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Customer Declaration Form

Please complete all declarations below. Your information is saved securely upon submission.

Full Name *

NRIC *

Mobile Number

Declarations

I declare that I have provided all personal detail accurately and completely.

I declare that the income document provider information submitted is true and correct.

Savings Account & AMLA Declarations

I hereby declare that I take full responsibility for the accuracy of the following declarations. I understand that failure to disclose any of the below will not be accepted with excuses such as "forgot", "don't remember", or "don't know", and the company reserves the right to reject my application accordingly.

I declare that I am not involved in any AMLA (Anti-Money Laundering Act) offence.

I declare that I did not borrow from my own savings account.

I declare that I did not rent out my own savings account.

Savings Account Held At (tick all that apply)

MaybankCIMBPublic BankRHBHong Leong BankAmBankAffin BankBank IslamBank RakyatBSNCitibankHSBCStandard CharteredUOBOCBCAlliance BankBank MuamalatAgrobankOthers

Repayment History (Past 10 Years)

For the past 10 years, have you had any bank facilities with repayment issues (e.g. late payment, restructuring, AKPK, legal action)?

This is a staff preview. Use "Save All Detail" to store this declaration as a draft, or generate a secure signing link to send to the customer.