REFLEX Service Request Maintenance Form

Complete all relevant sections and submit the application form along with required supporting document(s) (where applicable) to the account holding RHB Bank Branch

A. Customer Detailss
Corporate Name P AJ A K G ADA I EX P RE S S SD N B H D
Corporate ID 0 1 5 5 0 5
Reflex Primary Corporate Account No. 2 1 2 2 7 3 0 0 0 3 6 2 6 2

B. Service Requirement Details (Please tick √ whichever applicable)

/ Adding of Subsidiary Account(s)
1. Account No. 2 6 2 2 7 8 0 0 0 3 5 5 0 5 Account Name AR RAHNU EXPRESS SDN BHD
2. Account No. Account Name

3. Account No. Account Name

4. Account No. Account Name

Note: Please ensure supporting documents as below is/are furnished along with this form:
1. Board Resolutions (for Sdn.Bhd.) or Letter Of Authorization from related subsidiary company(ies)
2. Form 49 (for Sdn.Bhd.) or Business Registration by SSM from related subsidiary company(ies)

Adding of Subsidiary Bodies

EPF/KWSP Employer Reference No. SOCSO/PERKESO Employer Reference No. IRB/LHDN Employer Reference No.
E

Change From Standard Premium package to SME package

Note: Please ensure SME Declaration form is furnished along with this form.

Change Billing Account

Account No. Account Name

Update of Company Details

Corporate Name
Business/
Correspondence
Address

Postal Code City

State/Province

Country

Note: For change of Corporate/Company Name, please ensure Form/Borang 13 from SSM is furnished along with this form

Temporary Block Corporate ID

User ID User Name

Token Serial Number

Reasons
 Change Details of System Administrator(s)
SYSADMIN1: Maker/Data Entry

Name (Mr/Mrs./Ms)*

Mobile No.*

E-mail*

SYSADMIN2: Checker/Authoriser

Name (Mr/Mrs./Ms)*

Mobile No.*

E-mail*

Replacement of System Administrator(s)

SYSADMIN1: Maker/Data Entry

Name (Mr/Mrs./Ms)*

Designation*

NRIC*/Passport* Mobile No.*

Office Tel. No.* Fax No.*

E-mail*

SYSADMIN2: Checker/Authoriser

Name (Mr/Mrs./Ms)*

Designation*

NRIC*/Passport* Mobile No.*

Office Tel. No.* Fax No.*

E-mail*

Additional Token Request

Kindly indicate the required quantity.
Please note that RM50.00 will be imposed on each unit of additional tokens issued and the sum will be debited from the Primary Corporate Account

Replacement of Token

User ID

Token Serial Number

Replacement Reason Lost/Stolen Defective/Damage Battery Low

Authorized Signatory(ies) of Reflex Primary Corporate Account

For BANK use only

Branch Code: Date:

Processing Checklist: Processed by, Verified by,

Duly completed form, along with the necessary supporting
documents.

Authorised signatory(ies) is/are as per account operating Name: Name:

mandate (Reflex Primary Corporate Account). Designation: Designation: