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~Maybank PERMOHONAN UNTUK KIRIMAN WANG/APPLICATION FOR REMITTANCE

D Pindahan Telegraf
Telegraphic Transfer (TT)
D ~e\Ju~bank/ ~ / "
an er s Chequ..2'
_,I, ,-
Giro Antarabank
1n t er b an k Giro
D Rentas □ Maybank Money Express
Tarikh/Date:

Membership No: ...............

------------
D
Lain-Lain/
Other:
KAEOAH PEMBAYARAN/ MODE OF PAYMENT
,
O Tunai/Cash Debit Akaun/Debit Account No : D /
BUTIR-BUTIR PEMOHON / APPLICANT Dl;TAIL5
D Cek Maybank/ Maybank Cheque No :
AMAUN KIRIMAN & IMTAWANG /AMOUNT & REMITTING CURRENCY.
Nama / N~me:
Jumlah RM / RM Amount: 1?"5,000
Jumlah Matawang Asing / Foreign Currency Amount: /
No ID /ID No:
1 □ Resident D Non-Resident Caj/Charge:
Alamat / Address:
Jumlah /Total : l?-5,COQ
KADAR TUKARAN / EXCHANGE RATE
Negara/Country : Contract No /Dealing Chit No (If Applicable) : ,
No. Tel /Tel. No: Kadar /Rate : /
Pekerjaan /Occupation : BUTI~-BUTIR BAN\( PENERIIM / BENEFICIARY BANK DETAILS .
•.

k✓o"'"'t Vl:?~Y\L
BUTIR-BUTIR PENERIMA / BENEFICIARY DETAILS Nama / Na",'e: ~-V\. {) /
/
Na1 t~ ~,Yv s;Yt ~~) No Akaun / Account No/lBAN: CD - l OQ - --i ·5 / - C/\ u I
No ID /ID No: ~....:L) I l-1 ? IV\
! ~ r I
Res~~nt ✓---1D~oi Re~ident
Alamat / Address:

Alamat / Address: \'-.l O . \ O , ~ ""- Y\ ~IA/ J L-- '.7 1 '-He, IV V -\",C)Vv--- ~ Negara/Country:
¾"7 C:,~~V\'2117 V Q:;., ✓ l{,A f\.uv,', /~ t?\ National Clearing Code(FW/SC)/Swift Code: Intermediary Bank:
Ne11ara/Countrv :
No. Tel /Tel. No:
Sumber Dana Dan Mi!jikal)'Bagi Transaksi Tunai RMS0,0!)0.00 dan ke/atas / For Cash Transaction Amount RMS0,000.00 and above please specify source of fund & employer
Sumber Dana/
Source Of Funds:
'>-'~V\.C., r .,,._
·/\('\
Ay--\1> ~ 1r> IMajikan/
Employer :
TUJUAN BAYARAN/ PURPOSE OF PAYMENT
Pindahan ke akaun sendiri/ I
□
Lai n· lain Pindahan/ Urus Niaga Modal /
Barangan/
Goods
Perkhidmatan/
Services D Own Fund Transfer D Other Transfer Capital Transaction □ □
Urus Niaga Wang Asing/ No Rujukan Kebenaran BNM(Jika Berkaitan) /
Derivatif /
Denvatives Forex Tradin~ D D
BNM Approval Reference No (If Applicable)
'Bank akan mengeluarkan Borang Al<Uan Pernbayaran (Form P) bagi amaun RMZ00,001 .00 dan ke alas/ Bank will issue Payment Declaration Form (form P) for amount RMZ00,001 .00 and above
PERAKUAN UNTUK TUJUAN PELABURAN DAI.AM DAN LUAR NEGARA DAI.AM IMTAWANG ASING / DECLARATION FOR INVESTMENT IN FOREIGN CURRENCY ASSET ONSHORE AND OFFSHORE
D I/We (within its group of entities with parent-subsidiary relationship) do not have any "Domestic Credit Facilities" (as defined herein) from any source.
I/We do have Domestic Credit Facilities obtained from. (resident, including individuals, corporation & financial institutions) and confirm that my/our total
D investments (Foreign Currency Asset Onshore and Offshore) including this application do not exceed RM1 million (for resident individuals) or RMSO Million equivalent in
aggregate for a resident company (within its group of entities with parent-subsidiary relationship) imposed by BNM Malaysia for this calendar year.

D I/We have not utilized any foreign currency credit facilities for any investment (Foreign Currency Asset Onshore and Offshore) .
I/We have utilized any foreign currency credit facilities for any investment (Foreign Currency Asset Onshore and Offshore) but such utilisation does not exceed the
D equivalent of RM10 Million (for a resident individual) or RM100 Million (for a resident company within its group of entities with parent - subsidiary relationship)
I/We have obtained Bank Negara Malaysia (BNM) approval for investment (Foreign Currency Asset Onshore and Offshore) and/or utilisation of foreign currency credit
D facilities exceeding permitted limit CAJ PINDAHAN DANA/ FUND TRANSFER CHARGES
Saya /Kami mengesahkan bahawa keterangan yang diberikan dalam borang tnt adalah benar dan mematuhl Akta Perkhldmatan Kewangan 2013
Caj dalam negara dibayar oleh pemohon dan caj di luar
dan Akta Bank Negara Malaysia 2009. Saya/Kaml bertanggungjawab sepenuhnya bagt sebarang maklumat yang tidak tepat, palsu atau tldak
5ernpurna didalam borang ini. Saya/Kami juga mernberi kuasa kepada Bank untuk membenkan maklumat Im kepada Bank Negara MalaySla D SHA negara dibayar oleh penerima / Local charges to be paid
by applicant and oversea chaf'!!es to be paid by
nieriurut Akta Perkhidmatan Kewangan 2013 dan Akta Bank Negara Malaysia 2009. beneficiary
>aya/Ka rni telah membaca dan memahami tentang syarat dan peraturan Y.ang tertulls di sebelah . Dengan ha! yg demtkian segala risiko dan
Lartziune jawab terhadap permohonan ini adalah tanggungan saya/kami. Sedari itu, sila keluarkan draf /klnmkan sepert, tersebul. D OUR Pemohon/ All local and overseas ~
applicant
o be paid by
1

TANDATANGAN PEMOHON /APPLICAN1,S[GNATJJR!;

Irv,,. t1CrE:by declare that the information given in this form is true and correct in full compliance w_ith Fina n_cial Ser~ices ~~t ~0 13 and Central

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/
r:;;. CJ f /,\;,la ..We shall be fully responsible for any inaccurate, untrue or inco':'1plete 1_ntor~at10~ prov1~ed m this form . I/ We /
I~ ~
:,
•I•11 y,,a Act 2009· 11
f ti n available to Bank Negara Malaysia in compliance with Fmanc1al Services Act 2013 and
11 auLliori:µ,: u,e Bank to make this in orma 0
.J

C..:ritrol ~ank uf Malaysia Act 2009 ,

✓/
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11·,i,-1,.
~ ,e read and understood the e
T rms & Conditions set forth herein and thus, I/We hereby instruct you to issue your draft/effect the
k
1

d respansibility or liability in connection with my/our application for the transfer herein. 1
/
/
lr.,i,•,Je, •< <1>tc1f1ed and !/We shall bear all rts s an .
\
f ifil d by -,[ I/ I

Menara Maybank, 100 Jalan Tun Perak, 50050 Kuala Lumpur~ Cu 5lomer Careline : 1300 88 6688
IAa l . rh d I Maybank Islamic Berhad, .. ..... ,,- .. ;~
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