HongLeongBank 3 HongLeong|slamic Bank
Personal Account Application Form Gorang Permohonan Akaun Peribadi
Protecod by IM up o RNZS0,000 foreach deposi.
ciindung on HM seat R250 000 bagi etp pendopost.
Please complete this form clearly and mark“ where applicable ila lengkapkan borang inl dengan elas dan tandakan “Y "di mana yang berkenaan
_ A eacent/savings Account Akaun Sernaso/Simpanan Fixed veposit Deposit Tetap [islamic islamic
‘Purpose of Account Opening juan Fembukaan Akaun - a
AL swiogs sinpanen D salary 6a (ting txpenses Pelion
T tnvestment Pelsburan Dred FcitesKerakan Kredit C) Edation Pendian
1 Remitancekiman Wag Business transaction TiansatsPemiagaon —C) athers Lain
EIEN cast arrcarvinonow vagin 2) :
PARTA= Personal Details utiranPedbadi = F
Name (as per New WRIC/Passport) 1 Me tock Ms ck Fees Puan others Lainsin
‘Nama (seperti dalam KP Baharu/Pasport)
New NRIC No,/Passport No.
No, KP Bahary/No,Pasport
10 Details (Passport Holdes) Issuing Country Negara Pengelur
tian 9 Pemenang Pasport) Date of sue Ta Dikeluatkat 124 Bate of Beng Toi Famnat O09 18 8
Date of Birth Tank Laie ay
Nationality Warganegara Ci Malaysian malaysia Clothers taimain:
PR of other Country Penduduk Tetap Negara Asing | C] Yes Ya [No tidak
Reside > 182 days in Malaysia (calendar year)
‘Tinga di dalam Malaysia» 12 ha (Laon Kalenday | CI ¥es ¥9 0 No Tidak
‘Bumiputra Taaf Bumiputr Di Bumiputra El Non-tumiputra Bukan Bumiputra
‘Gender Jantina Ci Mate telak Li Femate pevempuan
Race Bangs2 [Malay Melayu C)chinese Cina Clindian india CJothers tain-lain
‘Marital status Tarot Peskahwinan Single Buiang [] Married Berkahwin [] OWvorced Rexcerai Widowed Janca/Duda
Home Address Alamat Rumah ity Bandar Postcode Poskod
State Negeri Country Negara
Correspondence Address Alina Su
Cy same as home address City oandar Postcode roskod
Sama dengon alamot rumah State Negeti Country Negara
Home Tel. No. No. Tel, Ruma Country Cade Kod Negara
Country Code Kod Negara
| a _
4 Note: This mobile phone number will be automatically registered to receive Transaction
Authorisation Code (TAC), whichis required to complete selected transactions via Hong Leong
‘Mobile Phone No, Wo Tel Giniit Pestne rorinper fe ater eh
Nota Nvuhoe tl hii akan lidaflarkan secara autamatk ante menerina Kod Pengesahan
Transaks! (TAC yana dlpetukan untuk melakukan transakstterplh melalulPecharkan Dalam Taian dan
‘Muda Alin Hong Leong Connect
Note: this account will be automatically enrolled for e-statement, and this e-mail address will
automatically be registered to receive email statement.
Noa Akaun to akan didaftrkac untuk espenyata secara autornatik, dan alamat e-mel ini akan
Aidaftarkan secara automatk untuk menerima penyata e-mel
E-mall Addcess Alamat EmelPaar
Employment details Butiran Pekerjaan
‘Occupation Pekerj2an|
C1 employer C1 Government Employee/civil Servant
Majkan Pekarja Kerajaan/Penjawat Avan
cap liqaenk Y9pe SE PERERA C1 seltemployed Private sector Employee
Leslee nieial aia Bekerja Send Pokera SektorSwast
1 unemployed 1 Retiree/Housewife/student
Pesava/Suni Rumah Tangga/Pelajar
Tidak Bekeria
Employer Name Nara Najkan
Employer's Nature of Business
Jens Pemiagaan Majin
1 Nittiads Cl RM240,000
RMI20,000, RM200,000 Rum240,000
‘PART C-FATCA Declaration for Primary Applicant Pengakuan FAICA untuk Pemohon Utama
Please complete the following section to provide your FATCA (“Foreign Account Tax Compliance Act") status declaration:
sila lengkapkan seksyen yang berkut untuk memibe pengakuan FATCA (‘AktaPeratuhan Cukal Akaun Asin’) anda
‘Yerva No Tidak
2) At east one of the below tems is applicable tom oo
Sekang-rangaya salah salu buan di Dowah adalah besaitan dengan sya
+ tam aus. étizen
Saya adalah sorang warganegara AS.
+ Yam aus. resident
Saya adalah sorang pemastauin AS
+ tholda US. green card
Saya meregang kad ju AS.
8) At least one ofthe below items is applicable to me: oo
Sekurangrkuangnya sal at btian Dawah i aslah berkaitan dengan sy:
+ twas born inthe US.
saya daikan dia.
+ thave a current Us. residence or mailing adress including a US. RO. Box address.
Saya mempunyalalamatkedlaman sta alamatsuat-menyurat erase di A, termasukalamat Pet Surat Peabat Pos AS.
+ thave aU. telephone numbe
Saya mempuayel nombortlelon AS
+ ony have a“hold mail” or “in cave of” address that is my sole addvess.
Saya hanya mempunya slat “hold mail” atu lam jagsan yang mecupakan stusatunyo alamat saya,
Note: Nota:
IW you have answered YES for (A), please complete a Form W-9.
Jka anda telah menjowab YA bag (8), sa lengkapkan Borg W:3,
if you have answered NO for (A) and YES for (8), lease complete a Form W-30EN.
}Wa anda telah menjawab TAK bagi (A) dan VAbagi (8), sil engkapkan Borang W-BBEN
PART - Common Reporting Standard Self Certification for Primary Applicant Perauan Bi tandard Pelapran untuk Pemohon Utama
{hereby confirm that have read the Definition contained in Annexute 1 af this form and hereby declare as follows:
Saya mengesahkan bakaw saya telah membaca Detinis yang terkandung dalam Lampian 1 i borag ini dan menisytharkan sepert best:
‘ce you ONLY a Malaysian tax resident? Adakch anda pemastautncukai Malaysia SAHAJA? Chvesva ——) No Tidak"
“you have answered NO, please request and complete an additional form “Annexure 2~ Self Certification of Tax Residency Status”.
Jikaanda menjawab TIOAK, sila minta dan lengkapkan lembaran tambahan “Lampiran 2 Perakuan Di Taraf Cukal Pemastautin’(EERIE sown areica renown ceasana
Existing HLB/HUSB customers: Pelanggan HLB/HLISD sedia ada:
Please use this form to update your information. Simply fill n your new I¢/Passport and the updated information.
Sila guna orang int untuk mengemaskini mallumat anda: Lengkapkan borang ini dengan no KP baharufpasport dan maldumattetki
PARTA-Personal Details Butiran Peribadi
Relationship to Primary Applicant:
Hubungan dengan Pemohon Utama,
1 Spouse Pasangan
Tl other Relative Saudaio C1 F
1 Parent ibu bapa
nd Kawan
I child Anak
other tain
sibling Adik Bera
Name (as per New NRIC/Passport)
Nama (seperti dalam KP Bahacu/Pasport)
CO Mrndk CMs ck CMs Puan
Clotherstain-tan
New NRIC No,/Passport No. No. KP Bahacu/No.
Pasport
10 Details (Passport Holder)
Butizan D (Pemegang Paspert)
Issuing Country Negara Pengehia:
Date of tsue Tari Dikeuarkan
Date of Expiry
Date of Birth Tak Lahr
| Nationality Warganegara
Gy Malaysian Wataysia
Dlothers ainain:
PR of other Country Pendk Telap Negara Asig | [Yes Va No rida
Reside > 182 days in Malaysia (calendar year)
Tinggal di dalam Malaysia > 182 har (tahun Kalenday) | CI Yes Yo non wf
omit Toa umiata Cl ewripa wpm tan rip
Gender antina C1 mate telat female Peerpuan
Race Bangsa Malay Melayu Clehinese Gna /Endian ie others ainsi
[Marital status Taal Petkahwinan
single Bujang
vorced Berceral
J Widowed janda/Duda
Ci mad in
20,000,
Home AddeessAlamat Rumah City Bandar / Postcode Paskod
state Negeri country Negara
‘Correspondence Address Alamat Surat Menyat
1] Same as home address ity Bandar / Postcode Poskod
Sama dengan alamat rumah stateNeged country Negara
ome Tel. No, No. Te. Rumah Country Cade Kod Negara
Mobile Phone No. No Tel Smt Country Code od Negara
mall Address lanai Emel 7
ssrorseeresercrmenle
4 =
Occupation Pekan ;
1 Employer Government Employee/civil Servant
wakan Pekerja Kerajaan/Penjawat Awam
Jens Pekerjaan | C1 Selt-tmptoyed Private sector Employee
Employment type ens Pekeson Bekerja Send Poker Sektor swasta
1 Unemployed 1 Retivee/Housewife/Student
Tidak Bekey Pesata/Suri Rumah Tangga/Pelajar
Employer Name Nam ia
Employer's Nature of Business
Jes Perniagsanbajkan L 7
UO Nittiads Ld