To: For Internal Micron use only:

Micron Semiconductor Malaysia Sdn Bhd Vendor ___________________

Tanjong Agas Industrial Area, P.O. Box 62, 84007 Muar, Malaysia
Email : msa_vmd@micron.com * = Mandatory Information

New Change

Electronic Funds Transfer (EFT) Enrollment Form

* Company Name:__ _______

* Company Address: __________________________________________________________________________

Bank Information (please also refer to Important Notes on Page 2):

* Exact Account Name:

* Bank Account No.:

* Bank Name:

* Bank Code: * Currency: _______________________

* Bank Branch Name: __________________________________________* Bank Branch Code : ________________

* Bank Address:

* Routing/ABA No. (for Telegraphic Transfer) :

* Swift Code: ______________________________________ * IBAN No. ___________________________________

For assistance with verification of above information (please also refer to Important Notes on Page 2):

Bank Contact Name:

Bank Contact Phone Number:

Bank Contact Fax Number:

* Company Contact Person(s)

* Company Contact Phone Number:

* Company Contact Fax Number:

* Company Registration No. _____________________ *Tax Identification No. (GST): ________________________

* Company Contact E-Mail:_______________________________________________________________________

* Remittance E-Mail Contact:______________________________________________________________________

I certify that the information above is true and correct and that as an authorized signer for the above named
company authorization is given to Micron Accounts Payable to electronically deposit payments to the
designated bank account. In addition, the Company hereby authorizes Company’s bank to release to Micron
verification of the accuracy of the bank information contained herein.

Acknowledged and Agreed to (please also refer to Important Notes on Page 2):

* Authorized Signature * Company Stamp

_______
* Print Name * Title
_______
* Phone Number * Date
Important Notes:

1. Please provide a copy of your company’s latest bank statement showing the company name and the relevant
bank details to support this EFT form. You can omit sensitive transaction data.

2. Please provide a copy of your company’s BIZFILE business registration certificate to support the information
filled for company registration and GST Tax registration numbers.

3. Please ensure that the person who prepares the form is not the same person who reviews, approves and signs
the form.

4. Please ensure that the approver is a Managing Director / Financial Controller / General Manager or someone
of equivalent seniority.

5. Please remember to affix your company stamp. If you don’t have a company stamp, please provide
explanation.