Account No.: ……………………………….

AmBank (M) Berhad / AmBank Islamic Berhad

Credit Support & Administration,
Wisma AmFirst, Tower 1, Level 14
Jalan Stadium SS 7/15,
47301 Petaling Jaya,
Selangor Darul Ehsan

Dear Sirs,
RE ;REFUND OF ANY EXCESS AMOUNT.

Kindly have our instruction with regards to the above matter to credit the following account:

Beneficiary Name as per Savings or Current account below:

___________________________________________________

NRIC No. : ________________________________

Contact No. : ________________________________

Receiving Banker : ________________________________

Full Digit Account No.: 1. Saving Account : _______________________________

(Please select and tick )
2. Current Account : _______________________________

(TO ENCLOSE COPY FRONT PAGE PASSBOOK DETAILS OR STATEMENT OF ACCOUNT FOR
VERIFICATION PURPOSE)

(The successful transfer of refund shall depend on the accuracy of details provided. Please ensure
that the type of account is accepted by the receiving bank, beneficiary’s account is active and the
name matches the account provided. No third party transfer is allowed)

We hereby agree and undertake to fully indemnify you at all times against all liabilities, claims,
demands, actions, fines, penalties and legal proceeding whatsoever made against or charged or
imposed arising from or in connection with any act of omission done or omitted to be done by any
person in respect of the above.

Yours faithfully,

___________________________
Signature
Name :
NRIC :

NOTE: Should there be any excess payment towards the facility, we will refund the amount to
you accordingly. If you do not have CASA accounts with our Bank kindly furnish us
with your details by filling up the form and e-mail to customercare@ambankgroup.com
or contact 03-2178 8888.