citibank credit card application form / · pdf filei wish to apply for/ airasia gold masaya...
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![Page 1: CITIBANK CREDIT CARD APPLICATION FORM / · PDF fileI wish to apply for/ AirAsia Gold MaSaya ingin memohon? sterCard?AirAsia Ma CITIBANK CREDIT CARD APPLICATION FORM / BORANG PERMOHONAN](https://reader036.vdocument.in/reader036/viewer/2022082205/5a70eb397f8b9aa2538c807e/html5/thumbnails/1.jpg)
I wish to apply for / Saya ingin memohon ? AirAsia Gold MasterCard ? AirAsia MasterCard
CITIBANK CREDIT CARD APPLICATION FORM /BORANG PERMOHONAN KAD KREDIT
Bank name / Nama bank Type of account / Jenis akaun
1 TELL US ABOUT YOURSELF / MAKLUMAT TENTANG DIRI ANDA
Full name as in NRIC or passport (underline surname) / Nama seperti di dalam K.P. (gariskan nama keluarga) :
Name to appear on card (max 19 letters) / Nama yang akan tertera pada kad (maksima 19 huruf) :
Date of birth / Tarikh lahir :
New NRIC no. or passport no. / No. K.P. baru : Old NRIC no. / No. K.P. lama :
Nationality / Warganegara :
Home address / Alamat rumah : Home tel. no. / No. tel rumah :
Handphone no. / No. tel mudah alih :
Permanent home address (If different from above) / Alamat rumah tetap (Jika berlainan daripada di atas) :
Mother's maiden name / Nama ibu:
? Single / Bujang ? Married / Berkahwin
? Widowed / Janda atau Duda ? Divorced / Bercerai
Residence / Rumah : ? Owned / Milik sendiri ? Parents’ / Ibu-bapa ? Employer’s / Majikan ? Rented / Sewa ? Mortgaged / Dipajak
? Mr /Encik ? Mrs /Puan ? Ms / Cik
? Bumiputra / Bumiputra ? Non-Bumiputra / Bukan Bumiputra
Marital status / Taraf perkahwinan :
For / Untuk
years / tahun
m m d d y y y y
Post code / Poskod :
Postcode / Poskod :
Annual salary or income / Gaji atau pendapatan tahunan : RM
EMERGENCY CONTACT PERSON (RELATIVE NOT STAYING WITH YOU) /ORANG UNTUK DIHUBUNGI SEMASA KECEMASAN (SAUDARA YANG TIDAK TINGGAL BERSAMA ANDA)
3
Name / Nama : Contact phone no. / No. talifon berhubung :
YOUR BILLING ADDRESS / ALAMAT BIL ANDA 4
Send card to /Hantar kad ke : ? Home address / Alamat rumah ? Work address / Alamat Pejabat
Send bill to/hantar bil ke : ? Home address/ Alamat rumah ? Work address/ Alamat Pejabat ? E-mail*/ E-mel*
For credit card applicant (Please tick one only) / Untuk pemohon kad kredit (sila pangkah satu) :
* Please find out latest bonus rewards promotions at citibank.com.my / Sila layari citibank.com.my untuk promosi mata ganjaran bonus terkini
E-mail / E-mel :
? Photocopy of charge card or credit card (both sides) issued by a bank / Salinan kad caj atau kad kredit (depan dan belakang) yang diisu oleh bank
? Photocopy of I.C. (both sides) or passport / Salinan K.P. (depan dan belakang)
? Photocopy of I.C. (both sides) or passport / Salinan K.P. (depan dan belakang)
? Latest salary slip / letter from employer or / Slip gaji terkini atau surat pengesahan pekerjaan atau
? Bank statement with last 3 months' salary
credits or / Penyata bank dengan rekod 3 bulan gaji terkini atau
? Any other income supporting documents / Sebarang dokumen menyokong pendapatan
? Photocopy of I.C. (both sides) or passport / Salinan K.P. (depan dan belakang)
? Photocopy of business registration
(And Form 9, 24 & 49) / Salinan pendaftaran perniagaan (Dan Borang 9, 24 & 49)
? Latest 6 months' bank statements or / Penyata bank untuk 6 bulan terkini atau
? Form B or any other income supporting documents / Borang B atau sebarang dokumen menyokong pendapatan
ENCLOSED DOCUMENTS ARE NON-RETURNABLE / DOKUMEN YANG DISERTAKAN TIDAK AKAN DIKEMBALIKAN
If you have a credit card (18 months)/charge card (12 months) / Jika anda mempunyai kad kredit (18 bulan)/kad caj (12 bulan) :
Salaried Employee / Kakitangan Bergaji Self-employed / Bekerja Sendiri
DOCUMENTS REQUIRED / DOKUMEN-DOKUMEN YANG DIPERLUKAN5
Yes, I/my immediate family members
PUBLIC FIGURE DECLARATION FOR FOREIGNERS (e.g. ministerial/diplomatic positions)
For credit card applicant only / Untuk pemegang kad kredit sahaja :
? currently hold / seeking ? have held
Position held : From to
Senior public office :
mm dd yy mm dd yy
For bank’s use.
PV B01 B06 B25 B33 B35 B55 B44 B88 Incomp IN ID PR IT PP RJ ______ D ______
PLEASE SIGN HERE / SILA TANDATANGAN DI SINI7
By signing below, I confirm that I have read and agreed to abide by the declaration below / Dengan tandatangan di bawah, saya mengesahkan bahawa saya telah membaca dan memahami terma-terma dan syarat-syarat yang dicetak di bawah dan bersetuju terikat dengannya.
SUPPLEMENTARY CARD / KAD TAMBAHAN6
Supplementary card applicants must be at least 18 years of agePemohon kad tambahan mesti berumur sekurang-kurangnya 18tahun
Full name as in NRIC/passport (underline surname) / Nama seperti di dalam K.P. (gariskan nama keluarga) :
Name to appear on card (max. 19 letters) / Nama yang akan tertera pada kad (maksima 19 huruf) :
Mother's maiden name / Nama ibu :
Date of birth / Tarikh lahir : Nationality / Warganegara :
m m d d y y y yNew NRIC no./Passport no. / No. K.P. baru/No. Paspot : Old NRIC no. / No. K.P. lama :
Current home address (If different from principal cardmember) /Alamat rumah terkini (Jika berlainan dari pemegang kad utama) :
Home tel. no. / No. tel rumah :
Post code / Poskod :
For bank’s use only:
Reminder: The total combined spend cannot exceed the principal cardmember's current approved credit line.Peringatan: Jumlah kombinasi had kredit tidak boleh melebihi kredit pemegang kad utama yang diluluskan.
? Yes, I wish to assign monthly spend limit of / Ya, saya ingin menetapkan had kredit bulanan sebanyak
Date / Tarikh
Supplementary Card Applicant / Pemohon Kad Tambahan
xx
RM
Date established / Tarikh penubuhan :
Business reg no. /No. pendaftaran :
No. of Staff /Bilangan pekerja :
PLEASE COMPLETE ONLY IF SELF-EMPLOYED / SILA ISI JIKA BEKERJA SENDIRI
Annual Sales Turnover / Pulangan Tahunan
m m y y y y
TELL US ABOUT YOUR EMPLOYMENT OR BUSINESS / BUTIRAN PEKERJAAN ATAU PERNIAGAAN ANDA2
Name of employer / Nama majikan :
Work address / Alamat pejabat :
Nature of business / Jenis perniagaan :
Position /Jawatan :
Date joined / Tarikh mula kerja :
Work tel. no. (general line)/Talian am pejabat :
Post code / Poskod :
m m d d y y y y
Name of previous employer (If less than 2 years in current employment) /Nama majikan dahulu (Jika bekerja kurang dari 2 tahun dengan majikan sekarang) :
Previous Employment Period /Tempoh bekerja dahulu :
For / Untuk years / tahun
Signature of Principal Card applicant / Tandatangan pemohon Kad Utama
Date / Tarikhx
( Sign in black ink only / Sila guna dakwat hitam)
( Sign in black ink only / Sila guna dakwat hitam)
For Credit Card applicant only / Untuk Permohon Kad Kredit Sahaja : I confirm that my signature above / Saya faham bahawa tandatangan saya di atas
/ constitutes a request for a AirAsia MasterCard if I do not qualify for a AirAsia Gold
Ext no.
Agent Code
Source Code (Citibank)
MasterCard/ merupakan permohonan untuk kad kredit AirAsia MasterCard jika saya tidak layak untuk memohon kad AirAsia Gold MasterCard
![Page 2: CITIBANK CREDIT CARD APPLICATION FORM / · PDF fileI wish to apply for/ AirAsia Gold MaSaya ingin memohon? sterCard?AirAsia Ma CITIBANK CREDIT CARD APPLICATION FORM / BORANG PERMOHONAN](https://reader036.vdocument.in/reader036/viewer/2022082205/5a70eb397f8b9aa2538c807e/html5/thumbnails/2.jpg)
Citibank AirAsia Chinese New Year Fly Away Fair Application Check List
1. Please complete and sign the application form
2. Please prepare the following documents:
3. Visit us at the First Floor, South Court of Mid Valley Megamall to submit your application.
4. Remove the FREE event updates portion as this event will be held for 3 weeks.
a. Your Identification Card b. A credit card you have held for more than 18 months OR A copy of your 3 months latest payslip