PB Card Online Application Form
Please fill in the following information to enable us to process your PB debit card application:

(Fields marked with an * are mandatory.
)
 
CARD SELECTION
   
  Debit Card PB Visa Electron
     
PERSONAL DATA OF PRINCIPAL CARDMEMBER
     
  Title *
Name to Appear on Card *
(maximum 15 characters)
Name (as per NRIC/Passport) *
Nationality/Citizenship *
NRIC * (Old)
  - - (New)
Passport Number (for Non-Malaysian)
Date of Birth (dd/mm/yyyy) * //
No of Dependants
Sex * Male Female
Marital Status
Mother's Maiden Name in Full
(For Security Verification)
Race *
Email Address *