info* Approved Housing Loan/Financing

Saving Account Total Loan/Financing Amount
Current Account
Fixed or Term Deposit
Unit Trust
Bancasurrance
-Single Premium/Contribution
Bancasurrance
-Regular Premium/Contribution (only fully
paid)
Structured Investment
Total
*Please provide proof of AUM information.

Attended by Signature

Attended Name:

Branch Manager / Centre

Manager Name:

Branch /Premier Centre:

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

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