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Borang Permohonan Membuka

Akaun Peribadi CIMB Bank Berhad 13491-P CIMB Islamic Bank Berhad 671380-H
Account Opening Application Form (Personal)
Jenis pelanggan Jenis akaun/pemohon Nama produk
Customer type Account/Applicant type Product name
Baru Sedia ada Individu Bersama Utama Bersama Lain-lain
New Existing Individual Joint Main Joint Others

BUTIRAN PERIBADI / PERSONAL DETAILS BUTIRAN PEKERJAAN TERKINI

CURRENT EMPLOYMENT DETAILS
Gelaran
Salutation Pekerjaan
Encik Puan Cik Lain-lain Occupation
Mr Madam Miss Others CEO/Pengarah Pengurus/Penyelia Pegawai
Nama seperti K.P. / Pasport CEO/Director Manager/Supervisor Officer
Name as per NRIC / Passport Pesara Kerani Penuntut
Retiree Clerical & non-clerical Student
Ahli perniagaan Nyatakan jenis perniagaan, profesion dll
Businessman Specify nature of business, profession, etc
No. K.P. baru / Sijil kelahiran No. K.P lama Profesional
Professional
New NRIC / Birth certificate no. Old NRIC number
Lain-lain
Others
Nombor pengenalan lain Majikan
Other identification number Employer
Pasport Tentera/Polis
Passport Army/Police
Jantina Tarikh lahir (hh/bb/tttt) Pendapatan bulanan
Gender Date of birth (dd/mm/yyyy) Monthly income
Lelaki Perempuan Sehingga RM3,000 RM3,001 hingga RM7,000
Male Female Up to RM3,000 RM3,001 to RM7,000
Untuk bukan warganegara Malaysia sahaja RM7,001 hingga RM15,000 RM15,000 ke atas
For non-Malaysian only RM7,001 to RM15,000 More than RM15,000
Warganegara
Citizenship PERAKUAN / DECLARATION
Penduduk tetap
Status Permanent resident 1. Saya/Kami mengaku bahawa semua maklumat adalah benar. I/We declare that the above information is correct.
2. Saya/Kami mengesahkan bahawa saya/kami telah menerima, membaca dan memahami terma-terma dan syarat-syarat
pemastautin berkenaan pengendalian dan/atau pengurusan akaun dan bersetuju mematuhi syarat-syarat dan segala pindaan yang akan
Residence status Malaysia Rumah Keduaku diperkenalkan oleh pihak Bank. Bank merujuk kepada CIMB Bank Berhad atau CIMB Islamic Bank Berhad (yang mana
Malaysia My Second Home berkenaan) sebagai institusi kewangan berlesen yang menawarkan akaun dan/atau produk perbankan seperti yang disebutkan
di dalam borang ini. I/We declare that I/we have received, read and understood the Banks Rule and/or Terms and Conditions
Bangsa governing the operation and/or conduct of the account, and agree to comply with and be bound by the same and any
Race amendments to the same which the Bank may subsequently introduce. The Bank refers to CIMB Bank Berhad or CIMB Islamic
Bank Berhad (as the case may be), being the licensed financial institution offering the account(s) and/or banking product(s)
Bumiputera Cina India Lain-lain referred to in this application form.
3. Saya/Kami mengesahkan bahawa saya/kami telah membaca, memahami dan menyimpan satu salinan terma-terma dan
Bumiputera Chinese Indian Others syarat-syarat mengenai Kad ATM/Perbankan Telefon dan bersetuju mematuhinya. I/We confirm having read, understood and
retained a copy of the Terms and Conditions in respect of ATM Card/Phone Banking and agree to be bound by them.
Alamat rumah tetap 4. Saya/Kami tidak terlibat dengan sebarang tindakan kebankrapan pada masa akaun dibuka. I/We have not committed any
Permanent home address act of bankruptcy at the time the account is opened.
5. Saya/Kami akan mematuhi segala keperluan bagi pembukaan akaun dan saya/kami memahami pembukaan akaun Bank
adalah tertakluk kepada pengesahan yang perlu dibuat oleh pihak Bank. Pihak Bank berhak menutup akaun saya/kami tanpa
memberi apa jua sebab sekiranya akaun saya/kami tidak memenuhi keperluan Bank. I/We shall comply with all the Banks
requirements for opening of the account and understand that the Banks opening of the account shall be subjected to the
Bank performing any necessary verification. The Bank reserves the right to close my/our account at its absolute discretion
without giving any reasons if my/our account does not comply with the Banks requirements.
Poskod 6. Untuk Akaun Semasa/Akaun Semasa-i Saya/Kami mengaku bahawa tiada akaun saya/kami sebelum ini pernah dilaporkan
Postcode kepada Sistem Maklumat Cek Tidak Laku Bank Negara Malaysia. For Current Account/Current Account-i I/We declare
Negeri Negara that no account(s) in my/our name(s) has/have been previously reported to the Dishonoured Cheque Information System of
State Country Bank Negara Malaysia.
7. Untuk Akaun Bersama Akaun bersama ini beroperasi untuk penyimpanan, pengeluaran atau penutupan akaun oleh salah
Alamat surat menyurat (lengkapkan jika berbeza daripada atas) seorang daripada kami melainkan diberitahu sebaliknya seperti di atas. Salah seorang di antara kami diberi kuasa untuk
menyimpan sebarang instrumen bayaran yang boleh dibayar untuk permintaan salah seorang daripada kami,tanpa tandatangan
Mailing address (to be completed if different from above) persendirian pembayarannya. Jika salah seorang di antara kami meninggal dunia, pihak Bank diberi kuasa membayar baki
akaun ini kepada yang masih hidup, tertakluk kepada penetapan perundangan yang relevan, polisi dalaman pihak Bank
dan/atau di dalam kes pembukaan akaun dengan CIMB Islamic Bank Berhad, prinsip-prinsip Shariah. For Joint Account
The joint account shall be operated by anyone of us, including any deposit, withdrawal or closure, unless specified otherwise
above. Any one of us is authorised to deposit any instruments for payments of money payable to the individual orders of any
of us without the personal endorsement of the payee. In the event of the death of either/any of us, the Bank is authorised to
Poskod pay any credit balance of the account to the survivor(s) subject to compliance (if required) with the relevant statutory legislation,
Postcode the Banks internal policy and/or in the case of an account opened with CIMB Islamic Bank Berhad, Shariah principle.
8. Saya/Kami mengesahkan bahawa pihak Bank diberi kuasa untuk meneliti dan/atau membuat pemeriksaan dan/atau
Negeri Negara mendapatkan mana-mana maklumat dan/atau pengesahan, dengan atau daripada mana-mana agensi rujukan kredit, termasuk
State Country tetapi tidak terhad kepada CCRIS, FIS dan/atau mana-mana agensi dan/atau daripada mana-mana institusi kewangan,
terhadap saya/kami dan/atau sesiapa jua, individu dan/atau sebuah entiti yang pihak Bank anggap wajar,untuk apa jua tujuan
Status perkahwinan yang pihak Bank anggap wajar. I/We confirm that the Bank is authorised to verify and/or make any checks and/or obtain any
Marital status information and/or confirmation, with or from any credit reference agencies, including but not limited to CCRIS, FIS and/or
any other agencies and/or from any financial institution, on me/us and/or any other person, individual and/or entity as the
Bujang Berkahwin Lain-lain Bank may deem fit, for any purposes which the Bank deems fit.
Single Married Others 9. Saya/Kami bersetuju akan menyemak segala Penyata Akaun yang dihantar kepada saya/kami atau Rekod Urusniaga Akaun
saya/kami dan memberitahu sekiranya terdapat kesilapan, ketidakaturan dan/atau kelainan di dalam Penyata Akaun atau
Rekod Urusniaga Akaun saya/kami dan juga akan memberitahu pihak Bank sekiranya saya/kami gagal menerima Penyata
Alamat E-mel Akaun tersebut (jika berkenaan). I/We agree to examine the Statement of Account sent to me/us or Transaction History of
Email address my/our Account and notify the Bank of any errors, irregularities and/or discrepancies in the said Statement of Account or
Transaction History of my/our Account and also to notify the Bank if I/we fail to receive such Statement of Account (if
applicable).
10. Saya/Kami dengan ini bersetuju dan membenarkan pihak Bank untuk mendedahkan kepada sesiapa sebarang maklumat
mengenai atau berkaitan dengan hal saya/kami dan/atau akaun perbankan yang dibenarkan oleh undang-undang atau untuk
No. telefon rumah/pejabat No. telefon bimbit tujuan-tujuan yang pihak Bank anggap sesuai atau perlu demi kepentingan pihak Bank. I/We hereby agree and authorise
Home/Office phone no. Mobile phone no. the Bank to disclose to any person any information about or with regard to my/our affairs and/or banking accounts as
authorised by law or for such purposes as the Bank deems fit in its interest to do so.
11. Pencegahan Pengubahan Wang Haram (AMLA) Saya/Kami memberi jaminan kepada pihak Bank bahawa saya/kami akan
berhati-hati agar tidak memudahkan dana daripada hasil kutipan kegiatan haram disalurkan ke dalam akaun saya/kami
dengan Bank dan bersetuju untuk membekalkan maklumat-maklumat dan dokumen-dokumen yang relevan, apabila
No. faks dikehendaki, untuk tujuan pengenalan saya/kami dan/atau pengesahan sumber dana saya/kami berdasarkan prinsip-prinsip
Fax no. Kenali Pelanggan Anda. Anti-Money Laundering (AMLA) I/We assure the Bank that I/we will exercise due care not to
facilitate funds from proceeds of any unlawful activity to be channelled through my/our account(s) with the Bank and undertake
to provide the Bank with all relevant information and documents, as and when requested, for purposes of my/our identification
and/or verification of the source of my/our funds under the "Know Your Client" principle.

Page 1 of 2 Version 1.04 (05/09)

 Pemohon bersama 2 / Joint applicant 2
PENGENDALIAN AKAUN / ACCOUNT OPERATION
Sendiri Semua Mana-mana satu
Selepas borang lengkap diisi, sila cetak
Tandatangan
Sole All to sign Any one to sign Signature dan turunkan tandatangan
Mana-mana ___ untuk tandatangan Nyatakan bil.
Any ___ to sign Specify no. On completion of this form,
please print and sign by hand
TANDATANGAN / SIGNATURES Nama penuh
Full name
Pemohon utama / Main Applicant No. KP/ Pasport
NRIC/Passport no.
Selepas borang lengkap diisi, sila cetak Hubungan dengan pemohon utama
Tandatangan Relationship with main applicant
Signature dan turunkan tandatangan
Tarikh
On completion of this form, Date
please print and sign by hand No. Kad ATM
ATM Card No.
Nama penuh Menerima Kad ATM (Sila sahkan) Sila sahkan
Full name Acknowledged receipt of ATM Card (Please initial) Please initial
Tarikh
Date
No. Kad ATM UNTUK KEGUNAAN BANK / FOR BANK USE
ATM Card No.
Senarai semakan dokumen
Menerima Kad ATM (Sila sahkan) Sila sahkan Document checklist
Acknowledged receipt of ATM Card (Please initial) Please initial
Salinan KP/MyKad/Pasport
Pemohon bersama 1 / Joint applicant 1 Photocopy of NRIC/MyKad/Passport
Surat daripada majikan
Selepas borang lengkap diisi, sila cetak Letter from employer
Tandatangan
Signature dan turunkan tandatangan Lain-lain dokumen pengenalan, sila nyatakan di bawah
Other identification documents, please state below
On completion of this form,
please print and sign by hand
Nama penuh
Full name
Dikendalikan oleh
No. KP/ Pasport Attended by
NRIC/Passport no.
Hubungan dengan pemohon utama
Relationship with main applicant
Disahkan oleh
Tarikh Verified by
Date
No. Kad ATM
ATM Card No. Diluluskan oleh
Menerima Kad ATM (Sila sahkan) Sila sahkan Approved by
Acknowledged receipt of ATM Card (Please initial) Please initial

For validation For joint applicants only, please ensure:

(i) CIF validation is printed
(ii) Associated account number is written below

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