AEON FORMAEON_1AEON_2

AUTO DEBIT FORM

Non-member: OffExpress Card Member: OffEZ Apply: 0: 0: Off

Please tick: OffMr: OffOthers-1: 0: Off2: Off3: Off1: Off4: Off

Miss: OffMadam: OffNationality: Off(Specify)-1: 2: 0: 3: 4: 1:

Present Residential Address-1: 0: 1: 2:

Full Name As In NRIC-1: 0: 1:

New NRIC: Military/Police ID: Email Address: Name To Appear On Card: Permanent Residential Address-1: 0: 1: 2:

Postcode Present Residential Address: Postcode Permanent Residential Address: 0: 0:

Handphone No: DOB DD: DOB YY: Office Address-1: 0: 1: 2:

Company Postcode: Sex M: OffSex F: OffPresent Home Address: OffOffice: OffOwn Property: OffParent's Property: OffRelative's Property: OffMarried: OffSingle: OffWidowed: OffDivorced: OffRenting: OffCompany's Quarter: OffMalay: OffChinese: OffIndian: OffHome Tel No: No: of Dependent:

Years of Stay YY: Years of Stay MM: Office Tel No: Office Tel No Ext: Years of Service YY: Years of Service MM: Nature of Business: Monthly Salary: Salary Date DD: Mid Month Salary Date DD: Position: Source of Other Income: Employed: OffSelf-Employed: OffDepartment: Other Income: Emergency Contact Home Tel No: Emergency Contact Name: Emergency Contact Handphone No: Emergency Contact Present Residential Address-1: 0: 1: 2:

Emergency Contact Office Tel No Ext: Emergency Contact Postcode Present Residential Address: Old IC No: Name of Company: Relative: OffDOB MM: Emergency Contact Office Tel No: Parent: OffAuthorise: OffCheck Box1: 0: 0: 0: 1: Off

1: 1: 0: 0: Off1: Off

1: 0: Off1: Off

0: 1: Off0: Off

Applicant Name: Applicant NRIC: Brand-1: Description-1: Model-1: Brand-2: Description-2: Model-2: Brand-3: Description-3: Model-3: Installment Period: Bank: Branch: Account Holder Name: Account Number: Sila Nyatakan Akaun Gaji Anda: No Akaun / Account No: 0:

No Kad Pengenalan / Identity Card No: Alamat / Address-1: 1: 0: 2:

Nama / Name: Poskod / Postcode: No Telefon / Telephone No: Malayan Banking Berhad: 0: 0: Off

Standard Chartered Bank Berhad: OffAmbank (M) Berhad: OffAlliance Bank Berhad: OffCIMB Bank Berhad: OffPublic Bank Berhad: OffBank Muamalat Malaysia Berhad: OffRHB Bank Berhad: Off