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YES, I would like to apply for the American Express Gold Card.

Annual Fee:RM238

YES, I would like to apply for the American Express Card.

Annual Fee:RM140

APPLYTODAY

In order to apply you must:

Be over 21 years of age and have a minimum annual income of RM24,000 to qualifyfor the American Express Card or RM48,000 to qualify for the Gold Card.

Are you an American Express Cardmember?

CurrentIn the pastNever Current card no. (if applicable)Full name as in NRIC or Passport (underline surname)Name to appear on the CardOld NRICNo.New NRICNo.NationalityDate of BirthPassport No. (for non-Malaysians only)Present home address (please do not indicate P.O. Box address)Home phoneMobile phoneE-mailYears thereOwn propertyFamily/RelativeRentedPermanent home addressPlease send monthly statementTo homeTo office

ABOUT MYSELF

PostcodePostcode

Mr.Mrs.Ms.Others

MYRELATIONSHIPWITH AMERICAN EXPRESS

Company’s NameOffice AddressGeneral lineDirect lineDeptPositionType of businessLength of employmentGross annual salaryOther incomeSourcesName of previous employer (if less than 1 year in present employment)Years therePrevious position

You are

SalariedSelf employed - BRC No. if you are self-employedYES! Please enrol me in MembershipRewards and bill the amount to my Card AccountRM25 annual fees for Non-Frequent Traveler OptionRM50 annual fees for Frequent Traveler Option (inclusive of Non-Frequent Traveler Option) Are you a member of any frequent flyer program?YesNoIf yes, please indicate program/membership no.:Name and address of the nearest relative not living with you.Tel No.RelationshipIt is important to complete the following to ensure your application is processed as quickly as possible.Bank/Branch Account No.Account type

ABOUT MYJOB

PostcodeMMYY

MYFINANCIALDETAILS

Card IssuerAccount No.

REFERENCE

MEMBERSHIPREWARDS/MILES

PostcodeMember SinceCredit Limit(Please tick one)

Full name as in NRIC or Passport (underline surname)Name to appear on the CardOld NRICNo.New NRICNo.NationalityDate of BirthPassport No. (for non-Malaysians only)Home address (even if same as Principal Cardmember)Home phoneMobile phoneE-mail

Relationship to Principal Cardmember

•Photocopy of the Supplementary Card applicant’s identity card (both sides)•Applicant must be 18 years old &above•Gold Supplementary Card (annual fee RM125)•American Express Supplementary Card (annual fee RM95)

Specimen Signature of Supplementary Applicant

SignatureDateFor office use only

Specimen Signature of Principal Applicant

SignatureDateFor office use only

PLEASE SIGN

SUPPLEMENTARYCARD

Postcode

EXPRESS AUTOPAY

Would you be interested to pay your bills using Express AutoPay?

Yes

, tell me more

, prefer other modes of payments (i.e. cash, cheque)

, already enrolled with other cards

TERMS &CONDITIONS

I/We declare that the above information given by me/us is true and complete. I/We hereby authorize you to verify information on me/us and any supplementaryapplicant(s) from whatever source you consider appropriate from any financial institution and the Director General of Inland Revenue Department on anyinformation which Malayan Banking Berhad may require.

I/We also confirm that none of my/our spouse(s), parents and/or children are employees of Malayan Banking Berhad or Malayan Banking Group.

I/We confirm that I/we shall read the Terms and Conditions of the Maybankard American Express ChargeCard Agreement and agree to be bound by them and all future amendments thereto before accepting and receiving the card(s). I/We further agree that the PrincipalCardmember shall be responsible for all liabilities and obligations of the Principal Cardmember as well as those of the Supplementary Cardmember(s). TheSupplementary 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 understand the card(s) remain the property of Malayan Banking Berhad andshall be subject to cancellation without notice and would be returned upon request. I/We hereby agree to you disclosing information to Bank Negara Malaysiaregarding my/our credit facilities and my/our account with you, as may be required, whether pursuant to law or otherwise. Malayan Banking Berhad shall not beliable whether directly or indirectly to me/us or any other persons for such disclosure.(For External Account Holders Only)I/We confirm that my /our borrowings from all sources within Malaysia do not exceed in aggregate of RM200,000.

MMDDYY

Mr.Mrs.Ms.Others