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 Debit Card
PERSONAL DATA OF PRINCIPAL CARDMEMBER
(Old)
- - (New)
/ /
- (House)
- (Office)
RESIDENCE


- (House)
PROFESSION


- (Office)
- (Mobile)
ACCOUNT DATA

Please indicate existing Public Bank Account Nos. (if any)

1) 2)

SMS TRANSACTION ALERT

Please select your preferred threshold amount:


MY CARD DELIVERY AND BILLING OPTIONS INSTRUCTIONS (Fields marked with an * are mandatory)

Please send my card to

(Delivery cannot be made to P.O. Box address / oversea address)

Please send my statement to

FATCA SELF-CERTIFICATION




IMPORTANT INFORMATION

Please take a moment to read the following:

Declaration

DECLARATION BY NON-MALAYSIAN APPLICANT (TICK WHERE APPROPRIATE)

Position held
Date From to

The following transactions are enabled by default for your PBB Debit Card:

(a) Card-Not-Present*
(b) Overseas Transaction*
*Applicable to transaction that does not require One-Time Password (OTP) authentication.


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 liabilities 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.


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:

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 purpose 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.


CREDIT SURE

I declare that I am under 60 years of age and in good health and have not been suffering from any illness, bodily injury, and / or physical impairments / defects, and have not received or expect to receive treatment or advice with regards to any illness, bodily injury, accident, AIDS or HIV related conditions.

I hereby acknowledge and confirm that I have fully understood the essential information on the major benefits and exclusions of the product described in leaflet and Product Disclosure Sheet of PB Credit Sure, which have been summarily disclosed to me but not exhaustive. I understand that I shall receive a Certificate of Insurance which details the benefits, exclusions, terms and conditions of the insurance Policy.

I authorise Public Bank to provide my relevant personal and credit card information to AIA or any AIA selected third party (reinsurance and claims investigation companies and insurance industry associations) in or outside Malaysia to process this application, communicate with me for such purpose and payment instructions for this product. I understand that I am entitled to obtain access to and to request correction of any personal information held by AIA and such request can be made to AIA Care Line: 1800 181 464.

Important Notice

  1. Pursuant to Section 149(4) of the Insurance Act 1996, you are to disclose in this application form fully and faithfully all facts which you know or ought to know. Otherwise the Certificate of Insurance issued under the Policy may be null and void.
  2. This application form of PB Credit Sure should be read / used in conjunction with PB Credit Sure leaflet and Product Disclosure Sheet. PB Credit Sure is underwritten by AIA Bhd. You are advised to follow up with Public Bank Berhad or AIA Bhd. if you do not receive the Certificate of Insurance within 1 month from the day you sign up.

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)

Public Bank Berhad and its subsidiaries in Malaysia, including Public Islamic Bank Berhad, and their respective branches (“PBB Group”) are compliant foreign financial institutions under FATCA of the United States of America (“U.S.”). FATCA requires enhanced due diligence procedures on customers/account holders within the PBB Group to enable identification and reporting of U.S. Persons and substantial U.S. Shareholders of foreign entities to the Malaysian Competent Authority** and ultimately, to the U.S. Internal Revenue Service (IRS). Pursuant to an Intergovernmental Agreement (”IGA”) between Malaysia and the U.S., the Malaysian Competent Authority has issued guidance in order for foreign financial institutions in Malaysia to comply with FATCA.

**The Malaysian Competent Authority appointed by the Malaysian Government is the oversight body for the enforcement of FATCA provisions of the U.S. tax law governing the domestic financial institutions.

In some instances, PBB Group will request certain information to be submitted by its customers / account holders to meet its FATCA obligations. Failure by customers/account holders to provide this information will result in reporting of customer / account holder information to the Malaysian Competent Authority and may result in a 30% withholding tax on certain payments of U.S. source income, where applicable. Payments to the PBB Group’s customers/account holders will generally not be subject to withholding, provided that appropriate certification or other documentation concerning their status is provided to the PBB Group as instructed. To ensure that customer’s / account holder’s information is accurate, PBB Group requires that customers/account holders provide notification in the event of changes in customers information, including change of mailing address, phone number and nationality within 30 days of a change in circumstances that causes the account opening form to become incorrect.

I / We / The Individual(s) / Representative of the organisation hereby confirm and declare that all information provided by me / us / U.S. shareholder(s) in this Form to the best of my / our knowledge is true and correct.

I consent to allow the Bank the following uses of the information contained in this form as required under FATCA:

  • Disclosure of information to the Malaysian Competent Authority and the U.S. Internal Revenue Service
  • Authorisation to effect withholding requirements

Note: The Malaysian Competent Authority appointed by the Malaysian Government is the oversight body for the enforcement of FATCA provisions of the U.S. tax law governing the domestic financial institutions.

IMPORTANT

DOCUMENTS TO BE SUBMITTED

  • Photostat copy of your NRIC (both sides) or Passport and Work Permit for Non-Malaysians;
  • Photostat copy of your Work Permit/Student Pass (for Non-Malaysian only).
  • Photostat copy of your Parent's/Guardian's NRIC (both sides) or Passport and Work Permit for Non-Malaysian Parent/Guardian (Applicable for applicant between 12 and 18 years old).

NOTE

  1. Documents submitted are non-returnable.
  2. If the above required documents do not reach PB Card Services within 30 days from the date the PB Card Online Application Form is submitted, your application will be cancelled automatically.

    Address
    PB Card Services
    10th Floor, Menara Public Bank,
    146 Jalan Ampang,
    P.O. Box 11722,
    50754 Kuala Lumpur
    Tel. No. : 03-2176 8000

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 Debit 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 Debit 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.



To proceed, select "Yes" below and click the "Submit" button. If you do not wish to proceed any further, select "No" below and click the "Cancel" button. Your application will not be processed.



ENTER SECURITY CODE