Auto Financing

Application (Individual)
Enquiries 03-6204 7788 CIMB Islamic Bank Berhad (671380-H) CIMB Bank Berhad (13491-P)

1 APPLICANT DETAILS
PERSONAL DETAILS Highest Level of Education Obtained*
Salutation Postgraduate Professional Qualification Degree
Mr Madam Miss Others Diploma Secondary Primary Others
Name As Per NRIC EMPLOYMENT DETAILS
Employer’s Name

Gender
Male Female
New NRIC Number Old NRIC Number* Position

Other Identification (complete if you do not have an NRIC) Employer’s Address

Army/ Specify
Passport Police Number
Date of Birth (DD/MM/YYYY)

E-mail Address* Postcode

State Country
Home Phone Number Mobile Phone Number
Employer’s Phone Number (use ‘ext’ to indicate extension number)

Marital Status
Single Married Others Employment Type
Employed (Fixed) Own Business (Non Professional)
Number and Age(s) of Dependant Children*
Employed (Non Fixed) Unemployed (With Other Income)
Age(s)
Unemployed (Without Income, Pensioner, Housewife, Student)
Nationality
Occupation Date Employed (DD/MM/YYYY)
Malaysian Others
If not Malaysian, what is your residence status?
Non-Malaysian Resident Malaysia My 2nd Home Main Monthly Gross Income Other Monthly Income
Permanent Resident RM RM

Race Type of Company

Malay Chinese Indian Others CIMB Group Non Profit Organisation

Bumiputra Financial Institution Private Limited Company

Government Agency Public Limited Company
Yes No
Bursa Listed School/College
Permanent Home Address
Multi National Company
(Non Financial Institution) Sole Proprietor/Partnership

Size of Current Employment Company

Postcode
Small Medium Big Business
(<15 employees) (15-50 employees) (>50 employees)
State Country
Total Working Experience
Years Months
Duration at Permanent Address (current and all previous employment)

Years Months Are you an existing CIMB Group customer? Yes No

Current Residence Status EMERGENCY CONTACT DETAILS*
Owned - Charged Rented Relatives Full Name As In NRIC
Owned - Not Charged Company Quarters Parents
Mailing Address (complete if different from above)
Relationship with Main Applicant

Postcode Home Phone Number Mobile Phone Number

State Country

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 2 SPOUSE DETAILS (Complete Only If Your Spouse Is Not A Guarantor)
Name As Per NRIC New NRIC Number Old NRIC Number*

Other Identification
(complete if your spouse does not have an NRIC)
Passport Army/ Police Specify Number
Home Mobile Office
Phone Number Phone Number Phone Number

3 GUARANTOR DETAILS
PERSONAL DETAILS Mailing Address (complete if different from above)
Salutation
Mr Madam Miss Others

Name As Per NRIC Postcode

State Country

Gender Relationship to Applicant Highest Level of Education Obtained*

Male Female Postgraduate Professional Qualification Degree
Diploma Secondary Primary Others
New NRIC Number Old NRIC Number*
EMPLOYMENT DETAILS
Employer’s Name
Other Identification (complete if you do not have an NRIC)
Army/ Specify
Passport Police Number
Department
Date of Birth (DD/MM/YYYY)

Employer’s Address
E-mail Address*

Home Phone Number Mobile Phone Number Postcode

State Country

Marital Status Employer’s Phone Number (use ‘ext’ to indicate extension number)
Single Married Others

Number and Age(s) of Dependant Children* Employment Type

Age(s)
Employed (Fixed) Own Business (Non Professional)
Nationality Employed (Non Fixed) Unemployed (With Other Income)
Malaysian Others Unemployed (Without Income, Pensioner, Housewife, Student)

If not Malaysian, what is your residence status? Occupation

Non-Malaysian Resident Malaysia My 2nd Home
Permanent Resident Date Employed (DD/MM/YYYY)
Race
Malay Chinese Indian Others Main Monthly Gross Income Other Monthly Income
Bumiputra RM RM

Yes No Type of Company

Permanent Home Address CIMB Group Non Profit Organisation
Financial Institution Private Limited Company
Government Agency Public Limited Company
Bursa Listed School/College
Postcode
Multi National Company
(Non Financial Institution) Sole Proprietor/Partnership
State Country

Size of Current Employment Company

Duration at Permanent Address
Small Medium Big Business
Years Months (<15 employees) (15-50 employees) (>50 employees)
Current Residence Status Total Working Experience Are you an existing
Owned - Charged Rented Relatives (current and all previous employment) CIMB Group customer?
Owned - Not Charged Company Quarters Parents Years Months Yes No

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 4 REFEREE DETAILS*
Name of Referee

Occupation Relationship to Applicant

Home Phone Number Mobile Phone Number Office Phone Number (use ‘ext’ to indicate extension number)

Address

Postcode State Country

5 FINANCE AND VEHICLE DETAILS

Deal Type Financing Promotion Type
Dealer Direct Case
Dealer/Seller’s Name Salesman’s Name

Product Type Application Type

Fixed Rate Variable Rate New Unregistered Reconditioned Used Used Reconditioned
Purchase Location
Peninsular Malaysia Labuan Langkawi Sabah and Sarawak

Year Made Date of Registration Registration Number Make Model

Engine Capacity (CC) Fuel Type

<1000 CC 1000-2000 CC >2000 CC Petrol Diesel Others

Price of Vehicle Amount Financed Tenure Interest/Profit Rate

RM RM Months %

Where is the Vehicle Kept?

Postcode State Country

6 TRADE-IN DETAILS
Make Model

Registration Number Year Made Trade-in Value

RM

7 DOCUMENTS ENCLOSED
Which of the following documents are you providing with this form?

Copy of applicant's NRIC/Passport Latest 3 months bank statements

Photocopy of Driving License Latest 3 months salary slip or other income evidence
Photocopy of Registration Card Latest EA Form/Form B with proof of tax payment/EPF Statement

Page 3 of 6 * Optional
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 SMSA 9 0 4 9
Branch Code
Employee I/D
Credit Card-i & Credit Card Application Form
MINIMUM INCOME PER ANNUM
Gold/Platinum Visa SIGNATURE World MasterCard Visa INFINITE Enrich World Elite

RM24,000 RM100,000 RM100,000 RM150,000 RM250,000

1 I WISH TO APPLY FOR THE FOLLOWING CARD (PLEASE CHOOSE A MAXIMUM OF 2 CARD PRODUCTS ONLY) :
A. CIMB BANK CREDIT CARD
u CIMB PETRONAS Platinum MasterCard u CIMB Platinum MasterCard u CIMB Visa SIGNATURE
u CIMB Cash Rebate Platinum MasterCard u CIMB Visa Platinum (Basic) u CIMB Visa INFINITE
u CIMB World MasterCard

u CIMB Tesco Platinum MasterCard

By applying for the CIMB Tesco Platinum Credit Card, I agree that CIMB Bank may share my information contained in this application form with
TESCO STORES (MALAYSIA) SDN BHD (Company No. 521419-K) (“Tesco Stores”), its successor or any of its related companies to enable me
to enjoy the rewards, services and benefits including accumulation of Tesco Clubcard points offered under the CIMB Tesco Platinum Credit Card.
To start enjoying and earning Tesco Clubcard points, kindly insert your existing Tesco Clubcard No. here:

If you do not have your Clubcard number with you, please call our Clubcard Helpline at 1 300 13 1313 for immediate assistance.
If you are not an existing Tesco Clubcard member, Tesco Stores may contact you on the application of a Tesco Clubcard in order for you to enjoy
Tesco Clubcard rewards and benefits.

u CIMB Enrich Platinum MasterCard u CIMB Enrich World MasterCard u CIMB Enrich World Elite MasterCard

My Enrich Card No. :

u I do not have an Enrich Card and wish to be enrolled as a new Enrich member under the Enrich Frequent Flyer Programme. I hereby consent
to CIMB Bank sharing the information contained in this application form with Malaysia Airlines Berhad (1116944-X), its successor or any of its
related companies which upon receipt of my information herein will then consider my application for the same.

B. CIMB ISLAMIC CREDIT CARD-i

u CIMB Islamic PETRONAS Gold MasterCard u CIMB Islamic Platinum MasterCard

Important Note:
Principal Credit Card-i/Credit Card Applicant’s Signature :
(1) Additional credit card-i/credit card will share a combined credit limit.
(2) Please sign within the signature box. Date :

2 MY PERSONAL DETAILS

Name To Appear On Card (Not More Than 19 Letters) : Mother’s Maiden Name :

3 MY BILLING DELIVERY INSTRUCTIONS

E-mail :
Customers with e-mail address will be enrolled for e-Statement
automatically.

u Paper Statement : u CIMB CLICKS Internet Banking :

No, I prefer paper statement to be sent to my mailing address No, I prefer to receive my statement via CIMB Clicks Internet Banking

4 CIMB TOUCH ‘N GO ZING AUTOMATIC RELOAD AMOUNT

CIMB Touch ‘n Go Zing Card (Touch ‘n Go card linked to CIMB Bank/CIMB Islamic Bank Credit Card)
u I would like to have the CIMB Touch ‘n Go Zing Card with the following automatic reload amount
Principal Card u RM100 u RM200 u RM300
Note : If the auto reload amount is not specified, CIMB Bank/CIMB Islamic Bank will automatically set the default reload amount to RM100.

Customer’s NRIC / Passport No. : (Compulsory)

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 DECLARATION/DISCLOSURE BY APPLICANT**

**This declaration shall apply to all CIMB Bank Berhad and/or CIMB Islamic Berhad, as the case may be, (“the Bank” product(s) which you apply for as
stated in this application form and above table.

FOR ALL PRODUCTS:

(i) I/We declare that I/we have/do not have outstanding debt payment obligation from banks and non-banks (e.g. cooperative building societies, credit
companies and merchants that provide credit sales)
Particulars of the main applicant’s outstanding debt payment obligation are as follows (no declaration from the main applicant denotes that this
declaration is not applicable) :

No. Name of Entity Amount of Outstanding Debt (RM) Monthly Instalment Amount (RM)

(ii) I/We declare that the information furnished in this form are true, accurate and complete and I/we have not withheld any information which may
prejudice my/our financing/loan application or have a bearing on your financing decision.
(iii) Application(s) remains the Bank’s property regardless of whether the facility is approved and the Bank reserves the right to reject the application(s)
at its sole discretion without any reasons whatsoever.
(iv) I/We have not committed any act of bankruptcy and/or been adjudged a bankrupt.
(v) I/We shall comply with the Bank’s requirements in respect of my/our loan/financing application and understand that the Bank’s offer of the loan/
financing shall be subject to the Bank performing any necessary verification. The Bank refers to CIMB Bank Berhad or CIMB Islamic Bank Berhad
(as the case may be), being the licensed financial institution offering the loan/financing product(s) referred to this application form.
(vi) I/We confirm that the Bank is authorised to verify and/or make any checks and/or obtain any information and/or confirmation at any time and from time
to time now and/or in the future, with or from any credit reference/reporting agencies, including but not limited to CCRIS, FIS and/or any other agencies
and/or from any financial institution and to provide to such aforesaid party(s) with the required information requested to enable the Bank to ascertain my/
our status and/or any other person, individual and/or entity related to and/or associated with me/us as may be required by the Bank for the purpose of the
consideration of this application and thereafter if this application is approved for the purposes of the grant and/or continued maintenance of the facility/
account; and/or recovery of debts owing under the facility/account; and/or any purpose related to or in connection with the facility/account applied for;
and/or for any other purpose that is required or permitted by any law, regulations, guidelines and/or relevant regulatory authorities.
(vii) In connection with the Bank Negara Guidelines on Credit Transactions and Exposures with Connected Parties, I/we hereby declare that (no
declaration from the applicant(s) denotes that this declaration is not applicable) :
u I am a staff of the CIMB Group1
u To the best of my knowledge, I have close relative(s)2 employed under the CIMB Group.
Particulars of my close relatives in CIMB Group and whether they have acted as my guarantor :

Name I/C / Passport No. Relationship Acted As Guarantor (Indicate Yes or No)

u Yes u No

u Yes u No
CIMB Group means CIMB Bank Berhad or CIMB Islamic Bank Berhad or CIMB Investment Bank Berhad or other subsidiaries or companies controlled
1

by the aforesaid respective banking institutions.

Close relative(s) include parents/spouse of staff including the spouse’s dependents/children/spouse of the children/brother and sister/spouse of brother/
2

sister and any other dependents and persons who may influence/be influenced by the staff.

(viii) Subject to the provisions below which (i) prohibit disclosure of information to Group Companies if objected to by me/us; and (ii) require my/our
express consent for disclosure of information to third parties for the stated purposes, I/we hereby agree and authorise the Bank to disclose to
any of its agents, service providers, auditors, legal counsel, professional advisors, security providers and guarantors in or outside Malaysia and
to companies within the group of the Bank as well as companies within the group of CIMB Group Holdings Berhad, the Bank’s ultimate holding
company (“the Group Companies”) whether such Group Companies are residing, situated, carrying on business, incorporated or constituted within
or outside Malaysia any information relating to me/us, my/our affairs and/or any accounts maintained by me/us with the Bank for facilitating the
business, operations, facilities and services of or granted or provided by the Bank and/or the Group Companies to their customers.
Disclosure to Group Companies shall be for facilitating the operations, businesses, cross-selling and other purposes of the Bank and/or the Group
Companies provided always that disclosure for cross selling purposes shall not be effected if such disclosure is objected by me/us by
contacting the Bank at the following telephone number or address (which may be changed by the Bank from time to time by notice to me/us): 19th
Floor, Menara Bumiputra Commerce, 11 Jalan Raja Laut, 50350 Kuala Lumpur, Tel. No.: +603 6204 7788.
Further, where the Bank intends to share my/our information (excluding information relating to my/our affairs or account) with third parties for
strategic alliances, marketing and promotional purposes, (3)
u I/We hereby give my/our consent to the above disclosure to third parties.
u I/We do not consent to the giving of the above disclosure to third parties.
(ix) I/We also acknowledge that it is a requirement by Bank Negara Malaysia (“BNM”) that all information relating to this application, whether successful
or otherwise must be updated and/or transmitted to the Central Credit Reference Information System (“CCRIS”), a database maintained by BNM.
(x) CIMB Touch ‘n Go Zing Card
In addition to the declaration where I have confirmed that any credit card issued to me shall be subject to the Bank’s Cardholder Agreement, I also
agree to abide by the terms and conditions of the Touch ‘n Go Zing Card (“the Card”) and any other terms and conditions imposed by Touch ‘n Go
Sdn. Bhd. (“TNGSB”) and/or the Bank from time to time in respect of the use of the Touch ‘n Go features of the Card. I am aware the Card has an
automatic reload amount of RM100, RM200 or RM300 and that the automatic reload fee of RM1.59 is payable. I confirm and irrevocably authorize
the Bank to debit my Credit Card account linked to the Card, for each reload and automatic reload fee (where chargeable) whenever the account
balance drops to RM50 and below. In the event that I cancel my Card and my Card has an account balance at the point of cancellation, such balance
will be refunded, upon request, to my Credit Card account after deducting the processing fee of RM5.30. In the event that my Card does not have
any account balance when I cancel my Card, no processing fee will be charged. A RM10.00 fee is also chargeable for new Card replacements. By
signing and/or using the Card I agree to be bound by the terms and conditions imposed on the Card and other variations or amendments thereof. I
understand that the Zing Card remains the property of TNGSB and must be returned to TNGSB upon request.

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 DECLARATION/DISCLOSURE BY APPLICANT** ... CONTINUED
(xi) For Credit Card
I/We hereby request the Bank to issue, upon approval of this application, the credit card(s) which I/we have indicated. I/We acknowledge that the use of
the credit card(s) issued to me/us shall be subject to the Bank’s Cardholder Terms and Conditions (“Cardmember Agreement”) which will be sent to me/us
with the credit card(s) upon the approval of this application, and I/we further agree to be bound by the terms and conditions set forth in the Cardmember
Agreement upon issuance or use of the credit card(s). I, the Principal Applicant further agree to accept joint and several liability for all amounts incurred
arising from the use of the Principal and/or Supplementary credit card(s) issued pursuant to this application or at any time thereafter at my and/or the
Supplementary Applicant’s request. I/We further understand that the Bank shall not hold the Supplementary Applicant jointly and severally liable for the
debts or amounts incurred by the Principal Applicant or other Supplementary Applicant(s). I/We understand that the credit card(s) when issued shall at all
times remain the property of the Bank and must be duly returned upon request by the Bank. I/We further agree to accept liability for all amount incurred
arising from the use of my/our credit card(s) issued pursuant to this application or at any time thereafter at my/our request.
(xii) For Goods & Services Tax (GST) (Effective 1 April 2015)
I am aware that the published fees/charges are inclusive of “Goods and Services Tax (GST)”, where applicable and I hereby further agree that I shall
be liable for all GST payable in connection with or arising out of the products applied for under this application form or any account or any services in
connection therewith and you shall be authorised to debit my account for the same.

PRIVACY NOTICE ACKNOWLEDGEMENT

I hereby acknowledge that I have accessed and/or read the Privacy Notice issued by CIMB Group (which is available at all CIMB branches as well as at the
CIMB website at www.cimbbank.com.my or www.cimbislamic.com.my or has otherwise been made available to me) and confirm my agreement to the same.

INSURANCE/TAKAFUL RENEWAL REMINDER SERVICE

Optional - Please (3) in the event you wish to receive the reminder service.
u I/We would like to receive the insurance or takaful renewal reminders issued by the Bank’s approved panel of insurance company or takaful operator.
I/We acknowledge that the insurance or takaful renewal reminder service is an extended service and I/we hereby give my/our consent to the Bank to
disclose my/our relevant information to the Bank’s approved panel of insurance company or takaful operator for purposes of sending to me/us the
renewal reminders.

DECLARATION ON FATCA (INDIVIDUAL)

Please check “3” Yes or No for each of the following questions: Yes No
1. Are you a U.S. Resident? (including a current work permit) u u If yes, Tax Number:
2. Are you a U.S. Citizen or a Citizen of a U.S. Territory? u u If yes, Tax Number:
3. Do you hold a U.S. Permanent Resident Card (Green Card)? u u If yes, Tax Number:
I/We hereby confirm the information provided and declarations above are true, accurate and complete.
Subject to the applicable local laws, I/we hereby give my/our consent to the Bank, the Group Companies and/or any of their licensed financial institution
affiliates (including branches) (collectively as “CIMB”) to share my/our information with domestic or overseas governmental, supervisory or regulatory
authorities where necessary to establish my/our tax liability in any relevant jurisdiction.
Where required by domestic or overseas governmental, supervisory or regulatory authorities, I/we also understand and agree that CIMB may be required
to obtain additional documents and/or forms, which I/we will sign, if I/we am/are subjected to the relevant jurisdiction’s requirements.
Where required by domestic or overseas governmental, supervisory or regulatory authorities, I/we understand and agree that CIMB may withhold, and
pay out, from any of my/our account(s) such amounts as may be required accordingly to applicable laws, regulations, directives, guidelines and/or
agreements with and/or from domestic or overseas governmental, supervisory or regulatory authorities.
I/We also agree and undertake to notify CIMB (within 30 calendar days), or provide the information if requested by CIMB, if there is a change in any
information which I/we have provided to CIMB.

I hereby confirm having read, understood and retained a copy of Product Disclosure Sheet that explains the benefits and my duties to my
application for the Product(s) that I/we applied for.
I am aware that the full terms and conditions of the product(s) that I applied for is/are also available in:

CIMB Hire Purchase and CIMB Credit Card : www.cimbbank.com.my +603 6204 7788
CIMB Islamic Hire Purchase and CIMB Islamic Credit Card : www.cimbislamic.com.my +603 6204 7788

Main Applicant’s Signature : Guarantor’s Signature :

Date : Date :

BANK USE ONLY

Serviced by :
Application ID :
Outlet : Date :

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