an GIRO FUND TRANSFER / RENTAS

Insura nce
lmponant : WRITE tN BLegK / pRtNT CLEARLY
Beneficiary Nanre

Business Reg. No (Non-lndividuat)

Resrdenl Stalus
Inesioent' !Non-Rosi6snr.,
NRIC No (lndividunl)
Nal.oralil/:--
Address

Bank6. Bank Codo

o Attin Bank Be.had ABB
o AmBank (M) Berhad AMBANK
o Alliance Bank Malaysia Berhad ASBHO
o Bank lslam Malaysia Berhad BIM
o Bank Kerjasama Rakyat Malaysia Berhad BKRM
o Bank lruamalat [4ataysia Berhad BM
o Bank of Af,erica MalaysiaBerhad BOA
o Bank Simpanan Nasional BSN
o CIMB Bank Berhad ctMB
o Citibank Berhad CBB ( 10)
o Deutsche Bank (Mataysia) Berhad DBA
o Hong Leong Bank Behad I.iLB
o HSBC Bank Malaysja Berhad HBMB
2)
o Ma,ayan Banklng Berhad MBB
o OCBC Eank (Malaysia) Berhad ocBc
o Public Bank Sehad PUB
o RHB Eank Berhad RHB
O Slandard Cha(ered Bank Malaysia Berhad sc8
O Uniied overseas Bank (Malaysia) Bhd UOBM
) Other (Please spec'fy) .... ............. . ......
Please selecl onlv one (lJ oreferred bank accounl
Please atlach a photocopy of lhe lop podan of you bank slatement ot relevanl pages ol yaor
savngs account bgok lo prcve the owhe9hjl) ol the account number provided

Payrenl advi@ can be emailed to :

EreilAddress :

Conlact Person Ofiice Telephone Handphone

l/We hereby request that payment(s) due lo me/us by Anceneral tnsurance gerhad (hereinafter called "Amceneral') be paid lo mylour bank accounl stated
above by way
of Giro Fund Transler/Rertas and conflrm that :
1. IfWe giYe consent tg AmGenetal lnsuraoce Berhad to release the above data to the selected Bank in order to faciliia(e payment(s) to me/us by way ot c(ro Fund Transfer/Renlas
2. All informations provided by m€/us herein are codect and accurate.
3. My/Our request shall be revocable only with the consenl o( Amceneral and Amceneral may al 6ny lme rn [s absolure drscretion etfect payrent(s) to me/us by other mode(s).
resulting hom any matters arising in relation to this GIRO Fund Transfer/Rentas requested by me/us including but not limiled to any e.rorlmisdgsqriplion of any information
furnrshed and/o. any other such cifcumstences beyond Amcenerel.the selecled Eank Bnd ils otficer(s)'s control.

lmoor(ant Claus.
1. ' Oelinltion ol Re.ldent
(i) A citizon of Malaysia (this excludes a citizen who has obtanled any per6anent R€sid€nt sta(us rn aily other country or teritory oulsde lvlalaysia and E a Rosid€nt
oulsrde Malaysia);
(ii) A non-citizen of Malaysia who has oblained a psrmenent Resideht 3tatus ih Malays;a and is ordinarily residing in Malaysiai
(iii) A body corpo€te IncoDorated or established, or registered with/or,approv.d by any authority, in Malaysia,
(iv) An unincorporated body registered with/or approved by any authorily h Malavsia; or
(v) The Government or any State Government.

2 .. Oefiniti'n of Non-Resident
(i) Any gorson other than a Resident;
(ii) An oveGeas branch, a subsidiary, reglohal office, sales office or represeniative office ol a Resident comPany;
(iii) Erbassies, Consulates, High Comfiissions, sup€national or intemational organisationsi or
(iv) A citiEn ot Malaysia who has obtained pcrmaneht Rcsid€hl stalus in a counlry or a lerrilory outside Malaysia and is r.siding outside Malaysia'

3. Applicablo only to Joint Accounts Hold€rs

1976)1, where on€ of the iolnt account holdor i6 a
For Joint accouni between husband and wife lpursuant to the Law Retorfi {Ma.riage ard Drvorce Act
Resident while the other is € Non.Resident, the iornt account will be a Resident account. olheeise,
in other circumstances. the account will be trealed as a
Non-Resident Account where one of the ioint accounl holder is a Non'Resident

Authorised Signatory (ies) Company StamP

AfrGenercl lnsuftnce Beffiad ' Oflice Use

Processed By
verifgd By

Amceneral lhsurance Berhad 14191'P)

A Nhbt ol the Angahk eNP w P Rvda Lum@'
I 1228 GPO Xuela LumPUr 507a0
knara Shdl, No, 21 1. Jalan Tun $db3ina. 5o47o Kuela Lumpr P o Bor
T;.6032268 1333 fi+603 2268 2222 Wr amganehlnsurance
cm
( G Sf R. gbtalb No. :0007 A87' *8)
1