DATA CORRECTION REQUEST FORM

Section 1 : INDIVIDUAL CLIENT (Please complete the relevant fields in BLOCK letters)

NAME

NIRC/PASSPORT NO CLIENT CODE :

CDS ACCOUNT NO. : 0 6 6 - 0 0 -

Please update/correct my personal data below (Note: please tick at the relevant box where the data need to be corrected):

□ NAME ::

□ CORRESPONDENCE
NRIC / PASSPORT NO :

□ MAILING ADDRESS :
ADDRESS

POST CODE : TOWN / STATE / COUNTRY :

□ TELEPHONE NO. : - MOBILE NO : -

□ E-MAIL ADDRESS
:

□ NATIONALITY :
PERMENANT
RESIDENCY (PR)
:

□ POLITICALLY EXPOSED PERSON (PEP) : □ YES □ NO

□ OCCUPATION & FINANCIAL DETAILS (MANDATORY UPDATE FOR MARGIN CLIENT-CCRIS REPORTING)
EMPLOYMENT STATUS :
EMPLOYEE □ SELF-EMPLOYED □ □ OTHERS (specify: _______________________)
NAME OF COMPANY /
_______________________________________________
EMPLOYER :
ADDRESS OF COMPANY/
EMPLOYER :

DURATION OF EMPLOYMENT
/ BUSINESS : POSITION :

NATURE OF BUSINESS
:

ANNUAL PERSONAL INCOME : □ BELOW RM25,000 □ RM25,001 - RM50,000 □ RM50,001 - RM100,000

□ RM100,001 - RM200,000 □ RM200,001 -RM300,000 □ RM300,001 – RM500,000

□ RM500,001 – RM1 million □ ABOVE RM1 million (specify:RM_________________________)

ESTIMATED NET WORTH : □ BELOW RM100,000 □ RM100,001 - RM250,000 □ RM250,001 - RM500,000

□ RM500,001 - RM1,000,000 □ RM1,000,001 to RM 3million □ ABOVE RM3 million

(specify: RM_______________)

SOURCE OF WEALTH/ FUNDS : □ SALARY / BUSINESS INCOME □ INVESTMENT INCOME □ INHERITED WEALTH

□ DIRECTORSHIP □ SAVINGS □ OTHERS (specify:______________________)

 □ RESIDENT STATUS
Permanent Resident Status
Length of time residing
Citizenship of a country Residency Status
outside Malaysia
Outside Malaysia
Malaysian Citizen No N/A Resident
> 182 days* Non-Resident
Yes
< 182 days* Resident

Permanent Resident Status Length of time Residing in

Citizenship Residency Status
in Malaysia Malaysia
Non-Malaysian Citizen No N/A Non-Resident
> 182 days* Resident
Yes
(Please state country of < 182 days* Non-Resident
Origin/birth)
 Computation of 182 days is based on per calendar years and need not be on a continuous basis.
st st
Per calendar year means from 1 January 20X1 to 31 December 20X1.

□ FAMILY MEMBER / NEXT OF KIN DETAILS

CLIENT CODE : RELATIONSHIP :

NAME :

NRIC NO. : CONTACT NO :

EMPLOYMENT STATUS : □ EMPLOYEE □ SELF-EMPLOYED □ OTHERS (specify: ___________________________)

NAME & ADDRESS OF

COMPANY :

POST CODE : TOWN / STATE / COUNTRY :

POSITION : POLITICALLY EXPOSED PERSON (PEP) : □ YES □ NO

□ ADDITION OF PERSONAL DATA (* Please indicate the personal data to be added and attach additional sheets where necessary)
Personal Data Item Personal Data to be added

□ DELETION OF PERSONAL DATA (Please indicate the personal data to be deleted and attach additional sheets where necessary)
Personal Data Item Reason(s) for Deletion

SECTION 2 : DECLARATION

I, ______________________________________________________ hereby certify that the information given in this form and any documents
submitted enclosed are true and accurate. I understand that (i) it will be necessary for Hong Leong Investment Bank Berhad (“HLIB”) to verify
my / the Third Party Requestor’s identity, and (ii) that HLIB may contact me in order to verify the personal data to be corrected.
I also understand that any and/or all personal data provided by me in this Personal Data Correction Request Form will be collected and
processed by HLIB as personal data in accordance with the Personal Data Protection Act 2010 and HLIB’s Privacy Policy as may be
amended from time to time. Copies of the current and prevailing privacy policy may be obtained from the HLIB website (www.hlebroking.com).
Further, I hereby warrant and represent to HLIB that prior to submission of this form the consent of all persons named under the family
member/next of kin details section (“ Relevant Data Subjects”) have been obtained, for HLIB’s collection, processing, holding and use of the
personal information of the Relevant Data Subjects in accordance with the Personal Data Protection Act 2010 and HLIB’s Privacy Policy as
may be amended from time to time.

Signed: _____________________________

Date: _______________________________

Ver 062018

Hong Leong Investment Bank Berhad (10209-W)

 GUIDE FOR MAKING A PERSONAL DATA CORRECTION REQUEST (“DCR”)
FOR THE PURPOSE OF THIS FORM:
 a Data Subject is an individual who is requesting to correct his/her personal data and/or his/her family member/next of kin’s personal
data.
SUPPORTING DOCUMENTS REQUIRED:
 Please contact our Settlement department for the required supporting document(s).
COMPLIANCE WITH REQUESTS:
Please note that Hong Leong Investment Bank Berhad (“HLIB”) may not be able to comply with your request in certain circumstances, e.g.
where HLIB is not satisfied that the personal data to which your request relates is inaccurate, incomplete, misleading, not duly authorised or
not up-to-date in the first place; or where HLIB is of the view that the update requested is inaccurate, incomplete or misleading. However,
we will notify you of any such decision.
COMPLETED FORM:
Please return the duly completed forms and documents to our Settlement department at the office address as follows:-

Location Address

Principal Office Level 27 & 28 Menara Hong Leong

No 6, Jalan Damansara,
Bukit Damanasara,
50490 Kuala Lumpur

Branch Offices

Kia Peng Level 7, Menara HLA, Bukit Level 3A, Block B, HP Towers
No.3 Jalan Kia Peng, Damansara No.12, Jalan Gelenggang
50450 Kuala Lumpur Bukit Damansara
50490 Kuala Lumpur

Ipoh 51-53, Persiaran Greenhill

30450 Ipoh
Perak Darul Ridzuan

CONTACT US:
Should any advice or guidance be required in completing this form, please contact our Helpdesk at tel no. +603 – 2080 8777

PERSONAL DATA CORRECTION REQUEST

Please tick [√] one of the following:
[ ] I am / was a customer of HLIB and I would like to correct my personal data
(Please proceed to Section 1 of this form)

[ ] For all other requestors, please contact us directly or please specify : _______________________________________________

FOR OFFICE USE ONLY

Part I – Margin Account Updating Checklist

a. Any Margin account update ( Yes / No) – if yes, please check item b
b. Any error updated in the a margin account (Yes/ No) – if yes, please check item c
c. Please update changes in “CCRIS – SDIS 1 / SDIS 1A (Individual) Update” screen as follows:-

Data Amended Status Reason Code File Status File Submit

Error Record has No action required. Change the error record

No action required. Leave it
NOT been submitted Leave it as “Genuine from “Ready to Submit” to
as “SDIS1”.
Address, Occupation & to BNM Data Update” “Exclude from Submission”
Telephone
Select the amended
Error Record No action required. Leave it Select the amended record
record & update to
submitted to BNM as “Ready to Submit” & update to “SDIS1A”.
“Error Data Update”

Error Record has No action required. Change the error record

No action required. Leave it
NOT been submitted Leave it as “Genuine from “Ready to Submit” to
as “SDIS1A”.
to BNM Data Update” “Exclude from Submission”
Other data items
Select the amended
Error Record No action required. Leave it No action required. Leave it
record & update to
submitted to BNM as “Ready to Submit” as “SDIS1A”.
“Error Data Update”

Hong Leong Investment Bank Berhad (10209-W)

FOR OFFICE USE ONLY – cont.

Part II – FATCA Updating Checklist

Questions below to be considered in conjunction with all documents & forms collected from clients.

FATCA checklist Yes / No Instruction

U.S. Passport

☐ Yes
Sight if the passport provided is a U.S. passport.
☐ No If any of the questions
on the left have “Yes”
☐ Not applicable
answers, to request
Nationality client to complete W-9.

☐ Yes
Check if the citizenship is U.S.
☐ No

Address

(i) Check if the permanent address or mailing address provided is a U.S. address ☐ Yes
(including P.O. Box). ☐ No

(ii) Check if only a “hold mail” or “in care of” U.S. address that is the sole address for this
☐ Yes
account.
☐ No If any of the questions
on the left have “Yes”
Telephone number answers, to request
client to complete W-
Check if the only telephone number provided is a U.S. telephone number (country code ☐ Yes 8BEN.
+1) ☐ No

Others

Has the account holder(s) provided any other indication of being U.S. citizen or resident?
☐ Yes
If yes, please list the identified indication: __________________________________
☐ No
____________________________________________________________________

Conclusion
Bank’s assessment of client(s)’ FATCA classification: Client is:

☐ U.S. Person ☐ Non U.S. Person ☐ Recalcitrant (Clients who do not provide Form W9 / Form W-8BEN)

Part III – CRS Updating Checklist

Common Reporting Standard (“CRS”) checklist Yes / No Instruction

Correspondence Address

☐ Yes
Any changes of Correspondence address from Malaysia to address in overseas?
☐ No

Telephone Number

☐ Yes If any of the questions

Check if the only telephone / mobile number updated is an overseas contact? on the left have “Yes”
☐ No answers, to request
client to complete
“Standalone CRS –
Permanent Residency
Individual” form
☐ Yes
Any changes from Malaysia to overseas country?
☐ No

Employer / Business Address

☐ Yes
Any changes from Malaysia to overseas country?
☐ No

Verified by : Date :

Updated by : Date :

Checked By : Date :