DECLARATION AND CONSENT FOR EMPLOYEE SCREENING

I, _______________________________ (NRIC No: ______________________________ hereby

agree, consent and authorize Bank Simpanan Nasional (where applicable):

1. To make an inquiry into my previous employment records which covers all current and former
employers and referees where relevant to disclose my employment history including (date of
employment, position(s) held, details of salary upon departure and appraisals of my performance,
capabilities and character), facts and details of any internal disciplinary / criminal proceedings
which I have been subject to irrespective whether such proceedings have been concluded or/were
initiated after my employment in accordance with Bank Negara Malaysia’s policy document on
Employee Screening.

2. The details of my current and former employers in the period of seven (7) years prior to the date
of the application for employment with BSN are as follows:

No Current & Previous Employer Duration HR Email Address

3. Where relevant, authorize Financial Markets Association of Malaysia (FMAM) to disclose facts and
details of any case of financial market misconduct I have been subjected to, including disciplinary
proceedings under the Asian Institute of Chartered Bankers (AICB)-FMAM Joint Disciplinary
Scheme.

4. To conduct relevant credit references with external parties including but not limited to
CTOS/CCRIS, other credit reference agencies and any other Financial Institutions and the
information above shall be for the sole use of BSN.

5. To conduct the employee screening with my current employer* (Please tick √ ) :

Yes
No

*If the answer to item 5 is NO, the employee screening with current employer will only be done once the offer
is finalized and the offer shall be conditional subjected to record clearance before joining.

As disclosed above, I have made full and true disclosure of all material facts or information and
have not concealed or omitted any material fact or information and I fully understand that if any of
the declarations, materials facts or information given above are found to be incorrect, incomplete
or untrue, BSN reserves the right to terminate my employment without notice or compensation.

I irrevocably release any contractual binding that limit my current/ former employers and where
relevant, the AICB, and /or FMAM from disclosing any information about me to the Bank and
irrevocably authorize them to disclose any information but not limited to the information stated as
above.

Signature : __________________________________

Name : __________________________________

Date : __________________________________