Declaration

DECLARATION BY NON-MALAYSIAN APPLICANT (TICK WHERE APPROPRIATE)

No, I/my immediate family members    do not hold    have never held Senior Public Office    Yes, I/my immediate family members    currently hold    have held

Position held     Date From     to

I/We confirm that all the above information is true and complete and authorise the Bank to verify from whatever sources the Bank may consider appropriate including Inland Revenue Board and further to seek and obtain credit information related to my/our application from any source and by any means as the Bank deems fit. I/We acknowledge that the Card may only be used subject to the Terms and Conditions of the PB Visa Cardmember Agreement and agree to be bound by the Terms and Conditions of the Card. I/We agree to pay the prevailing annual fees upon approval and shall accept joint and several liability for all charges on my/our Card Account(s) with the Bank. The Bank shall reserve the absolute right to approve or reject my/our application as the Bank deems fit without assigning any reason.

I/We irrevocably consent to and authorise the Bank to disclose to Bank Negara Malaysia, any authority/body having jurisdiction over the Bank, any guarantor(s)/security parties, and/or its lawyers or any other debt collection agent, companies which are related to the Bank by virtue of Section 6 of the Companies Act 1965 at any time and without notice or liability any information relating to my/our affairs, banking accounts or conduct thereof (including my/our credit standing) to such extent and for such purposes as the Bank may in its absolute discretion deems necessary or expedient.

In addition, I/We hereby irrevocably authorise the Bank to release, divulge, disclose or reveal any information to any of the Bank's existing or future business partners.

TO BE COMPLETED BY THE PARENT/GUARDIAN FOR APPLICANT BETWEEN 12-18 YEARS OLD I  ,              (Name of Parent/Guardian)           (Parent's/Guardian's NRIC) being the Parent/Guardian of ,         (Name of Applicant)                         (Applicant's NRIC) hereby agree and give my consent to this application. In consideration of the Bank issuing a PB Visa Electron Card to the abovenamed Applicant at my request, I hereby agree to save the Bank harmless and indemnify the Bank (its successors in title and assigns) from and against all actions, suits, proceedings, claims, demands, losses, damages, costs, charges and expenses whatsoever incurred by the Bank or which may be taken or made against the Bank arising from my request and authorisation given herein and the issue and/or the use of the PB Visa Electron Card by the abovenamed Applicant. I further agree that my obligation herein shall continue and shall remain in full force and effect until my obligations herein are fully discharged to the Bank's satisfaction. This indemnity shall be valid during the continuance of this agreement and shall continue to remain in force up to 6(six) months after the eighteenth birthday of the abovenamed Applicant and shall be binding on my personal representatives and my heirs.