Auto Financing Application (Individual) Enquiries

03-2295 6688

CIMB Islamic Bank Berhad (671380-H)

CIMB Bank Berhad (13491-P)

APPLICANT DETAILS

1

Highest level of education obtained*

PERSONAL DETAILS Salutation Mr

Postgraduate Madam

Miss

Diploma

Others

Name as per NRIC

Professional qualification Secondary

Degree

Primary

Others

EMPLOYMENT DETAILS Employer's name

Gender Male

Female

New NRIC number

Old NRIC number*

Other identification (complete if you do not have an NRIC) Army/ Specify Passport Police number

Position

Employer's address

Date of birth (dd/mm/yyyy)

Email address*

Postcode State

Home phone number

Mobile phone number

Country

Employer's phone number (use 'ext' to indicate extension number)

Marital status Single

Married

Employment type

Others

Employed (Fixed)

Number and age(s) of dependant children*

Employed (Non Fixed)

Age(s)

Own Business (Non Professional) Unemployed (with other income)

Unemployed (without income, Pensioner, Housewife, Student) Nationality Malaysian

Date employed (dd/mm/yyyy)

Occupation

Others

If not Malaysian, what is your residence status? Malaysia My 2nd Home

Non-Malaysian resident Permanent resident

Other monthly income

RM

RM

Type of company

Race Malay

Chinese

Indian

Others

Bumiputra Yes

Main monthly gross income

No

Financial Institution

Private Limited Company Public Limited Company

Bursa Listed

School/College

MNC (Non FI)

Sole Proprietor/Partnership

Size of current employment company Small Medium (50 employees) Years

(current and all previous employment)

Duration at permanent address Years

Non Profit Organisation

Government Agency

Permanent home address

State

CIMB Group

Rented

Relatives

Company quarters

Full Name As In NRIC

Parents

Mailing address (complete if different from above) Relationship With Main Applicant

Postcode State

Home phone number

Mobile phone number

Country

Page 1 of 6

* Optional V5.0 (01/15) AF-CB/APP/0015-EN-2 (01/15) - BCF

SPOUSE DETAILS (Complete only if your spouse is not a guarantor)

2

Name as per NRIC

New NRIC number

Other identification (complete if your spouse does not have an NRIC)

Home phone number

Passport

Army/ Police

Old NRIC number*

Specify number

Mobile phone number

Office phone number

GUARANTOR DETAILS

3

Mailing address (complete if different from above)

PERSONAL DETAILS Salutation Mr

Madam

Miss

Others

Name as per NRIC

Postcode State

Gender

Relationship to applicant

Male

Country

Highest level of education obtained* Postgraduate

Female

New NRIC number

Old NRIC number*

Diploma

Professional qualification Secondary

Primary

Degree Others

EMPLOYMENT DETAILS Other identification (complete if you do not have an NRIC) Army/ Specify Passport Police number

Employer's name

Department

Date of birth (dd/mm/yyyy)

Employer's address

Email address*

Home phone number

Mobile phone number

Postcode Country

State

Marital status Single

Married

Employer's phone number (use 'ext' to indicate extension number)

Others

Number and age(s) of dependant children* Employment type

Age(s)

Employed (Fixed) Nationality

Own Business (Non Professional)

Employed (Non Fixed)

Malaysian

Others

Unemployed (with other income)

Unemployed (without income, Pensioner, Housewife, Student)

If not Malaysian, what is your residence status?

Occupation

Malaysia My 2nd Home

Non-Malaysian resident Permanent resident

Date employed (dd/mm/yyyy)

Race Malay

Chinese

Indian

Others

Bumiputra Yes

No

Main monthly gross income

Other monthly income

RM

RM

Type of company

Permanent home address

CIMB Group

Non Profit Organisation

Financial Institution

Private Limited Company

Government Agency

Public Limited Company

Postcode State

Country

Months

Current residence status Owned - charged Owned - not charged

School/College Sole Proprietor/Partnership

Size of current employment company Small Medium (50 employees) Are you an existing CIMB Group customer? Yes

No * Optional

REFEREE DETAILS*

4

Name of referee

Occupation

Relationship to applicant

Home phone number

Office phone number (use 'ext' to indicate extension number)

Mobile phone number

Address

Postcode

State

Country

FINANCE AND VEHICLE DETAILS

5

Deal type Dealer

Financing promotion type Direct case Salesman's name

Dealer/Seller's name

Product type Fixed rate

Application type Variable rate

New

Recon (Unregistered)

Used

Used recond

Purchase location Peninsular Malaysia Year made

Labuan

Langkawi

Date of registration

Sabah and Sarawak Registration number

Engine capacity (CC) 2000 CC

Amount financed

RM

Petrol

Diesel

Duration

Others Interest/Profit rate

RM

%

Months

Where is the vehicle kept?

Postcode

State

Country

TRADE-IN DETAILS

6 Make

Model

Registration number

Year made

Trade-in value RM

7

DOCUMENTS ENCLOSED

Which of the following documents are you providing with this form? Copy of applicant's NRIC/Passport

Latest 3 months bank statements

Photocopy of Driving License

Latest 3 months salary slip or other income evidence

Photocopy of Registration Card

Latest EA Form/Form B with proof of tax payment/EPF Statement

Page 3 of 6

* Optional

SMSA

9

0

4

9

Branch No. i-Branch No. Employee No.

CIMB Bank Credit Card Application Form 1

CIMB Islamic Credit Card Application Form

I WISH TO APPLY FOR THE FOLLOWING CARD :

 

CIMB Cash Rebate Platinum MasterCard



CIMB Islamic PETRONAS Gold MasterCard

CIMB Cash Rebate Gold MasterCard



CIMB Islamic Platinum MasterCard

 

CIMB PETRONAS Platinum MasterCard



CIMB Islamic Gold MasterCard

   

CIMB Platinum MasterCard

  

CIMB Visa INFINITE

CIMB PETRONAS Gold MasterCard

CIMB Gold MasterCard CIMB Visa Platinum CIMB Visa Gold

CIMB WORLD MasterCard CIMB Visa SIGNATURE

Notes : 1. Additional credit cards will share a combined credit limit. 2. Minimum annual income per annum for Gold (RM24,000), Platinum (RM60,000), Visa SIGNATURE/WORLD MasterCard (RM100,000) and Visa INFINITE (RM150,000).

Card Applicant’s Signature : Date :

2

MY PERSONAL DETAILS

Name To Appear On Card (Not More Than 19 Letters) :

3

Mother’s Maiden Name :

MY BILLING DELIVERY INSTRUCTIONS

Please send my/our Statement(s) for the credit card(s) selected above and all my/our other credit cards that I/we have with the Bank to my/our :

 E-mail

4

 CIMB Clicks Internet Banking

 Home Address

CIMB TOUCH ‘N GO ZING AUTOMATIC RELOAD AMOUNT

CIMB Touch ‘n Go Zing Card (Touch ‘n Go card linked to CIMB Bank/CIMB Islamic Credit Card)

 I would like to have the CIMB Touch ‘n Go Zing Card with the following automatic reload amount Principal Card  RM100  RM200  RM300 Note :

Customer’s NRIC / Passport No. :

(Compulsory)

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DECLARATION/DISCLOSURE BY APPLICANT*** *** This declaration shall apply to all CIMB Bank Berhad and CIMB Islamic Bank Berhad (“the Bank”) product(s) which you apply for as stated in this application form and above table.

FOR ALL PRODUCTS: (i)

I/We declare that I/we have/do not have outstanding debt payment obligation from banks and 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)

1 2 (ii)

I/We declare that the information furnished in this form are true, accurate and complete and I/we have not withheld any information which may

(iii) Application(s) remains the Bank’s property regardless of whether the facility is approved and the Bank reserves the right to reject the application(s) at its sole discretion without any reasons whatsoever. (iv) I/We have not committed any act of bankruptcy and/or been adjudged a bankrupt. (v)

(vi) to time now and/or in the future, with or from any credit reference/reporting agencies, including but not limited to CCRIS, FIS and/or any other agencies our status and/or any other person, individual and/or entity related to and/or associated with me/us as may be required by the Bank for the purpose of the consideration of this application and thereafter if this application is approved for the purposes of the 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. (vii) 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) :  I am a staff of the CIMB Group1  To the best of my knowledge, I have close relative(s)2 employed under the CIMB Group. 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)

 Yes

 No

 Yes

 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/

(viii) 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): 19th Floor, Menara Bumiputra Commerce, 11 Jalan Raja Laut, 50350 Kuala Lumpur, Tel. No.: 1 300 880 900. 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, ( )  I/ We hereby give my/our consent to the above disclosure to third parties.  I/ We do not consent to the giving of the above disclosure to third parties. (ix) I/We also acknowledge that it is a requirement by Bank Negara Malaysia (“BNM”) that all information relating to this application, whether successful or otherwise must be updated and/or transmitted to the Central Credit Reference Information System (“CCRIS”), a database maintained by BNM. (x)

CIMB Touch ‘n Go Zing Card agree to abide by the terms and conditions of the Touch ‘n Go Zing Card (hereinafter collectively referred to as “the Card”) and any other terms and conditions imposed by Touch ‘n Go Sdn. Bhd. (hereinafter referred to as “TNGSB”) and/or the Bank from time to time in respect of the use of the Touch ‘n Go features of the Card. I am aware the Card has an automatic reload amount of RM100, RM200 or RM300 and that the automatic reload Bank Credit Card account, as the case may be, for each reload and automatic reload fee (where chargeable) whenever the account balance drops to RM50 and below. In the event that I cancel my Card and my Card has an account balance at the point of cancellation, such balance will be refunded, upon request, to my CIMB Bank/CIMB Islamic Bank Credit Card account and the processing fee of RM5 will be debited from my CIMB Bank/CIMB Islamic Credit Card Account for such refund. In the event that my Card does not have any account balance when I cancel my Card, no processing fee will be charged. A RM10 fee is also chargeable for new Card replacements. By signing and/or using the Card I agree to be bound by the terms and conditions imposed by the Card and other variations or amendments thereof. I understand that the Touch ‘n Go Zing Card remains the property of TNGSB and must be returned to TNGSB and/or the Bank, as the case may be, upon request.

Page 5 of 6

DECLARATION/DISCLOSURE BY APPLICANT*** ... CONTINUED (xii) For Credit Card I/We hereby request the Bank to issue, upon approval of this application, the credit card(s) which I/we have indicated. I/We acknowledge that the use of the credit card(s) issued to me/us shall be subject to the Bank’s Cardholder Terms and Conditions (“Cardmember Agreement”) which will be sent to me/us with the credit card(s) upon the approval of this application, and I/we further agree to be bound by the terms and conditions set forth in the Cardmember Agreement upon issuance or use 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(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. (xiii) For Goods and Services Tax (GST) Without prejudice to any other provision herein, I/we shall be liable for goods and services tax payable in connection with or arising out of this facility/ account/product or any other services in connection therewith. (xiv) For Email Statement Delivery I agree to be bound by CIMB Bank/CIMB Islamic Bank Terms & Conditions for E-Mail Statement Delivery available at CIMB Bank/CIMB Islamic Bank website - www.cimbbank.com.my/cb.cimbislamic.com.my in respect of all my credit card statements requested to be sent to me by e-mail. (xv) For View/Receive Statements By CIMB Click Internet Banking Where I have a CIMB Clicks Internet Banking account (“CLICKS”) and have requested to view all my CIMB Bank/CIMB Islamic Bank credit card Statement(s) via CLICKS. I agree to be subject to the Terms and Conditions for Credit Card e-statement accessed via CIMB clicks published on CIMB Bank’s/CIMB Islamic Bank’s website. I agree that I will not receive hardcopy Statements nor will I receive Statement(s) via E-mail. 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 to the same. DECLARATION ON FATCA (INDIVIDUAL) Please check “3 ” Yes or No for each of the following questions:

Yes

No

1. Are you a U.S. Resident? (including a current work permit)

  

  

2. Are you a U.S. Citizen or a Citizen of a U.S. Territory? 3. Do you hold a U.S. Permanent Resident Card (Green Card)?

If yes, Tax Number: If yes, Tax Number: If yes, Tax Number:

authorities where necessary to establish my/our tax liability in any relevant jurisdiction. Where required by domestic or overseas governmental, supervisory or regulatory 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 subjected to the relevant jurisdiction’s requirements. Where required by domestic or overseas governmental, supervisory or regulatory authorities, I/we understand and agree that CIMB may withhold, and pay out, from any of my/our account(s) such amounts as may be required accordingly to applicable laws, regulations, directives, guidelines 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 CIMB, if there is a change in any information which I/we have provided to CIMB.

application for the Product(s) that I/we applied for. I am aware that the full terms and conditions of the product(s) that I applied for is/are also available in:

Hire Purchase

:

www.cimbbank.com.my

03-2295 6688

Islamic Hire Purchase

:

http://cb.cimbislamic.com.my

03-2295 6688

CIMB Islamic Credit Card

:

http://cb.cimbislamic.com.my

03-6204 7788

CIMB Credit Card

:

www.cimbbank.com.my

03-6204 7788

Main Applicant’s Signature : Date :

Guarantor’s Signature : Date : BANK USE ONLY

Serviced by : Application ID : Outlet :

Date :

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