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

Basic Card Applicants must be at least 21 years of age.
For Malaysian basic credit / charge card holders (at least 1 year), please attach photocopies of the following documents (non-returnable) with your completed application form:-
  1. I.C. (both sides) including supplementary applicant's.
  2. Your credit / charge card (both sides).
  3. Last 2 months' card statements.

If you do not hold any other basic credit / charge card, please attach photocopies of the following documents (non-returnable) with your completed application form:-

  1. I.C. (both sides) including supplementary applicant's.
  2. Past 2 years' Income Tax Returns (Form J) or last 2 months' salary slips or Letter of Employment confirming length of service, position, salary and allowance (if any).
  3. If self-employed - last 3 months' bank statements and Business Registration Certificate / Form 9, 24, 49.
Sila Pilih Jenis MBF Card Credit Yang Dipohon :
Please Select Type of MBF Card Credit Applied*
I would like to choose ONE of the following(sila Pilih Satu Sahaja):Promosi sah sehingga 31hb Ogos 2004
The Gold Card Package is exclusive to Gold CardMember while the Classic Card Package is for Classic CardMember. All delivery charges for the gift to be borne by the CardMember (RM20 for Peninsular Malaysia and RM35 for East Malaysia). Terms & Conditions apply.
CARD MEMBERSHIP APPLICATION FORM
ABOUT MYSELF
FULL NAME (AS IN I.C. / PASSPORT, UNDERLINE SURNAME)
1.

2. TITLE

NAME TO APPEAR ON THE CARD (MUST NOT EXCEED 22 SPACES)
3.

4. NEW I.C. NO.

DATE OF BIRTH (DD/MM/YYYY)
6.

NATIONALITY
8.

5. OLD I.C.NO.


7.     Jantina:

9. NO. OF DEPENDANTS
10. RACE 11. MARITAL STATUS

12. ACADEMIC QUALIFICATION

PRESENT HOME ADDRESS (DO NOT PROVIDE P.O BOX ADDRESS)
13.
     
     
      POSTCODE TOWN / CITY

14. HOME PHONE
      AREA CODE      0 TEL. NO.

15. MOBILE PHONE
      AREA CODE      0 TEL. NO.

16. E-MAIL

17. YOUR PROPERTY        YEARS THERE

18. BILLING OPTION          

19. YOUR PERMANENT HOME ADDRESS (IF DIFFERS FROM 13. ABOVE)

     
     

FULL NAME OF SPOUSE (AS IN I.C. / PASSPORT, UNDERLINE SURNAME)
20.

I.C. / PASSPORT NO.

NAME OF SPOUSE'S EMPLOYER
        TEL. NO.

21. MOTHER'S MAIDEN NAME (THIS SECURITY FEATURE IS FOR VERIFICATION PURPOSES)


  MY FINANCIAL DETAILS
BANK NAME
BRANCH

ACCOUNT NO.

22. CREDIT / CHARGE CARDS CURRENTLY OR PREVIOUSLY HELD
      TYPE OF CARD
      CARD ACCOUNT NO.
MY EMERGENCY CONTACT
NAME AND ADDRESS OF NEAREST RELATIVE / FRIEND NOT LIVING WITH ME


HOME PHONE    RELATIONSHIP
MY JOB
NAME OF COMPANY
23.

OFFICE ADDRESS (DO NOT PROVIDE P.O. BOX ADDRESS)
24.
     
      POSTCODE TOWN / CITY

25. DEPARTMENT    NATURE OF BUSINESS

26. OFFICE PHONE
      AREA CODE      0 TEL. NO. EXT. NO.

27. FAX NO.
      AREA CODE      0 TEL. NO.

28. POSITION HELD        YEARS THERE

29. GROSS ANNUAL INCOME    OTHER INCOME (please attach documents)


PREVIOUS EMPLOYMENT DETAILS (if less than 2 years in present employment)
30. NAME OF COMPANY

31. POSITION HELD YEARS THERE
MY SUPPLEMENTARY APPLICANT  (PENUHKAN JIKA ANDA MEMERLUKAN SUPPLEMENTARY CARD )
SUPPLEMENTARY CARD APPLICANT MUST BE AT LEAST 18 YEARS OF AGE
FULL NAME (AS IN I.C. / PASSPORT, UNDERLINE SURNAME)
32.

33. TITLE

NAME TO APPEAR ON THE SUPPLEMENTARY CARD (MUST NOT EXCEED 22 SPACES)
34.

35. NEW I.C. NO.  

DATE OF BIRTH (DD/MM/YYYY)
37.

PASSPORT NO. (FOR NON MALAYSIAN ONLY)
39.
36. OLD I.C.NO.

38.      Jantina    


RELATIONSHIP TO BASIC APPLICANT
40.

HOME ADDRESS (IF DIFFERENT FROM BASIC APPLICANT'S)

 TEL:

NAME AND ADDRESS OF EMPLOYER

 TEL:

GROSS ANNUAL INCOME    POSITION HELD    
YEARS THERE

41. E - MAIL

MOTHER'S MAIDEN NAME (THIS SECURITY FEATURE IS FOR VERIFICATION PURPOSES)
42.

                                                                                           

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Untuk Makluman: Selepas anda menghantar Borang ini,pihak kami akan mengisi kembali data-data yg diberikan kedalam borang permohonan sebenar dan akan mengepos borang permohonan sebenar untuk ditandatangan oleh anda.Lepas anda menandatangani borang permohonan sebenar,anda dikehendaki mengembalikan borang permohonan sebenar kepada kami berserta dokumen diperlukan dengan seberapa SEGERA yang mungkin.

*Tiada sebarang bayaran dikenakan oleh pihak kami,Kos Pengeposan adalah PERCUMA dimana kos setem dan urusan pos borang permohonan akan ditanggung sepenuhnya oleh pihak kami.

Perhatian : Segala maklumat yang anda isi adalah sulit dan persendirian sahaja, pihak kami tidak akan mempamirkan maklumat data yang diisi oleh anda kepada pihak umum.harap maklum.