AUTOMOBILE ASSOCIATION OF MALAYSIA (AAM)

225, Block 4, No. 7, Persiaran Sukan, Laman Seri Business Park

Section 13, 40100 Shah Alam, Selangor Darul Ehsan, Malaysia
Tel No: 603 5511 1932

Fax No: 603 5511 3314

Hotline No.: 1 300 226 226

Email : tmkt@aam.org.my

AAM MEMBERSHIP NEW APPLICATION / RENEWAL FORM

*** FOR RENEWAL ONLY

MEMBERSHIP NO :

EXPIRY DATE :

PARTICULARS UPDATE
PLEASE TICK ( / ) WHERE APPLICABLE
( / ) YES! I/WE WOULD LIKE TO APPLY OR RENEW MY/OUR AAM CARD
FULL NAME :

GENDER :
(

) MALE

NRIC NO :

MARITAL STATUS :
(

) FEMALE

) SINGLE

DATE OF BIRTH :

ADDRESS :

CONTACT :
HOUSE :

HANDPHONE :

OFFICE :

HANDPHONE :

FAX :

HANDPHONE :

EMAIL :

OCCUPATION :

NATIONALITY :

) MARRIED

AAM MEMBERSHIP PLAN

YES! I/WE WOULD LIKE TO APPLY FORM FOR MY AAM CARD (PLEASE TICK WHERE APPLICABLE)
NOTE : ENROLMENT FEE (COMPULSORY), RM 25 FOR BASIC, ORDINARY AND ELITE. (FOR NEW APPLICATION ONLY)

BASIC MEMBERSHIP (
(

) ***NEW APPLICATION : ENROLMENT FEE (COMPULSORY) = RM 25 (

) 1 YEAR/RM 75

ORDINARY MEMBERSHIP (

) 2 YEAR/RM 130

)***

) 3 YEAR/RM 195

) ***NEW APPLICATION : ENROLMENT FEE (COMPULSORY) = RM 25 (

)***

1) PRINCIPAL
(

) 1 YEAR/RM 75

2) SPOUSE'S NAME
(

) 2 YEAR/RM 130

) 3 YEAR/RM 195

) 2 YEAR/RM 60

) 3 YEAR/RM 90

) 3 YEAR/RM 90 x (

) 1 YEAR/RM 30

3) CHILD SUPPLEMENTARY (17 - 21 YEARS OLD)

(

) 1 YEAR/RM 30 x (

) PERSON

) 2 YEAR/RM 60 x (

) PERSON

CHILD'S NAME
1)
2)
3)

) PERSON

DATE OF BIRTH

4) DRIVER'S SUPPLEMENTARY (MAXIMUM 2 PERSON)

(

) 1 YEAR/RM 30 x (

) PERSON

) 2 YEAR/RM 60 x (

) PERSON

DRIVER'S NAME

) 3 YEAR/RM 90 x (

) PERSON

VEHICLE NO.

ADDITIONAL CAR (MAXIMUM 4 CARS), FIRST 2 CARS REGISTRATION IS FREE

(

) 1 YEAR/RM 30

) 2 YEAR/RM 60

VEHICLE NO. (THIRD CAR) : ______________________

ELITE MEMBERSHIP (

) 3 YEAR/RM 90

VEHICLE NO. (FOURTH CAR): ____________________

) ***NEW APPLICATION : ENROLMENT FEE (COMPULSORY) = RM 25 (

)***

1) PRINCIPAL
(

) 1 YEAR/RM 100

2) SPOUSE'S NAME
(

) 2 YEAR/RM 200

) 3 YEAR/RM 300

) 2 YEAR/RM 100

) 3 YEAR/RM 150

) 3 YEAR/RM 150 x (

) 1 YEAR/RM 50

3) CHILD SUPPLEMENTARY (17 - 21 YEARS OLD)

(

) 1 YEAR/RM 50 x (

) PERSON

) 2 YEAR/RM 100 x (

) PERSON

CHILD'S NAME
1)
2)
3)

) PERSON

DATE OF BIRTH

4) DRIVER'S SUPPLEMENTARY (MAXIMUM 2 PERSON)

(

) 1 YEAR/RM 50 x (

) PERSON

) 2 YEAR/RM 100 x (

) PERSON

DRIVER'S NAME

) 3 YEAR/RM 150 x (

) PERSON

VEHICLE NO.

ADDITIONAL CAR (MAXIMUM 4 CARS), FIRST 2 CARS REGISTRATION IS FREE

(

) 1 YEAR/RM 50

) 2 YEAR/RM 100

VEHICLE NO. (THIRD CAR) : ______________________

) 3 YEAR/RM 150

VEHICLE NO. (FOURTH CAR) : ____________________

VEHICLE DETAILS
***VEHICLE & DRIVING LICENSE PARTICULAR TO FILL IN BY ALL MEMBERS***

CAR REGISTRATION NO.

ROAD TAX EXPIRY DATE

MAKE/MODEL/YEAR/CC

1)
2)
3)
4)
DRIVING LICENSE NO. :

EXPIRY DATE :

MEGAPAL PA COVERAGE (OPTIONAL)

1) INDIVIDUAL PLAN

) 1 YEAR/RM 25

) 2 YEAR/RM 50

) 3 YEAR/RM 75

) 2 YEAR/RM 100

) 3 YEAR/RM 150

1) FAMILY PLAN

) 1 YEAR/RM 50

FORM OF PAYMENT
1) AAM BASIC MEMBERSHIP

GRAND TOTAL

= RM

2) AAM ORDINARY MEMBERSHIP

GRAND TOTAL

= RM

3) AAM ELITE MEMBERSHIP

GRAND TOTAL

= RM

CASH (WALK-IN APPLICATION ONLY)

CHEQUE
(CHEQUE MUST BE MADE PAYABLE TO "THE AUTOMOBILE ASSOCIATION OF MALAYSIA"

CREDIT CARD

AMEX

CARDHOLDER'S NAME

CARD NO.

EXPIRY DATE

DINERS

VISA

MASTER

DEBIT

CREDIT CARD / CHARGE AUTO DEBIT

(

YES

TO AVOID MY AAM MEMBERSHIP CARD FROM LAPSING, PLEASE CHARGE THE RENEWAL FEE OF CREDIT/
CHARGE CARD INDICATED UNTIL FURTHER WRITTEN NOTICE.

NO

I DECLARE THAT ABOVE INFORMATION IS TRUE AND COMPLETE. I HAVE READ AND UNDERSTOOD THE
TERMS AND CONDITIONS CONTAINED HEREIN AND AGREE TO BE BOUND BY THEM AND ALL
AMENDMENT THERETO. I HEREBY AUTHORIZE AAM TO CHARGE MY CREDIT/CHARGE CARD FOR THE
AMOUNT STATED ABOVE OR ANY OTHER AMOUNT THAT MAY BECOME DUE UNTIL FURTHER NOTIVE
IS GIVEN.

CARDHOLDER'S SIGNATURE

DATE