STATUTORY DECLARATION FOR EMPLOYMENT WITH ALLIANCE BANK

I, ………………………………………………………………………………………………………….................................

NRIC No ………………………………………………. do solemnly and sincerely declare that

* Please delete / circle whichever is applicable (i – iii)

(i) I have / have not been convicted of any past crimes under any written law relating to companies,
financial services, capital markets, prevention of money laundering or terrorism financing, and other
offences involving dishonesty or fraud under any written law, whether in or outside Malaysia, if any;

(ii) I have / do not have any pending criminal investigations, inquiries or criminal charges or any
other criminal proceedings against me relating to laws and offences referred to in paragraph (i) above, if
any;

(iii) I have / had / have not been employed as a dealer or brokers (if you have / had) please
indicate duration from ____________ to ____________.
(iv) The details of my current and former employers in the last seven years prior to application with Alliance

Bank Malaysia Berhad are as follows;

Start Date End Date

(DD/MM/YY) (DD/MM/YY) Company Name

I make this solemn declaration conscientiously believing the declaration to be true, and by virtue of the Statutory
Declarations Act 1960.

Subscribed and solemnly declared by the abovenamed

…………………………………………………………………….
at ………………………………………………………………….
in the State of ……………………………………………………
this …………………………………………………., 20………..

Before me,

……………………………………………………………
(Signature of Sessions Court Judge, Magistrate,
Commissioner for Oaths or notary public)