AMANAH FINANCE APPLICATION FORM / BORANG PERMOHONAN PEMBIAYAAN AMANAH
MY/OUR ACCOUNT INFORMATION / MAKLUMAT AKAUN PERMOHONAN SAYA/KAMI
Branch / Cawangan
Existing Customer of HSBC/HSBC Amanah / Pelanggan HSBC/HSBC Amanah Sedia Ada
Existing Products
with HSBC/
HSBC Amanah /
Produk-produk
HSBC/HSBC Amanah
Sedia Ada
Category / Kategori
MY/OUR REQUIREMENTS / KEPERLUAN SAYA/KAMI
TYPE OF FACILITIES REQUIRED /
JENIS KEMUDAHAN YANG
DIPERLUKAN
TYPE OF APPLICATION /
JENIS PERMOHONAN
FOR HOUSING FACILITY ONLY /
UNTUK PEMBIAYAAN
PERUMAHAN SAHAJA
DETAILS OF PROPERTY /
MAKLUMAT HARTANAH
Issued by HSBC Amanah Malaysia Berhad (Company No. 807705-X) / Dikeluarkan oleh HSBC Amanah Malaysia Berhad (No. Syarikat 807705-X)
Region / Kawasan
Yes / Ya No / Tidak
HSBC Premier Account/HSBC Amanah Premier Account-i / Time Deposit/Term Deposit-i /
Akaun HSBC Premier/Akaun-i HSBC Amanah Premier Simpanan Tetap/Deposit Bertempoh-i
(Protected by PIDM up to RM250,000 per depositor/Dilindungi oleh (Protected by PIDM up to RM250,000 per depositor/Dilindungi oleh
PIDM setakat RM250,000 bagi setiap pendeposit) PIDM setakat RM250,000 bagi setiap pendeposit)
HSBC Advance Account/HSBC Amanah Advance Account-i / Credit Card(s)/-i / Kad Kredit/-i
Akaun HSBC Advance/Akaun-i HSBC Amanah Advance
(Protected by PIDM up to RM250,000 per depositor/Dilindungi oleh Basic Current Account/-i / Akaun/-i Semasa Asas
PIDM setakat RM250,000 bagi setiap pendeposit) (Protected by PIDM up to RM250,000 per depositor/Dilindungi oleh
Basic Savings Account/-i / Akaun/-i Simpanan Asas PIDM setakat RM250,000 bagi setiap pendeposit)
(Protected by PIDM up to RM250,000 per depositor/Dilindungi oleh
PIDM setakat RM250,000 bagi setiap pendeposit)
Financing Facility / Kemudahan Pembiayaan
Sole / Persendirian Joint / Bersama Customer No. / No. Pelanggan
HomeSmart-i (MH3) HomeSmart-i Priority (MH7)
HomeSmart-i Reserve (MH5) Business Premises Smart-i (MG4)
HomeSmart-i Advantage (MH6)
Other Products / Lain-lain Produk
(Please Specify / Sila Nyatakan)
Purpose of Facility / Tujuan Pembiayaan
Sole / Sendiri Joint / Bersama
For New Purchase / Untuk Pembelian Baru
Developer / Pemaju Non-developer / Bukan Pemaju
Purchase Price / RM Net Purchase Price / RM
Harga Belian Harga Belian Bersih
Discount/Rebates / RM Current Market Value / RM
Diskaun/Rebat Nilai Pasaran Semasa
For Refinancing / Untuk Pembiayaan Semula
Unencumbered / Tiada Bebanan Encumbered / Ada Bebanan
Current Market Value / RM Name of Financing Instituation / Nama Institusi Pinjaman
Nilai Pasaran Semasa
Outstanding Financing / RM
Pembiayaan Belum Dibayar
Completed with Certificate of Completion and Compliance / Under Construction / Dalam Pembinaan
Dilengkapkan dengan Sijil Penyiapan dan Pematuhan
Landed / Hartanah Non-landed (Condo/Apartment/Flat) /
Bukan Hartanah (Kondo/Pangsapuri/
Rumah Pangsa)
Type of Property / Jenis Hartanah
Link House/Semi-detached House/Bungalow / Service Apartment / Shophouse/Shoplot /
Rumah Berangkai/Rumah Berkembar/Banglo Pangsapuri Perkhidmatan Rumah Kedai
Condo/Apartment/Townhouse / SOHO/SOFO/SOVO Others (Please Specify) /
Kondominium/Pangsapuri/Rumah Bandar Lain-lain (Sila Nyatakan)
Ver. Sept 2020
C1
DETAILS OF TITLE / Residential Title / Hakmilik Kediaman Commercial Title / Hakmilik Komersial
MAKLUMAT HAKMILIK Non-HDA HDA
Freehold / Pegangan Bebas Leasehold / Pegangan Berjangka
Remaining Lease / Baki Tempoh Pegangan Year / Tahun

Individual Title / Hakmilik Individu Strata Title / Hakmilik Strata Master Title / Hakmilik Induk

Lot No. / No. Lot Title No. / No. Hakmilik

Section/Mukim / Seksyen/Mukim District / Daerah

State / Negeri

Project Name / Nama Projek Project Phase / Fasa Projek

Address of Property / Alamat Hartanah

State / Negeri

Name of Developer and Business

Registration No. / Nama pemaju dan
No. Pendaftaran Syarikat
Current Registered Owner(s)
& Identification No. /
Pemilik Berdaftar Sekarang
dan No. Identifikasi
Developer Code / Kod Pemaju

Name of New Registered Owner(s) /

Nama Pemilik yang Baru Berdaftar

Identification No. of New Owner /

No. Identifikasi Pemilik Baru

My/Our First House / Yes / Ya No / Tidak Malay Reserve Land / Yes / Ya No / Tidak
Rumah saya/kami Tanah Rizab Melayu
yang Pertama

My/Our Only House / Yes / Ya No / Tidak Native Title/Native Land / Yes / Ya No / Tidak
Rumah saya/kami Geran Asal/Tanah Asli
yang Tunggal

Owner Occupied / Yes / Ya No / Tidak

Didiami Pemilik

FACILITY REQUIRED / Total Facility Applied / Jumlah Kemudahan Yang Dipohon RM , of which /
KEMUDAHAN YANG yang mana,
DIPERLUKAN
(a) Legal and Valuation Fees Amount (Combined) / RM (Combined Amount /
Amaun Bayaran Guaman dan Penilaian (Tergabung) Amaun Tergabung)

(b) Legal Fees (Individually - where the Financing is only RM (Individual Amount /
Legal Fees) / Bayaran Guaman (Individu - yang mana Amaun Individu)
Pembiayaan hanyalah Bayaran Guaman)

(c) Valuation Fees (Individually - where the Financing is only RM (Individual Amount /
Valuation Fees) / Bayaran Penilaian (Individu - yang mana Amaun Individu)
Pembiayaan hanyalah Bayaran Penilaian)

TOTAL FINANCING For Refinancing Only / Untuk Pembiayaan Semula Sahaja

REQUIRED TO PAY FOR /
JUMLAH PEMBIAYAAN
UNTUK PEMBAYARAN (a) Redemption Sum / Jumlah Penebusan RM

(b) Legal and Valuation Fees Amount (Combined) / RM (Combined Amount /

Amaun Bayaran Guaman dan Penilaian (Tergabung) Amaun Tergabung)

Legal Fees (Individually - where the Financing is only RM (Individual Amount /

Legal Fees) / Bayaran Guaman (Individu - yang mana Amaun Individu)
Pembiayaan hanyalah Bayaran Guaman)

Valuation Fees (Individually - where the Financing RM (Individual Amount /

is only Valuation Fees) / Bayaran Penilaian Amaun Individu)
(Individu - yang mana Pembiayaan hanyalah
Bayaran Penilaian)

(c) Others / Lain-lain RM

(Pls specify e.g. Hire Purchase, Credit Card, etc /
Ver. Sept 2020

Sila nyatakan misalnya, Sewa Beli, Kad Kredit, dll)

(d) Standby / Tunggu Sedia RM

Total / Jumlah RM
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Payment Period / Tempoh Bayaran

(Years / Tahun) (Months / Bulan)

If the payment period extends beyond your retirement age, it is important for you to have a plan for your payment obligations during retirement.
Jika tempoh pembayaran menjangkaui usia persaraan anda, anda perlu mempunyai rancangan untuk menjelaskan bayaran anda semasa bersara.

Margin of Financing / Margin Pembiayaan %

Source of Funds / Punca Dana:

Personal Savings (including EPF) / Contribution From Relatives/

Investment Returns / Simpanan Peribadi Sumbangan Dari Ahli Keluarga
(termasuk KWSP)/Pulangan Dari Pelaburan

Sale of Asset (eg. Property, Land, Car) / Others (Please Specify)/

Penjualan Aset (contohnya Hartanah, Tanah, Kenderaan) Lain - lain (Sila Nyatakan)

Additional Security: Time Deposit-i under lien / RM

Jaminan Tambahan: Deposit Bertempoh-i di bawah lien

Ver. Sept 2020

C3
 ABOUT MYSELF/OURSELVES / MENGENAI DIRI SAYA/KAMI

MAIN APPLICANT / PEMOHON UTAMA CO-APPLICANT / PEMOHON BERSAMA

1. Full Name as in IC/Passport/ 1. Mr/Mdm/Ms/Dr / En/Puan/Cik/Dr 1. Mr/Mdm/Ms/Dr / En/Puan/Cik/Dr
Nama Penuh seperti
dalam KP/Pasport

2. Former or Other Name 2. Mr/Mdm/Ms/Dr / En/Puan/Cik/Dr 2. Mr/Mdm/Ms/Dr / En/Puan/Cik/Dr

(if applicable) / Nama Dahulu
atau Lain-lain (jika ada)

3. Nationality/ 3. Malaysian / Warga Malaysia 3. Malaysian / Warga Malaysia

Kewarganegaraan Non-Malaysian / Bukan Warga Malaysia Non-Malaysian / Bukan Warga Malaysia
Please state / Sila nyatakan: Please state / Sila nyatakan:

Other Nationalities / Lain-lain Kewarganegaraan Other Nationalities / Lain-lain Kewarganegaraan

1) 1)
2) 2)
A) For Malaysian/
Untuk Warga Malaysia

Primary ID / ID Utama New IC No. / No. KP Baru New IC No. / No. KP Baru

Secondary ID / ID Kedua Old IC No. / No. KP Lama Old IC No. / No. KP Lama
(Choose one if applicable / Pilih satu
sekiranya ada)

Permanent Resident No. / Permanent Resident No. /

No. Penduduk Tetap (PR) No. Penduduk Tetap (PR)

B) For Non-Malaysian/
Untuk Bukan Warga Malaysia

Primary ID / ID Utama Passport No. / No. Pasport Passport No. / No. Pasport

Country / Region of Issue / Negara / Kawasan Dikeluarkan Country / Region of Issue / Negara / Kawasan Dikeluarkan

Date of Issue / Tarikh Dikeluarkan Date of Issue / Tarikh Dikeluarkan

(dd/mm/yyyy) (dd/mm/yyyy)
Expiry Date / Tarikh Luput Expiry Date / Tarikh Luput
(dd/mm/yyyy) (dd/mm/yyyy)

Secondary ID / ID Kedua Malaysia Permanent Resident No. / Malaysia Permanent Resident No. /
No. Penduduk Tetap (PR) Malaysia No. Penduduk Tetap (PR) Malaysia

Resides in Malaysia more than 182 days in the past Resides in Malaysia more than 182 days in the past
12 months / Tinggal di Malaysia lebih daripada 12 months / Tinggal di Malaysia lebih daripada 182 hari
182 hari dalam tempoh 12 bulan yang lalu dalam tempoh 12 bulan yang lalu
Yes / Ya No / Tidak Yes / Ya No / Tidak

4. Sex / Jantina 4. Male / Lelaki Female / Perempuan 4. Male / Lelaki Female / Perempuan

5. Date of Birth / Tarikh Lahir 5. Age / Umur 5. Age / Umur

6. Country / Region of Birth / 6. 6.

Negara / Kawasan Lahir
7. Race / Bangsa 7. Bumiputra Chinese / Cina 7. Bumiputra Chinese / Cina
Indian / India Others / Lain-lain Indian / India Others / Lain-lain
8. Marital Status / 8. Single / Bujang Married / Kahwin 8. Single / Bujang Married / Kahwin
Status Perkahwinan Widowed / Balu/Duda Widowed / Balu/Duda
Divorced/Separated / Bercerai/Berpisah Divorced/Separated / Bercerai/Berpisah
9. No. of Dependents / 9. 9.
Bilangan Tanggungan
10. Education Level / 10. Limited/None / Terhad/Tiada Tertiary / Ijazah 10. Limited/None / Terhad/Tiada Tertiary / Ijazah
Tahap Pendidikan Primary / Rendah Postgraduate / Primary / Rendah Postgraduate /
Pasca ijazah Pasca ijazah
Secondary / Menengah Professional / Secondary / Menengah Professional /
Profesional Profesional
11. Relationship with / 11. Main Applicant / Pemohon Utama
Ver. Sept 2020

Hubungan dengan
Spouse / Suami isteri Others/
Lain-lain
Immediate Family*/
Ahli Keluarga Terdekat*
C4
 MAIN APPLICANT / PEMOHON UTAMA CO-APPLICANT / PEMOHON BERSAMA

Other Co-Applicant (if any) /

Pemohon Bersama Yang Lain (jika ada)
Name / Nama

Spouse / Suami isteri Others /

Lain-lain
Immediate Family*/
Ahli Keluarga Terdekat*

* Immediate family refer, to parents, children or siblings. / Ahli keluarga

terdekat merujuk kepada ibubapa, anak atau adik beradik.

12. Relationship with Director/ 12. Yes / Ya No / Tidak 12. Yes / Ya No / Tidak
Employee of HSBC or their If yes, name of Director/Employee or Service Provider/ If yes, name of Director/Employee or Service Provider/
Service Providers (including Landlord/Lessor/Vendor/Purchaser of real estate of HSBC/ Landlord/Lessor/Vendor/Purchaser of real estate of HSBC/
Professional Services) or Jika ya, nama Pengarah/Pekerja atau Penyedia Perkhidmatan/ Jika ya, nama Pengarah/Pekerja atau Penyedia Perkhidmatan/
Landlords/Lessors/Vendors/ Tuan Tanah/Pemberi Pajak/Vendor/ Tuan Tanah/Pemberi Pajak/Vendor/
Pembeli hartanah HSBC Pembeli hartanah HSBC
Purchasers of real estate or
capitalised leases /
Hubungan dengan Pengarah/
Pekerja HSBC atau Penyedia
Perkhidmatan mereka (termasuk
Perkhidmatan Profesional) atau
Tuan Tanah/ Pemberi Pajak/
Vendor/Pembeli hartanah atau
pajakan dipermodalkan
13. Relationship with Director of 13. Yes / Ya No / Tidak 13. Yes / Ya No / Tidak
HBAP (HongKong and
Shanghai Banking Corporation If yes, Director name of HBAP / Jika ya, nama Pengarah HBAP: If yes, Director name of HBAP / Jika ya, nama Pengarah HBAP:
Ltd) / Hubungan dengan
Pengarah HBAP (HongKong
and Shanghai Banking
Corporation Ltd)
14. Permanent Residence 14. 14.
Status - Country / Region /
Status Kediaman Tetap - Negara
/ Kawasan

15. Mailing Address / 15. 15.

Alamat Surat-menyurat

Postcode / Poskod Postcode / Poskod

Town / Bandar Town / Bandar
State / Negeri State / Negeri

16. Present Residential Address / 16. 16.

Alamat Kediaman Sekarang

Postcode / Poskod Postcode / Poskod

Town / Bandar Town / Bandar
State / Negeri State / Negeri
At This Address Since / (dd/mm/yyyy) (dd/mm/yyyy)
Di Alamat Ini Sejak

17. Previous Residential Address 17. 17.

Details if the Present
Residential Address is less
than 1 year / Postcode / Poskod Postcode / Poskod
Butir-butir Alamat Terdahulu
sekiranya Alamat Kediaman Town / Bandar Town / Bandar
Terkini kurang dari 1 tahun State / Negeri State / Negeri

18. Permanent Residential 18. 18.

Address / Alamat Kediaman Tetap
(If different from present residential address /
Jika berlainan daripada alamat kediaman Postcode / Poskod Postcode / Poskod
sekarang)
Town / Bandar Town / Bandar
State / Negeri State / Negeri

19. Contact No. / 19. Tel No. / No. Tel 19. Tel No. / No. Tel
No. untuk Dihubungi H/P No. / No. T/B H/P No. / No. T/B
E-mail / E-mel E-mail / E-mel

20. Residence is / 20. Rented / Menyewa RM 20. Rented / Menyewa RM

Kediaman adalah Parent’s/Relative’s / Ibubapa/Saudara Parent’s/Relative’s / Ibubapa/Saudara
Mortgaged / Pajakan Mortgaged / Pajakan
Ver. Sept 2020

Owned / Sendiri Owned / Sendiri

Employer’s / Syarikat Employer’s / Syarikat
Years There / Bilangan Tahun di sana Years There / Bilangan Tahun di sana

C5
 ABOUT MY/OUR JOB / MENGENAI PEKERJAAN SAYA/KAMI

MAIN APPLICANT / PEMOHON UTAMA CO-APPLICANT / PEMOHON BERSAMA

1. Name of Firm/Employer / 1. 1.
Nama Syarikat/Majikan

2. Nature of Business /
Jenis Perniagaan Majikan
3. If Own Business, Please
Provide Business Registration
No. / Jika Syarikat Sendiri, Sila
Nyatakan No. Pendaftaran Syarikat
4. Employment Status /
Status Pekerjaan
2. 2.
3. 3.
4. Private Sector Employees / 4. Private Sector Employees /
Kakitangan Sektor Swasta Kakitangan Sektor Swasta
Government Employees / Government Employees /
Kakitangan Kerajaan Kakitangan Kerajaan
Self-employed - Ltd/Private Ltd Cos/Sdn Bhd/Bhd / Self-employed - Ltd/Private Ltd Cos/Sdn Bhd/Bhd /
Bekerja Sendiri - Ltd/Private Ltd Cos/Sdn Bhd/Bhd Bekerja Sendiri - Ltd/Private Ltd Cos/Sdn Bhd/Bhd
Self-employed - Sole Trader / Self-employed - Sole Trader /
Bekerja Sendiri - Peniaga Tunggal Bekerja Sendiri - Peniaga Tunggal
HSBC/HSBC Amanah Staff / HSBC/HSBC Amanah Staff /
Kakitangan HSBC/HSBC Amanah Kakitangan HSBC/HSBC Amanah
Housewife / Surirumah Housewife / Surirumah
Retired/Pension / Pesara Retired/Pension / Pesara
Student / Pelajar Student / Pelajar
Unemployed / Penganggur Unemployed / Penganggur

5. Occupation Code / Kod Jawatan 5. 5.

6. Position Held / 6. 6.
Jawatan yang Dipegang
7. Date of Establishment/Joined / 7. 7.
Tarikh Didaftar/Mula Bekerja
Years There / Berapa Tahun
8. Business/Office Address / 8. 8.
Alamat Perniagaan/Pejabat

Postcode / Poskod Postcode / Poskod

Town / Bandar Town / Bandar
State / Negeri State / Negeri

9. Office Contact No. / 9. Tel No. / No. Tel 9. Tel No. / No. Tel
No. Perhubungan Pejabat Fax No. / No. Faks Fax No. / No. Faks
E-mail / E-mel E-mail / E-mel

10. Previous Employer / 10. 10.

Majikan Terdahulu
Name / Nama
Address / Alamat

Years There / Berapa Tahun

11. Gross Annual Income / 11. 11.

Pendapatan Kasar Tahunan

12. Other Annual Income (if any) / 12. 12.

Lain-lain Pendapatan Tahunan
(jika ada)
13. Country(ies) / Region / 13. i) 13. i)
Jurisdiction(s) of Tax Residence / ii) ii)
Negara / Kawasan / Bidang
Kuasa Cukai Kediaman iii) iii)
Ver. Sept 2020

C6
 ADDITIONAL INFORMATION / MAKLUMAT TAMBAHAN

MAIN APPLICANT / CO-APPLICANT /

PEMOHON UTAMA PEMOHON BERSAMA
My Number of Home Financing Facilities with Non-Financial Institutions /
Kemudahan Pembiayaan Rumah Anda Dengan Institusi Bukan Kewangan
My Total Monthly Instalments with Non-Financial Institutions
(Including Home Financing Facilities) /
Ansuran Bulanan Anda Dengan Institusi Bukan Kewangan
(Termasuk Kemudahan Pembiayaan Rumah)

Signature of Main Applicant / Tandatangan Pemohon Utama Signature of Co-Applicant / Tandatangan Pemohon Bersama

SENIOR PUBLIC OFFICER DECLARATION (E.G.: MINISTERIAL OR DIPLOMATIC POSITIONS) /

PENGAKUAN PEGAWAI KANAN AWAM ATASAN (MISALNYA: JAWATAN MENTERI ATAU DIPLOMAT)

Yes, I/my immediate family members / Ya, saya/ahli keluarga terdekat saya
Currently Hold / Kini Memegang Jawatan Have Held / Pernah Memegang Jawatan
Are Actively Seeking / Sedang Aktif Mencari Are Being Considered for / Sedang Dipertimbangkan untuk

Senior Public Officer / Jawatan Pegawai Kanan Awam Position Held / Jawatan Dipegang
Period Held From / Tempoh Dipegang Dari
/ / to / hingga / /
Day / Hari Month / Bulan Year / Tahun Day / Hari Month / Bulan Year / Tahun

No, I/my immediate family members do not hold, have never held, are not actively seeking and are not being considered for senior public officer. /
Tidak, saya/ahli keluarga terdekat saya tidak menyandang/memegang, tidak pernah menyandang, tidak aktif mencari dan tidak dipertimbangkan untuk
jawatan pegawai kanan awam.

MY/OUR DECLARATION/DISCLOSURE / PENGISYTIHARAN/PENGAKUAN SAYA/KAMI

1. I/We declare and confirm that I/we have fully disclosed in this application form, all the information on my/our outstanding debt obligations, including
secured and unsecured financing obtained from all financial institutions and other non-bank entities that provide credit facilities (e.g. cooperatives, building
societies, credit companies and merchants that provide credit sales) and that such information is correct, complete and not misleading. I/We authorise you
or your representative to confirm this from any source you may choose, including carrying out credit and other financial checks and obtaining credit reports
and information on me/us and also on all guarantors and security providers (as applicable) (collectively “Data Subjects”) from time to time, from Credit
Bureau Malaysia and any other credit reporting agencies registered under the Credit Reporting Agencies Act 2010 (as listed on the Bank’s website at
www.hsbcamanah.com.my), and I/we consent to Credit Bureau Malaysia sourcing and retaining information on me/us and all Data Subjects from any
available data source and disclosing to you any such information as you may request. I/We warrant that I/we have been irrevocably authorised by the Data
Subjects to give this consent on their behalf. / Saya/Kami dengan ini memperakui dan mengesahkan bahawa saya/kami telah mendedahkan sepenuhnya semua
maklumat di dalam borang ini mengenai kewajipan hutang saya/kami yang belum jelas – termasuk pembiayaan bercagar dan tidak bercagar yang diperolehi
daripada semua institusi kewangan dan entiti bukan perbankan lain yang memberikan kemudahan kredit (contoh: koperasi, persatuan pembinaan, syarikat kredit
dan pedagang yang memberi kemudahan jualan kredit) dan bahawa semua maklumat yang diberikan adalah betul, lengkap dan tidak mengelirukan. Saya/Kami
membenarkan pihak Bank atau wakilnya untuk mengesahkan perkara ini diperolehi daripada mana-mana sumber yang dipilih oleh pihak Bank, termasuk
melakukan pemeriksaan kredit serta kewangan lain dan mendapatkan laporan dan maklumat kredit mengenai saya/kami dan juga mengenai semua penjamin
dan penyedia cagaran (jika berkenaan) (secara kolektif “Subjek Data”) dari semasa ke semasa daripada Biro Kredit Malaysia dan mana-mana agensi pelaporan
kredit yang berdaftar dibawah Akta Pelaporan Kredit 2010 (seperti yang tersenarai di lawan web www.hsbcamanah.com.my), dan saya/kami bersetuju bahawa
Biro Kredit Malaysia boleh mendapatkan dan menyimpan maklumat mengenai saya/kami dan semua Subjek Data daripada mana-mana sumber maklumat yang
tersedia dan mendedahkan kepada anda sebarang maklumat yang diminta. Saya/Kami dengan ini memberi jaminan bahawa saya/kami telah mendapat
kebenaran yang tidak boleh dibatalkan daripada Subjek Data untuk memberi persetujuan ini bagi pihak mereka.
2. I/We understand that failure to provide full and correct material information that has a bearing on your decision whether or not to approve this application,
may lead to (i) rejection of this application or (ii) you imposing a higher lease rental rate or profit rate (as applicable) or (iii) termination of the financing, if
granted. / Saya/Kami memahami bahawa jika saya/kami gagal memberikan maklumat penting secara sepenuhnya dan sebenarnya, yang mempengaruhi
keputusan pihak Bank untuk meluluskan permohonan ini, tindakan tersebut boleh menyebabkan (i) permohonan ini ditolak; atau (ii) bank mengenakan kadar
sewa pajak atau kadar keuntungan lebih tinggi (iii) kemudahan ditamatkan, jika sudah diberikan.
3. If the financing tenure extends beyond my/our retirement age, I/we am/are aware of the importance of ensuring that I/we have sufficient funds to meet
my/our payment obligations after my/our retirement. / Jika tempoh pembiayaan melampaui usia persaraan saya/kami, saya/kami sedar betapa pentingnya
untuk memastikan saya/kami mempunyai dana secukupnya untuk menunaikan kewajipan pembayaran saya/kami di bawah kemudahan ini apabila saya/kami
sudah bersara.
4. I/We hereby irrevocably consent and agree that you may collect information on my/our application, facility, conduct thereof, accounts, other facilities
presently held and those which may be subsequently opened or obtained, including those of my/our supplementary cardholders (“Information”), and
process and disclose such Information in the manner described in the Bank’s Generic Terms and Conditions, Clause 10 “Collection, Processing and
Sharing of Customer Information” (available at the Bank’s website www.hsbcamanah.com.my or upon request). / Saya/Kami dengan ini memberikan
kebenaran dan persetujuan bahawa pihak bank boleh mengumpul maklumat mengenai permohonan, kemudahan, cara penyelenggaraan, akaun, kemudahan
semasa yang lain dan perkara yang seterusnya dibuka atau diperolehi, termasuk perkara berkenaan pemegang kad sampingan saya/kami (“Maklumat”), dan
memproses serta mendedahkan maklumat tersebut menurut cara yang dinyatakan dalam Klausa 10, Terma dan Syarat Umum Bank, "Pengumpulan,
Pemprosesan dan Perkongsian Maklumat Pelanggan" (boleh didapati di laman web www.hsbcamanah.com.my atau atas permintaan).
5. I/We understand that I/we may at anytime request for a copy of the Information by following the procedures set out in your Privacy Statement at
www.hsbcamanah.com.my and that I/we may have to pay a fee for the same. / Saya/Kami memahami bahawa saya/kami boleh meminta satu salinan
Maklumat pada bila-bila masa dengan mengikuti prosedur yang ditetapkan di dalam Penyata Sulit di www.hsbcamanah.com.my dan saya/kami mungkin perlu
Ver. Sept 2020

membayar fi bagi perkara tersebut.

6. I/We understand and accept that the granting of the Facility is subject to legislation which have imposed certain restrictions and prohibitions on the Bank
providing banking facilities (i) to persons related to officers, directors or shareholders of the Bank and that of the holding company of the Bank’s parent
company, The Hongkong And Shanghai Banking Corporation Limited, or (ii) to directors of any entity within the HSBC Group. These are (i) Section 57 of the
Islamic Financial Services Act, 2013 (“IFSA”) read with the Guidelines on Credit Transactions and Exposures with Connected Parties for Islamic

C7
 Banks issued by Bank Negara Malaysia, as the same may be replaced, amended or updated from time to time (the “Restrictions”), (ii) Section 83 of the
Banking Ordinance of Hong Kong Special Administrative Region, the law of the place in which the holding company of the Bank’s parent company is
located, and (iii) Section 224 of the Companies Act 2016, as the same may be amended, re-enacted or replaced (collectively, the “Prohibitions”). I/We
represent and warrant to the Bank that I/we (a) am/are not in any way connected to any of the officers, directors, shareholders or service providers (including
professional services) or landlords/lessors/vendors or purchasers of real estate or capitalised leases of the Bank and/or the Bank’s parent company and/or
the holding company of the Bank’s parent company or if the Customer is so connected, that the Customer has informed the Bank of the same, and (b) do(es)
not hold directorships within the meaning of the Restrictions and/or Prohibitions. I/We shall immediately inform the Bank if I/we become an individual(s) so
connected or prohibited under paragraphs (a) and/or (b). I/We further agree that it shall be an Event of Default in the event the Facility should at anytime,
whether at the time of granting or after the time of granting, be in contravention of the Prohibitions. The Bank reserves the right to cancel the Facility if it
contravenes the Restrictions and/or Prohibitions. Explanatory Notes: 1. Please note that for the purposes of the IFSA, “officer” encompasses “any employee
or the chief executive officer of the body corporate or unincorporated” and relative to an individual includes, “(a) the spouse of the individual; (b) the brother
or sister of the individual, or of the spouse of the individual; (c) any lineal ascendant or descendant of the individual, or of the spouse of the individual; (d)
the spouse of any individual referred to in paragraph (b) or (c); (e) any lineal descendant of an individual referred to in paragraph (b) or (d); (f) any uncle, aunt
or cousin of the individual, or of the spouse of the individual; or (g) any spouse, or any lineal ascendant or descendant, of an individual referred to in
paragraph (f). 2. “HSBC Group” means HSBC Holdings plc, its affiliates, subsidiaries, associated entities and any of their branches and offices (together or
individually), and “member(s) of the HSBC Group” has the same meaning. / Saya/Kami mengakui dan memahami bahawa pemberian Kemudahan ini adalah
tertakluk kepada undang-undang yang mengenakan sekatan dan larangan tertentu terhadap Bank untuk menyediakan kemudahan perbankan (i) kepada orang
yang berkaitan dengan pegawai, pengarah atau pemegang saham Bank dan pegangan syarikat induk, The Hongkong And Shanghai Banking Corporation
Limited, atau (ii) kepada pengarah atau mana-mana entiti di dalam Kumpulan HSBC. Ini merangkumi (i) Seksyen 57 Akta Perkhidmatan Kewangan Islam 2013
("APKI") yang dibaca bersama Garis Panduan Urus Niaga Kredit dan Pendedahan dengan Pihak Berkaitan bagi Bank-bank Islam yang dikeluarkan oleh Bank
Negara Malaysia, dan dokumen sama yang mungkin digantikan, dipinda atau dikemas kini dari masa ke masa (“Sekatan”), (ii) Seksyen 83 Ordinan Perbankan
Wilayah Pentadbiran Khas Hong Kong, undang-undang di mana terletaknya pegangan syarikat induk (iii) Seksyen 224 Akta Syarikat 2016, dan dokumen sama
yang mungkin dipinda, digubal semula atau diganti (secara bersama, “Larangan”). Saya/Kami menyatakan dan memberi jaminan kepada Bank bahawa
saya/kami (a) tidak dalam apa jua cara mempunyai kaitan dengan mana-mana pegawai, pengarah, pemegang saham atau pembekal perkhidmatan (termasuk
perkhidmatan pakar) atau pemilik/pemajak/penjual atau pembeli hartanah atau pajakan yang dipermodalkan Bank dan/atau syarikat induk Bank dan/atau syarikat
pegangan syarikat induk Bank, ataupun jika Pelanggan adalah berkaitan sedemikian, Pelanggan sudah memaklumkan pihak Bank mengenai perkara tersebut,
dan (b) tidak memegang jawatan pengarah menurut maksud Sekatan dan/atau Larangan. Saya/Kami hendaklah dengan serta-merta memaklumkan Bank jika
saya/kami menjadi individu yang berkaitan sedemikian ataupun terlarang di bawah perenggan (a) dan (b). Saya/Kami juga setuju bahawa Peristiwa Keingkaran
sudah berlaku jika Kemudahan didapati bercanggah dengan Larangan tersebut pada bila-bila masa, sama ada pada masa pemberian atau selepas pemberian.
Bank berhak untuk membatalkan Kemudahan jika ia melanggar Sekatan dan/atau Larangan. Nota Penjelasan: 1. Perhatian bahawa untuk tujuan APKI, “pegawai”
terdiri daripada “mana-mana kakitangan atau ketua pegawai eksekutif badan korporat atau bukan korporat”dan saudara-mara individu termasuk “(a) suami/isteri
individu tersebut; (b) adik-beradik individu tersebut atau suami/isteri individu tersebut; (c) mana-mana leluhur atau keturunan individu tersebut atau suami/isteri
individu tersebut; (d) suami/isteri individu yang dirujuk dalam perenggan (b) atau (c); (e) mana-mana keturunan zuriat individu yang dirujuk dalam perenggan (b)
atau (d); (f) mana-mana bapa saudara, ibu saudara atau sepupu individu tersebut, atau suami/isteri individu tersebut; atau (g) mana-mana suami/isteri, atau
leluhur atau keturunan zuriat individu yang dirujuk dalam perenggan (f). 2. "Kumpulan HSBC" bermaksud HSBC Holdings plc, syarikat gabungan, anak syarikat,
entiti yang berkaitan dan mana-mana cawangan serta pejabat mereka (secara bersama atau individu) dan "ahli Kumpulan HSBC" yang mempunyai pengertian
yang sama.
7. I/We understand that (i) the texts of the aforesaid Prohibitions will be made available upon request; (ii) approval of this application is at your sole discretion
and you reserve the right not to disclose or provide any reason if this application is unsuccessful; and (iii) it is Bank Negara Malaysia’s requirement for
information relating to this application, whether successful or otherwise, to be updated to the Central Credit Reference Information System (CCRIS)
database. / Saya/Kami memahami bahawa (i) teks dan ringkasan penjelasan Larangan di atas akan diberi atas permintaan; (ii) kelulusan permohonan adalah atas
budi bicara mutlak pihak Bank dan pihak Bank berhak untuk tidak mendedahkan atau memberikan sebarang sebab jika permohonan tidak diluluskan, dan
(iii) adalah menjadi syarat Bank Negara Malaysia bahawa maklumat yang berkaitan dengan permohonan, sama ada diluluskan atau tidak, mesti dikemaskinikan
ke dalam pangkalan data Sistem Maklumat Pusat Rujukan Kredit (CCRIS).
8. I/We understand that I/we can download a copy of the relevant Product Disclosure Sheet from www.hsbcamanah.com.my and I/we acknowledge that I/we
have read and understand the terms stated in the Product Disclosure Sheet for the type of facility(ies) required. / Saya/Kami memahami bahawa saya/kami
bolen memuat turun 1 salinan Lampiran Pendedahan Produk yang berkenaan dari www.hsbcamanah.com.my dan saya/kami mengesahkan bahawa saya/kami
telah membaca dan memahami terma yang terkandung di dalam Lampiran Pendedahan Produk tersebut bagi jenis kemudahan yang diperlukan.
9. I/We agree that the Facility (if granted) is also subject to the Bank’s Generic Terms and Conditions, Clause 8 “Financial Crime Risk Management Activity”,
Clause 10 “Collection, Processing and Sharing of Customer Information”, Clause 14 “Tax Compliance”, Clause 33 “Conflict & Order of Priority” and Clause
41 “Definitions”, which may be amended from time to time in accordance with Clause 7 “Amendment of Terms & Conditions” (available at the Bank’s
website www.hsbcamanah.com.my or upon request). / Saya/Kami bersetuju bahawa Kemudahan tersebut (jika diberikan) juga tertakluk kepada Terma dan
Syarat Umum Bank, Klausa 8 “Pengurusan Risiko Aktiviti Jenayah Kewangan”, Klausa 10 “Pengumpulan, Pemprosesan dan Perkongsian Maklumat Pelanggan”,
Klausa 14 “Pematuhan Cukai”, Klausa 33 “Konflik & Keutamaan Peraturan” dan Klausa 41 “Definisi”, yang boleh dipinda dari semasa ke semasa mengikut Klausa
7 “Pindaan Terma & Syarat” (boleh didapati di laman web www.hsbcamanah.com.my atau atas permintaan).
10. I/We understand that the prepayment amount and the credit balance available in all HomeSmart-i/Business Premises Smart-i accounts are protected by
Perbadanan Insurans Deposit Malaysia (PIDM) up to RM250,000 for each depositor. / Saya/Kami faham bahawa jumlah prabayar dan baki kredit yang terdapat
di dalam semua akaun HomeSmart-i/Business Premises Smart-i adalah dilindungi di bawah Perbadanan Insurans Deposit Malaysia (PIDM) setakat RM250,000
bagi setiap pendeposit.

Ver. Sept 2020

C8
 CONSENT FOR PROCESSING PERSONAL DATA / KEBENARAN UNTUK MEMPROSES DATA PERIBADI
I/We consent and agree that the Bank may disclose and process my/our information, for purposes as provided for in the Bank’s Notice to Customers relating to the
Personal Data Protection Act 2010 (the “Notice”) and the Bank’s Universal Terms and Conditions. This would include disclosing my/our information to Agensi Kaunseling
Dan Pengurusan Kredit (“AKPK”) if I/we seek AKPK’s financial counselling following the rejection of my/our financing application. I/We confirm that I/we have been given
a copy of the Notice and also confirm that I/we have read and agree to the contents and terms of the Notice. I/We understand I/we can also download a copy of the same
from www.hsbcamanah.com.my / Saya/Kami memberi kebenaran dan bersetuju bahawa Bank boleh mendedahkan dan memproses maklumat saya untuk tujuan yang
dinyatakan dalam Notis Bank kepada Pelanggan yang berkaitan dengan Akta Perlindungan Data Peribadi 2010 ("Notis") dan Terma dan Syarat Am Bank. Ini termasuk
mendedahkan maklumat saya/kami kepada Agensi Kaunseling Dan Pengurusan Kredit (“AKPK”) sekiranya saya/kami mendapatkan kaunseling kewangan AKPK berikutan
penolakan permohonan pembiayaan saya/kami. Saya/Kami mengesahkan bahawa saya/kami telah diberikan sesalinan Notis tersebut dan juga mengesahkan bahawa
saya/kami telah membaca dan bersetuju dengan kandungan dan terma Notis tersebut. Saya/Kami memahami bahawa saya/kami boleh memuat turun sesalinan Notis tersebut
dari www.hsbcamanah.com.my.

NON-RESIDENTS ONLY / BUKAN PEMASTAUTIN SAHAJA

I am/We are non-resident. I/We confirm that, at any one time and in accordance with the prevailing Foreign Exchange Administration Rules, as the same may be
amended from time to time: / Saya/Kami adalah bukan pemastautin. Saya/Kami mengesahkan bahawa, pada mana-mana satu masa dan menurut peraturan kawalan tukaran
yang sedia ada, seperti yang dipinda dari masa ke masa:
• This Ringgit credit facility(ies) is to finance activities in the real sector in Malaysia; or / Kemudahan kredit Ringgit ini adalah untuk membiayai aktiviti untuk sektor
hartanah di Malaysia; atau
• This Ringgit credit facility(ies) shall only be utilised for the purpose of financing or re-financing the purchase or construction of immovable properties in Malaysia, and
not solely for the purchase of land only; or the Ringgit credit facility(ies) is to finance margin financing for securities traded on Bursa Malaysia. / Kemudahan kredit
Ringgit ini hanya digunakan untuk tujuan membiayai atau membiayai semula pembelian atau pembinaan harta benda tetap di Malaysia, dan bukan semata-mata untuk
membeli tanah sahaja; atau kemudahan kredit Ringgit adalah untuk membiayai pembiayaan margin bagi sekuriti yang diperdagangkan di Bursa Malaysia.
In the event that this Ringgit credit facility(ies) does not satisfy the above criteria, I/We undertake to inform you and also obtain necessary approval from the relevant
authority. / Sekiranya kemudahan kredit Ringgit tidak memenuhi kriteria di atas, Saya/Kami berjanji untuk memaklumkan pihak Bank dan juga mendapatkan kelulusan
daripada pihak berkuasa yang berkenaan.

DIRECT MARKETING MATERIALS / MATERIAL PEMASARAN LANGSUNG

You may, at any time, choose not to receive marketing literature by sending us a message via Personal Internet Banking or write to: HSBC Supplied Services - Scanning Unit (c/o
Correspondence), 9th Floor, Wisma Hamzah Kwong Hing, No. 1, Leboh Ampang, 50100 Kuala Lumpur. / Jika anda, pada bila-bila masa, tidak mahu dihubungi oleh kami untuk
pemasaran langsung, sila hantarkan pesanan kepada kami melalui Perbankan Internet Peribadi atau dengan menulis kepada: Perkhidmatan Pembekalan HSBC - Unit Pengimbasan,
Dialamatkan Surat-menyurat, Tingkat 9, Wisma Hamzah Kwong Hing, No. 1, Leboh Ampang, 50100 Kuala Lumpur.

APPLICABLE FOR REFERRAL PROGRAMME ONLY / SAH UNTUK PROGRAM RUJUKAN SAHAJA
I/We hereby give consent to the Bank’s disclosure of my/our financing details (limited to my/our name(s), this financing amount and status) to the person referring me/us to the
Bank. / Saya/Kami dengan ini membenarkan maklumat pembiayaan saya/kami (terhad kepada nama, jumlah pembiayaan dan status) diberi kepada pihak yang memperkenalkan
pembiayaan ini kepada pihak Bank.

MORTGAGE PROTECTION PLANS / RANCANGAN PERLINDUNGAN MORTGAGE

I/We understand that protecting my/our Home Financing is essential and making the right decision will protect my/our loved ones if an unforeseen event
happens in the future. / Saya/Kami memahami bahawa melindungi Pembiayaan Perumahan saya/kami adalah amat penting dan membuat keputusan
yang tepat, ia dapat melindungi orang tersayang jika berlaku sesuatu yang tidak diingini pada masa hadapan.
In this regard, I/we would like the Bank to provide for the protection plan form to be completed by me/us: / Sehubungan dengan itu, saya/kami
meminta agar pihak Bank dapat menyediakan borang pelan perlindungan untuk dilengkapkan oleh saya/kami:
Yes / Ya No, I/we will arrange my/our own policy/coverage* / Tidak, saya/kami akan menguruskan sendiri polisi/perlindungan saya/kami*

If yes, note that protection plan will take effect after your proposal has been accepted by the takaful operator and contribution has been paid. / Jika
ya, perhatian bahawa pelan perlindungan akan berkuatkuasa selepas cadangan anda telah diterima oleh penyedia takaful dan sumbangan telah dibayar.
I/We understand that I/we am/are to maintain adequate homeowner takaful as the Bank may require to protect the Property for protection
against fire, lightning, riot and strike, malicious damage, explosion and other relevant risks for the replacement cost. / Saya/Kami memahami
bahawa saya/kami akan mengekalkan takaful pemilikan rumah secukupnya sepertimana keperluan pihak Bank untuk melindungi Hartanah tersebut
terhadap kebakaran, kilat, rusuhan dan mogok, kemusnahan akibat niat jahat, letupan dan risiko lain yang mengakibatkan kos penggantian.

I/We would like the Bank to arrange for a homeowner takaful scheme on my/our behalf: /
Saya/kami ingin pihak Bank menyediakan skim takaful homeowner bagi pihak saya/kami:
Yes / Ya No, I/we will arrange my own policy/coverage*# / Tidak, saya/kami akan menguruskan sendiri polisi/perlindungan saya/kami*#

* I/We understand that the Bank will only accept certificate/coverage from a licensed and reputable takaful operator with interest vested in this Bank as Chargee/Assignee. / Saya/Kami memahami bahawa
pihak Bank akan hanya menerima polisi/perlindungan dari penyedia takaful yang berlesen dan mempunyai reputasi yang baik serta berkepentingan sebagai Pemegang Gadaian/Pemegang Serah Hak bagi pihak
Bank.
# If I/we do not take up or renew the certificate/coverage within 2 weeks before the expiry date, or such other period as notified to me/us by the Bank, I/we expressly agree that the Bank may but is not obliged
to take up such a certificate/coverage on my/our behalf as it deems fit. / Jika saya/kami tidak mengambil atau memperbaharui polisi/perlindungan dalam masa 2 minggu sebelum tarikh lupus, atau jangkamasa
tertentu yang dinyatakan kepada saya/kami oleh pihak Bank, saya/kami sesungguhnya bersetuju bahawa pihak Bank mungkin tidak terikat kepada pengambilan polisi/perlindungan tersebut bagi pihak saya/kami
seperti yang dirasakan sesuai.

Signature of Main Applicant / Tandatangan Pemohon Signature of Co-Applicant / Tandatangan Pemohon Bersama

Name / Nama Name / Nama

Date / Tarikh Date / Tarikh

Signature Witnessed by / Tandatangan Disahkan oleh Signature Witnessed by / Tandatangan Disahkan oleh
Ver. Sept 2020

Disclaimer:
This bank documentation/information does not constitute an offer by HSBC Amanah Malaysia Berhad and no contract is concluded by your completion
of this documentation/your application.
C9
 FOR BANK USE ONLY / UNTUK KEGUNAAN BANK SAHAJA

Staff/Sales Agent Name / Nama Kakitangan/Ejen Jualan

Staff/Sales Agent ID / ID Kakitangan/Ejen Jualan Tel No. / No. Tel

Campaign Code / Kod Kempen Date Applied / Tarikh Permohonan / /

RISE Referral Programme Code / Kod Program Rujukan RISE

Panel Valuer / Panel Penilai Panel Lawyer / Panel Peguam

Location for Panel Valuer / Lokasi untuk Panel Penilai Location for Panel Lawyer / Lokasi untuk Panel Peguam

SPA Lawyer / Peguam yang mengendalikan Perjanjian Jual Beli

Location for SPA Lawyer / Lokasi untuk Peguam yang Mengendalikan Perjanjian Jual Beli

Customer's Name and IC Have Been Verified Against Original IC and Positively Identified / Yes / Ya No / Tidak
Nama dan KP Pelanggan Telah Disahkan Dengan KP Asli dan Dikenal Pasti Dengan Jelas

Secondary Document For Verification of Residential Address Obtained / Yes / Ya No / Tidak

Dokumen Sokongan Untuk Pengesahan Alamat Kediaman Telah Diperolehi

Sanction Countries / Sekatan Negara Yes / Ya No / Tidak

SCC Approval Obtained From Country Head of RBWM / Yes / Ya No / Tidak

Kelulusan SCC Telah Didapati Daripada Pengurus Besar RBWM

Customer is a PEP/Connected Person / Pelanggan ialah Orang yang PEP/Berkait Yes / Ya No / Tidak
Customer Involvement in High Risk Business Activities as per SCC Guidelines / Yes / Ya No / Tidak
Penglibatan Pelanggan Dalam Aktiviti Perniagaan Berisiko Tinggi Menurut Garis Panduan SCC

FCCRM Have Been Checked/Acted Upon / FCCRM Telah Diperiksa/Diambil Tindakan Yes / Ya No / Tidak

Signature of Staff/Sales Agent / Tandatangan Kakitangan/Ejen Jualan

Date / Tarikh

Recommended/Rejected / Disyorkan/Ditolak Recommended/Rejected / Disyorkan/Ditolak

Officer’s Name, Chop & Signature / Nama Pegawai, Cap & Tandatangan Manager’s Name, Chop & Signature / Nama Pengurus, Cap & Tandatangan

Date / Tarikh Date / Tarikh

Remarks / Catatan
Ver. Sept 2020

C10
 MY CREDIT CARD-i REQUIREMENTS / KEPERLUAN KAD KREDIT-i SAYA
Please complete in BLOCK LETTERS and tick ( √ ) where applicable. Then deliver FOR BANK USE ONLY
this form and the enclosures (non-returnable) by hand to your nearest HSBC Bank/ I have disclosed the Universal Terms and Conditions,
HSBC Amanah branch or send them to: which the Cardholder Agreement is a part of, and the Product
HSBC Amanah Malaysia Berhad, Card Services, Disclosure Sheet to
P.O. Box 13688, 50818 Kuala Lumpur.
Name:
IC No.:
HSBC Amanah Credit Card-i Date:
Application Form
Signature

I am applying for:

HSBC Amanah Premier World MasterCard® Credit Card-i HSBC Amanah MPower Platinum Credit Card-i

HSBC Amanah MPower Credit Card-i

All applicants must be 21 - 65 years of age.

FOR BANK USE ONLY
Staff CEPS Ref. No.: Salary Credited Staff Signature DOS PMA
Name: in HSBC Amanah/
Marketing Programme: HSBC Account: Authorised Staff Signature and Name
Staff ID: Branch
Name: Yes No

1. ABOUT MYSELF

Mr Ms Mdm Others

Gender: Male Female

Full Name as in IC/Passport:

Name to Appear on Card (not more than 19 letters):

E-mail Address:
Existing customers enrolled for a password protected PDF copy of respective HSBC Amanah Credit Card-i statement ("e-statement") will continue to receive their
e-statement electronically on monthly basis.

New Bank customers, please indicate statement preference below:

Email Statement Paper statement. A paper statement fee of RM1.00 per month will be applied for each credit card-i statement.

Relationship with Director of Hong Kong and

Yes No
Shanghai Banking Corporation LTD (HBAP).

If Yes, Director Name of HBAP:

Nature of Relationship:

2. MY ACCOUNT SETTLEMENT OPTIONS

Please debit my/our HSBC Amanah account no. monthly in settlement of my/our card account(s) as follows:
HSBC Amanah account no.:

% of current balance (to the nearest 5%) Minimum Payment Due (5%) Full Payment For joint accounts, all signatories
are to sign here
Ver. Sept 2020

C11
 HSBC FEES AND CHARGES / YURAN DAN CAJ-CAJ

Product Concept / This is a Credit Card-i issued by HSBC Amanah to the cardholder based on Shariah principle of Ujrah which refers
Konsep Produk to payment of fees in exchange for services, benefits and/or privileges as shall be determined by HSBC Amanah.
The Credit Limit of the Credit Card-i is assigned by HSBC Amanah to the Cardholder based on the Shariah
principle of Qard (loan) where the relationship between the Bank and the Cardholder are lender and borrower
respectively. / Ini adalah Kad Kredit-i yang dikeluarkan oleh HSBC Amanah kepada Pemegang Kad berdasarkan
prinsip Syariah Ujrah yang merujuk kepada bayaran yuran sebagai pertukaran untuk perkhidmatan, faedah dan/atau
keuntungan yang ditentukan oleh HSBC Amanah. Had Kredit Kad Kredit-i ditentukan oleh HSBC Amanah kepada
Pemegang Kad berdasarkan prinsip Syariah Qard (pinjaman) dimana hubungan antara Bank dan Pemegang Kad
masing-masing adalah pemberi pinjaman dan peminjam.

Annual Fee / Visa/MasterCard

Yuran Tahunan Card-i Type / Jenis Kad-i Primary / Utama Supplementary / Sampingan
HSBC Amanah MPower Credit Card-i RM90* RM45*
HSBC Amanah MPower Platinum Credit Card-i RM240 *
RM120*
HSBC Amanah Premier World MasterCard® Credit Card-i Waived Waived
* Waived for the 1st year. / Dikecualikan untuk tahun pertama.

Management Fee / Each type of card will be charged a fixed monthly management fee. /
Yuran Pengurusan Setiap jenis kad akan dikenakan yuran pengurusan bulanan tetap.
i) Fixed Monthly Fixed Monthly Management Fee /
Management Fee / Card-i Type / Jenis Kad-i
Yuran Pengurusan Bulanan
Yuran Pengurusan
Bulanan Tetap HSBC Amanah MPower Credit Card-i RM1,125
HSBC Amanah MPower Platinum Credit Card-i RM2,250
HSBC Amanah Premier World MasterCard® Credit Card-i RM2,250

ii) Actual Monthly The actual monthly management fee is calculated on a daily rest basis imposed on outstanding card transactions
Management Fee / from posting date of the said retail transactions. Retail transactions exclude Cash Advance, Balance Transfer and
any other credit plans. / Yuran pengurusan bulanan sebenar dikira pada kadar harian yang dikenakan ke atas
Yuran Pengurusan transaksi kad bermula daripada tarikh kemasukkan transaksi runcit tersebut. Transaksi runcit tidak termasuk Wang
Bulanan Sebenar Pendahuluan, Pemindahan Baki dan sebarang pelan-pelan kredit lain.
The actual monthly management fee is charged at the following applicable tiered management charges rate
structure for all retail transactions from posting date of the said retail transactions. / Yuran pengurusan bulanan
sebenar dikira akan dikenakan pada kadar caj pengurusan struktur yang berperingkat untuk semua transaksi runcit
dan tarikh kemasukan transaksi runcit tersebut.

Monthly Annual Rate /

Management Fee / Kadar Tahunan Remarks / Catatan
Yuran Pengurusan (Per Annum)
Bulanan

Tier I / Peringkat I: Cardholder with prompt payments for

12 consecutive months. / Pemegang Kad yang menyelesaikan
15.0%
bayaran minimum yang perlu dibayar bagi 12 bulan
berturut-turut.

Tier II / Peringkat II: Cardholder with prompt payment for

Purchases / 10 months or more in last 12 months balance. / Pemegang kad
Pembelian 17.0% yang menyelesaikan bayaran minimum yang perlu dibayar bagi
10 bulan atau lebih dalam satu kitaran 12 bulan.

Tier III / Peringkat III: Cardholder who does not fall under the
18.0% above categories. / Pemegang kad yang tidak termasuk dalam
kategori di atas.

Of the balance accrued from cash advance amount calculated

Cash Advance / 18.0% on daily basis. / Baki harus dibayar dari jumlah wang
Pendahuluan Tunai
pendahuluan yang dikira pada kadar harian.

Of the amount transferred, calculated on daily basis for a

Balance Transfer / Up to 18.0% / fixed duration. / Jumlah yang dipindahkan akan diambil kira
Pindaan Baki Sehingga 18.0% dengan kadar harian sehingga jangka masa tetap.

Of the balance accrued from Cash Instalment Plan amount

Cash Instalment Plan / Up to 18.0% / calculated on reducing balance basis. / Baki harus dibayar
Pelan Ansuran Tunai Sehingga 18.0% dari Pelan Ansuran Tunai (”CIP”) jumlah yang dikira
berdasarkan pengurangan baki asas.
Ver. Sept 2020

Of the balance accrued from Balance Conversion Plan amount

Balance Conversion Plan / Up to 18.0% / calculated on reducing balance basis. / Baki yang terakru
Pelan Penukaran Baki Sehingga 18.0% daripada jumlah dari Pelan Penukaran Imbangan dikira berdasarkan
pengurangan baki.
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iii) Rebate / The Bank may grant a rebate and the amount of rebate will be determined:
Rebat • Based on the difference between the Fixed Monthly Management Fee and the Actual Monthly
Management Fee at the relevant Statement Date; and
• Where the Actual Monthly Management Fee on the Current Balance is lesser than the Fixed Monthly
Management Fee.

Di atas budi bicara Bank akan memberi rebat dan jumlah rebat akan ditentukan:
• Berdasarkan perbezaan Yuran Pengurusan Bulanan Tetap dan Yuran Pengurusan Bulanan Sebenar pada
tarikh Penyata; dan
• Apabila Yuran Pengurusan Bulanan Sebenar pada Baki Semasa kurang daripada Yuran Pengurusan Bulanan
Tetap.

iv) Cash Advance / Cash advance amount will be taken into consideration when calculating the Actual Monthly Management Fee
Wang Pendahuluan at a fixed rate of 18% p.a. of the tiered management fee structure calculated from the date of disbursement until
payment in full. The Bank may grant a rebate as stated in item iii) Rebate above. / Jumlah wang pendahuluan akan
diambil kira semasa pengiraan caj pengurusan bulanan pengeluaran sebenar pada kadar tetap 18% setahun pada
struktur yuran pengurusan kadar bertingkat yang dikira bermula daripada tarikh pengeluran wang sehingga bayaran
sepenuhnya dibuat. Di atas budi bicara, Bank akan memberi rebat seperti yang dinyatakan di dalam item iii) Rebat
di atas.

v) Balance Transfer / The amount transferred will be taken into consideration when calculating the Actual Monthly Management Fee. The
Pemindahan Baki Actual Monthly Management Fee incurred for the transfer is calculated at a predetermined rate up to a maximum
of 18% p.a. of the tiered Management Fee structure calculated on a daily basis up to a fixed duration as selected by
Cardholder. Any balance of the transferred sum not paid in full within the selected period will be subjected to one
of the tiered management fee rate as listed in item ii) Actual monthly management fee above. / Jumlah yang
dipindahkan akan diambil kira semasa pengiraan yuran pengurusan bulanan sebenar. Yuran pengurusan bulanan
sebenar yang dikenakan atas pemindahan dikira pada kadar yang telah ditetapkan maksimum sehingga 18% setahun
pada struktur yuran pengurusan kadar bertingkat dikira dengan kadar harian sehingga jangka masa tetap yang dipilih
oleh Pemegang Kad. Sebarang lebihan yang tidak dibayar penuh dalam jangka masa yang dipilih akan mengikut salah
satu daripada kadar yuran pengurusan seperti pada item ii) Yuran pengurusan bulanan sebenar diatas.

Grace Period / 20 days grace period is granted on retail transactions provided all outstanding balances as per the monthly statement
Tempoh Bebas of the previous months are fully settled. / Tempoh bebas bayaran bermakna suatu tempoh sekurang-kurangnya 20 hari
Bayaran dari tarikh pengeposan transaksi runcit ke atas akaun kad tersebut, tertakluk bahawa tiada baki dibawa ke hadapan
dalam akaun Pemegang Kad.

Minimum Monthly
Payment / Pembayaran 5% of the outstanding balance or minimum of RM50. / 5% daripada baki tertunggak atau minimum RM50.
Minimum Bulanan

Cash Advance Fees / A charge of RM50 will be charged for every RM1,000 of the cash advance. /
Yuran Pendahuluan Caj RM50 akan dikenakan bagi setiap pendahuluan tunai RM1,000.
Tunai

Late Payment Charges / Minimum of RM10 or 1% of the outstanding balance, whichever is higher, up to a maximum of RM100*. /
Caj Bayaran Lewat Minimum RM10 atau 1% daripada baki belum jelas, yang mana lebih tinggi, sehingga RM100*.
*
Effective date: 2 April 2013 / Tarikh bermula: 2 April 2013

Conversion For If the Cardholder uses the Credit Card-i for transactions in a currency other than Ringgit Malaysia, such amount shall
Overseas Transactions / be converted at the exchange rate as determined by Visa International or MasterCard International, as the case may
Pertukaran Untuk be, on the date of conversion in addition to a foreign currency conversion cost of 1.00% as well as any transaction
Transaksi Luar Negara fee charged by Visa International or MasterCard International. / Jika Pemegang Kad menggunakan Kad Kredit-i untuk
transaksi dalam mata wang lain selain daripada Ringgit Malaysia, jumlah tersebut hendaklah ditukar berdasarkan kepada
jumlah pertukaran mata wang asing yang telah ditentukan oleh Visa International atau MasterCard International,
termasuk kos pertukaran mata wang asing sebanyak 1.00% serta sebarang yuran lain yang dikenakan oleh Visa
International atau MasterCard International.

Service Tax / RM25 per annum for every principal or supplementary credit card. /
Cukai Perkhidmatan RM25 setahun untuk setiap kad kredit utama atau sampingan.

Fees and charges as per the Bank’s Tariff and Charges and applicable tax, if any. /
Semua yuran dan caj adalah mengikut Tarif dan perubahan Bank serta cukai yang akan dikenakan, jika ada.

Issued by HSBC Amanah Malaysia Berhad (Company No. 807705-X) / Dikeluarkan oleh HSBC Amanah Malaysia Berhad (Company No. 807705-X)
Ver. Sept 2020
HBS195(a)H20

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 DECLARATION
I/We hereby declare and confirm that I/we have fully disclosed in this application form, all the information on my/our outstanding debt obligations, including secured and unsecured financing
obtained from all financial institutions and other non-bank entities that provide credit facilities (e.g. cooperatives, building societies, credit companies and merchants that provide credit sales) and
that such information is correct, complete and not misleading. I/We understand that failure to provide full and correct material information that has a bearing on HSBC Amanah Malaysia Berhad's (hereafter
referred to as "HSBC Amanah" or "the Bank" interchangeably) decision whether or not to approve this application, may lead to (i) rejection of this application; or (ii) termination of the credit card-i facility, if
granted. If the financing tenure extends beyond my/our retirement age, I/we am/are aware of the importance of ensuring that I/we have sufficient funds to meet the payment obligations for this credit card-i
facility after my/our retirement. I/We authorise HSBC Amanah to confirm any of the information given from any source HSBC Amanah may choose, including carrying out credit checks and obtaining credit
reports and information on me/us and also on all guarantors and security providers (as applicable) (collectively “Data Subjects”) from time to time, from Credit Bureau Malaysia and any other credit reporting
agencies registered under the Credit Reporting Agencies Act 2010 (as listed on HSBC’s website at www.hsbc.com.my), and I/we consent to Credit Bureau Malaysia sourcing and retaining information on
me/us and all Data Subjects from any available data source and disclosing to HSBC Amanah any such information as HSBC Amanah may request. I/We hereby warrant that I/we have been irrevocably
authorised by the Data Subjects to give this consent on their behalf. I/We confirm that I/we have read and accept HSBC Amanah's Universal Terms and Conditions in English, which the Cardholder
Agreement is a part of and I/we acknowledge that use of the credit card-i(s) is subject to HSBC Amanah's Universal Terms and Conditions. If I/we require a copy of HSBC Amanah's Universal Terms and
Conditions, I/we may request for a copy or download it from www.hsbcamanah.com.my. I/We further confirm that I/we am/are not (i) persons related/connected (i.e. as spouse, child or parent) to officers,
directors or shareholders of HSBC Amanah and that of The Hongkong and Shanghai Banking Corporation Limited in compliance with Section 57 of the Islamic Financial Services Act 2013 ("IFSA") read
with the Guidelines on Credit Transactions and Exposures with Connected Parties for Islamic Banks issued by Bank Negara Malaysia ("BNM") and Section 83 of the Banking Ordinance of the Hong Kong
Special Administrative Region, the law of the place in which the holding company of HSBC Amanah's parent company is located; and (ii) directors of any entity within the HSBC Group pursuant to Section
224 of the Companies Act 2016 as the same may be amended, re-enacted or replaced (collectively “Prohibitions”). I/We agree to immediately advise HSBC Amanah in writing should such relationship
creating a prohibited financing under the aforesaid Prohibitions be established subsequent to the approval of my/our application herein. I/We understand that (i) approval of the application is at HSBC
Amanah's sole discretion and HSBC Amanah reserves the right not to disclose or provide any reason if the application is unsuccessful; and (ii) it is BNM’s requirement that information relating to this
application, whether successful or otherwise, to be updated to the Central Credit Reference Information System (CCRIS) database maintained by BNM. I/We confirm and agree that HSBC Amanah may
collect, use or disclose information on this application, credit card-i facility(ies) (if approved) and conduct thereof, including those of my/our supplementary cardholders (“Information”), for any and all
purposes and to such parties including but not limited to those listed in the Cardholder Agreement, which is part of the Universal Terms and Conditions, Credit Bureau Malaysia, any other registered credit
reporting agency and/or any person HSBC Amanah believes in good faith to be tendering payment of monies on my/our behalf. I/We confirm that any credit card-i issued to me/us, including supplementary
credit card-i(s) issued under my/our account, shall not be used by me/us for or in connection with any unlawful activity or purpose (including without limitation online gambling), whether in whole or in part,
and any other transaction(s) that contravenes with the Shariah principle applicable for the Credit Card-i. I/We confirm that the person(s) promoting this credit card-i(s) to me/us has fully disclosed and
explained the salient features, terms and conditions, all the fees and charges as well as the effective annual/monthly management fee pertaining to this credit card-i(s). I/We irrevocably consent to the Bank
appointing any member of the HSBC Group and/or such third parties from time to time as the Bank deems fit for the purposes of recovering any outstanding sum due to us.

If you do not wish to share your information with other companies within HSBC Amanah for the purpose of promotions and offers, you may opt out by contacting our call centre at 1300 80 2626.

Consent for Processing Personal Data:

I/We consent and agree that the Bank may collect, process and disclose my/our information, for
purposes as provided for in the Bank's Notice to Customers relating to the Personal Data Protection
Act 2010 (the "Notice") and in the manner described in the Bank's Generic Terms and Conditions
(GTC), Clause 10 "Collection, Processing and Sharing of Customer Information". I/We confirm that
I/we have been given a copy of the Notice and also confirm that I/we have read and agree to the
contents and terms of the Notice. I/We understand I/we can also download a copy of the Notice and
GTC Clause 10 from www.hsbcamanah.com.my

Signature of Primary Card Applicant Date:

Explanatory Notes:
1. Please note that for the purposes of the IFSA, “officer” encompasses “any employee or the chief
executive officer of the body corporate or unincorporated” and relative to an individual includes,“ (a) the
spouse of the individual; (b) the brother or sister of the individual, or of the spouse of the individual; (c)
Full Name as per IC/Passport:
any lineal ascendant or descendant of the individual, or of the spouse of the individual; (d) the spouse
of any individual referred to in paragraph (b) or (c); (e) any lineal descendant of an individual referred to
in paragraph (b) or (d); (f) any uncle, aunt or cousin of the individual, or of the spouse of the individual;
or (g) any spouse, or any lineal ascendant or descendant, of an individual referred to in paragraph (f).
IC/Passport No.:
2. "HSBC Group” refers to HSBC Holdings plc and its subsidiaries, and companies in which any of the
aforesaid has an associate interest.

DOCUMENTS REQUIRED
Document Salaried Employee Self-Employed Expatriate
Photostat copy of IC (both sides)
 
Latest month salary slip
 
Latest Income Tax Return (Form BE with tax receipt) or Form EA or EPF statement 
Latest Income Tax Return (Form B with tax receipt) or Form EA or EPF statement
or 6 months bank statement 
Photostat copy of Business Registration Form
*

Photostat copy of Passport (personal details and work permit ) **

Letter of Appointment from employer (for current employment not more than
3 months)  
* Company must be established for a minimum of 2 years.
** Work permit must be valid for at least 1 year.

Note: Application forms with incomplete documentation may delay processing.

Ver. Sept 2020

Enjoy more interbank convenience and Conveniently pay your HSBC Amanah Credit Card-i bills through
improved account accessibility across MEPS InterBank GIRO. Available at participating banks via:
4 locally incorporated foreign banks. • over the counter
• their online banking service
HBS195(a)H20

Please log on to www.hsbcamanah.com.my for the list of HSBC Amanah branches.

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