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.

BANKING AND FINANCIAL INSTITUTIONS ACT 1989 (BAFIA) AND BNM GUIDELINES ON PRODUCT TRANSPARENCY AND DISCLOSURE

PERSONAL INFORMATION

I/We understand that the Bank would like to keep me/us informed of important information, announcements and news about the products and services including promotional offers and marketing material of the Bank and its Affiliates*. Should I/we agree to be informed, my/our personal information in the Bank's records will be made available to the Bank and its Affiliates for this purpose and as stated in the Bank's Privacy Policy.

My/Our preference is indicated below:

Yes, I/we would like to receive and be informed of the product and services including promotional offers and marketing material of the Bank and its Affiliates and I/we make available my/our personal information (excluding information relating to my affairs or account) in the Bank's records to the Bank and its Affiliates for this purpose and as stated in the Bank's Privacy Policy.   No, I/we do not want to receive and be informed of the product and services including promotional offers and marketing material of the Bank and its Affiliates.

I/We understand that I/we am/are entitled to obtain access to and to request correction of any personal information held by the Bank and that I/we can inform the Bank to cease using my/our personal information for the purposes above and that such request can be made in writing to the Bank at my/our account holding branch or by sending it to Customer Service Department, 13th Floor, Menara Public Bank, 146 Jalan Ampang, 50450 Kuala Lumpur.

*I/We understand that for details of the Bank's Affiliates, the collection, use, storage, sharing and maintaining the integrity of my/our information, I/we can refer to the Bank's Privacy Policy at www.PbeBank.com. or obtain a copy from the Bank's branches.

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.