Want to Apply Affin Bank Credit Card? How?

MBF Credit Card Application(Please complete this form below)
Preliminary Data Entry Form
All information provided through this form is strictly Private & Confidential


Please correctly enter your email address in order for us to contact you.
Your e-mail address: 
* SILA PENUHKAN RUANGAN BERTANDA MERAH / PLEASE / MUST FILL SPACE IN RED TAG

Preferred Card / Kad Pilihan /Please Select

MasterCard Gold VISA Gold MasterCard Classic VISA Classic  Red Hot MBF MasterCard Gold
MasterCard Gold / Visa Gold: Minimum annual income : RM40,000/- / MasterCard Gold / Visa Gold: Pendapatan tahunan minimum : RM40,000/- MasterCard Classic / Visa Classic: Minimum annual income : RM18,000/- / MasterCard Classic / Visa Classic: Pendapatan tahunan minimum : RM18,000/- Red Hot MBF MasterCard Gold: Minimum annual income : Only RM18,000/- / Red Hot MBF MasterCard Gold: Pendapatan tahunan minimum : Cuma RM18,000/-


Personal Details / Data Peribadi

Full name as in I/C / Nama Penuh Anda: 
Mr/EncikMrs/PuanMiss/Cik.

Name to appear on card (maximum 19 characters)/Nama yang akan dicetak di kad (maksimum 19 huruf)

Gender/Jantina: Male/LelakiFemale/Perempuan

Nationality/Kewarganegaraan

Marital Status/Status perkahwinan: Single/BujangMarried/BerkahwinDivorced/BerceraiWidow/Balu

New IC No./No. KP Baru

Old IC Number/No. KP Lama:

No. of dependents / Bilangan tanggungan(Anak + Isteri/Suami) *if single,tak perlu isi

Date of Birth (DD/MM/YY) / Tarikh Lahir (HH/BB/TT)

Mother's Name/ Nama Ibu:(ciri keselamatan ini adalah untuk tujuan pengesahan & keselamatan) 

Your Residental Address (please do not provide PO Box address) / Alamat kediaman Anda(Sila jangan berikan alamat Peti Surat)

Post Code/Poskod:

House Telephone/No.Telefon Rumah(kalau tak ada,boleh tulis no.tel saudara terdekat yg kenal anda)Mesti Tulis: 

Hand phone No. :

Residence is / Kediaman adalah
Own Property/Milik Sendiri Mortgaged/Gadai janji Parents/Relatives/Ibu Bapa/Saudara Rented/Menyewa
or/atau Other/lain -lain

Years there(house) / Bilangan tahun menetap di sini(rumah)

Higher Education Level / Tahap Pendidikan Tertinggi Anda
Primary/Rendah Secondary/Menengah College/Kolej University/Universiti  atau Others/Lain-lain 

Your Permanent Residental Address / Alamat kediaman tetap
*tak perlu isi jika sama dengan alamat kediaman diatas.

Post Code/Poskod:  No. Tel Rumah Tetap/Permanent House Phone No:

Full name of spouse as in I/C/Nama penuh suami/isteri (seperti dalam                                                          KP/Pasport): 

Name of spouse's employer/ Nama majikan suami/isteri

Spouse's Office Tel. No./No. Tel. pejabat suami/isteri :

Handphone No./No. Tel Bimbit(jika ada) : 


Employment Details/Maklumat Pekerjaan

Name of Company/Nama Syarikat:

Nature of Business / Jenis Perniagaan:

Check if self employed / Sila tandakan jika berkerja sendiri

years in service/Bilangan tahun berkhidmat :

Office Address (please do not provide PO Box address) / Alamat pejabat (Sila jangan berikan alamat Peti Surat)

Post Code/Poskod: 

Office Tel. No./Ext./No. Tel./Sumbangan    Office No. Fax :

Position held/Jawatan Dipegang:

Name of previous employer (if less than 2 years in present employment). Nama majikan sebelumnya (jika kurang daripada 2 tahun memegang jawatan sekarang)

Position held/Jawatan Dipegang Years in Service/Bilangan tahun berkhidmat 


Annual Income / Pendapatan Tahunan

Annual Gross Income (RM)/Pendapatan Kasar Tahunan (RM)

Sources of income and amount (RM)(if any)/Sumber pendapatan lain dan amaun (RM)(jika ada)

perlu ada supporting document.


Financial Details / Butir-Butir Kewangan
Current/Savings/Fixed DepositAccount/Akaun Semasa/Simpanan/Deposit Tetap
item Bank/Bank A/C No./No. Akaun Type of A/C/Jenis Akaun
1.
2.
Credit/charge cards held/Kad kredit/caj yang dimiliki
item Card No./No. Kad(NAMA BANK SHJ) Member since/Ahli sejak 
1.
2.

Personal Reference / Rujukan Peribadi

NAME OF NEAREST RELATIVE / FRIEND NOT LIVING WITH ME / Nama saudara/rakan/ahli keluarga  yang tidak tinggal bersama anda

Relationship / Hubungan / 

Residental Address OF NEAREST RELATIVE / FRIEND NOT LIVING WITH ME(please do not provide PO Box address) / Alamat kediaman saudara/rakan/ahli keluarga yg tidak tinggal dgn anda(jangan tulis P.O Box)

Post Code/Poskod:

House Telephone :

Hand phone : 

Office Telephone:

Email address :


Prefered Correspondence Address/ Alamat Surat Menyurat

To residence / Di kediamanTo office /Di pejabat


Term and condition apply. MBF Card Credit Centre.
 

 

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