PERSONAL DATA OF PRINCIPAL CARDMEMBER
(Old)
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(New)
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DECLARATION
DECLARATION BY NON-MALAYSIAN APPLICANT (TICK WHERE APPROPRIATE)
Position held
Date From
to
Please select your preference as indicated below:
I/We understand that for the details of the Bank’s Affiliates and strategic
business partners I/We can refer to the Bank’s Privacy Notice at www.PBeBank.com.
BNM GUIDELINES ON CREDIT CARDS
For new applicants who earn RM36,000 or less per annum:
DECLARATION
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 the Inland Revenue Board and further to seek and obtain credit information
related to my/our application from any Credit Reporting Agencies governed by Credit Reporting Agencies Act 2010.
I/We acknowledge that the Card may only be used subject to the Terms and Conditions of the Public Bank Visa/Public Islamic
Bank Visa/Public Bank Mastercard/Public Islamic Bank Mastercard 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. I/We further agree that the
Principal Cardmember shall be responsible for all liabilities and obligations of the Principal Cardmember as well as those
of the Supplementary Cardmember(s). The Supplementary Cardmember however, shall only be responsible for his/her own
liabilities and obligations. 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 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 or to such person(s) and/or entity(ies) as permitted by law, any information relating to my/our
affairs, banking accounts or conduct thereof (including my/our credit standing) as the Bank deems necessary or expedient.
I/We acknowledge that if my/our card application is approved, the yearly Annual Fee payable on the Card shall be waived
as per terms stipulated provided my/our Card Account is maintained to the satisfaction of the Bank, my/our Card Account
shall remain active for the duration of this period and there is no change in my/our credit standing as made known to the
Bank. The Bank shall be entitled to review my/our Card Account at its sole discretion and withdraw this privilege in
the event that any of the above conditions have not been fulfilled upon which the Annual Fee shall become payable.
I/We understand that the Bank will not be able to consider/process my/our application herein for the Card or continue
to provide the Card unless the Bank can disclose to, share with or receive My Personal Data from the parties mentioned
above in compliance with Personal Data Protection Act 2010 and Credit Reporting Agencies Act 2010.
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.
FOREIGN ACCOUNT TAX COMPLIANCE ACT (FATCA)
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FATCA is a piece of legislation enacted by the United States (U.S.) government to collect information on U.S.
taxpayers/citizens/permanent residents or green-card holders or persons with substantial physical U.S. presence
(named as U.S. Person or Specified U.S. Person) for reporting on their investment of assets/monies/funds in
countries outside of the U.S.
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This is to enable the U.S. government to collect taxable income from Specified U.S. Persons that have invested
their funds in countries other than the U.S. where their assets held in the financial accounts will be reported
to the U.S. Internal Revenue Service (IRS).
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FATCA have come into force in Malaysia effective 1 July 2014.
COMMON REPORTING STANDARD (“THE CRS”)
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Over 100 countries have signed an accord with the Organisation for
Economic Co-operation and Development (OECD), a global body helping governments
around the world to tackle economic, social and governance challenges by introducing a new information
gathering and reporting requirement for financial institutions in order to help protect the integrity of
tax systems which is similar to FATCA.
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Under the CRS, we are required to determine where you are a 'tax resident' i.e.
in which country you are liable to pay income tax.
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CRS is effective in Malaysia starting 1 July 2017.
Participating Countries under CRS :
List of Participating Countries Under CRS
CUSTOMER CONSENT
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I hereby undertake to inform Public Bank (PBB) within 30 days of any change in
circumstances that render this self-certification incorrect by providing the
required documentation within 90 days from the date of change.
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I acknowledge and consent to my account information to be exchanged with
the tax authorities of countries concerned if my foreign status falls under
the purview of the intergovernmental agreements under FATCA and CRS.
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I have read and understood on the provisions of FATCA and CRS as contained herein
and agree to be bound by such provisions.
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I declare that the information provided in this form is, to the best of my knowledge
and belief, accurate and complete.
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I declare that the Bank reserves the right as the Bank deems fit, to reject the
application or close the account or report the account to the relevant tax
authorities without assigning any reason whatsoever should any of the information
furnished is invalid, inaccurate, insufficient and incomplete.
IMPORTANT
FOR PROCESSING, PLEASE REMEMBER TO ENCLOSE:
- Photocopy of IC (both sides)
- Photocopy of passport and work permit - must be valid for at least a year (for foreigner / expatriate)
SOURCE OF INCOME |
MINIMUM SUPPORTING DOCUMENTS REQUIRED |
Salaried Employee |
- Latest month salary slip and / or
- Latest EA Statement and / or
- EPF Statement and / or
- Employment Letter / Letter of Confirmation
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Self-employed |
- Latest 1 year Tax Returns with Tax Receipts
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Variable Income |
- Latest 6 months of the following:
- Overtime as reflected on the salary slip
- Commission statements / vouchers
- Fee Statements / vouchers
- Latest 3 years of the following:
- Dividend statements / vouchers
- Interest (profit) statements / vouchers
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Other Income |
- Tenancy agreements and / or
- Pension Statements / vouchers and / or
- Annuities Statements
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Overseas Income |
- 3 months' salary slip
- Latest 2 years Notice of Assessment (for Singaporean only)
- Employment Letter
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Any additional income documents may be required at the absolute discretion of the Bank.
To proceed, select "Yes" below and click the "Submit" button.