PB/PIBB Card Online Application Form

PERSONAL DATA OF PRINCIPAL CARDMEMBER

RESIDENCE

PROFESSION

CREDIT DATA

EMERGENCY CONTACT

INTERACTIVE VOICE RESPONSE (IVR) TPIN NUMBER

SMS TRANSACTION ALERT FOR SIGNATURE BASED TRANSACTION

OVER LIMIT FEE (PUBLIC ISLAMIC BANK CARDS ONLY)

MY CARDS DELIVERY INSTRUCTION

DECLARATION

DECLARATION BY NON-MALAYSIAN APPLICANT (TICK WHERE APPROPRIATE)

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)

• 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.
• 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).
• FATCA have come into force in Malaysia effective 1 July 2014.

COMMON REPORTING STANDARD (“THE CRS”)

• 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.
• 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.
• CRS is effective in Malaysia starting 1 July 2017.

Participating Countries under CRS : List of Participating Countries Under CRS

CUSTOMER CONSENT

• 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.
• 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.
• I have read and understood on the provisions of FATCA and CRS as contained herein and agree to be bound by such provisions.
• I declare that the information provided in this form is, to the best of my knowledge and belief, accurate and complete.
• 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
Self-employed	Latest 1 year Tax Returns with Tax Receipts
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
Other Income	Tenancy agreements and / or Pension Statements / vouchers and / or Annuities Statements
Overseas Income	3 months' salary slip Latest 2 years Notice of Assessment (for Singaporean only) Employment Letter

Any additional income documents may be required at the absolute discretion of the Bank.

To proceed, select "Yes" below and click the "Submit" button.