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6 June 2008 AmBank_eCosway_Application Form_FA(Front) F4 Size: h39.3cm x w21cm

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Ch/Br Code:

eCosway AmBank PrePaid MasterCard

Application Form/Borang Permohonan

Gift Code: N

Programme Code:

Fee Code: 1 0 4

The Card That Gives You More Than Just Prestige & Acclaim. Every time you charge your spending to your eCosway AmBank Co-brand Card, you will chalk up eVolume (eV) or Silver Volume (SV) and earn income according to the eCosway or Cosway Profit Plan. For those signed up with eCosway, you will also earn Card Value Points (CVPs) that immediately give you huge savings on hundreds of exclusive and popular items, and allow you to win fabulous prizes in eCosway's "CVP Auction". You get · 1 CVP at regular merchants for every RM100 spent with the card · 2 CVPs at Partner Merchants for every RM100 spent with the card Also enjoy RM50 for each approved Principal eCosway AmBank Platinum & Gold Credit Card application introduced by you under the "Member Get Member Campaign". PrePaid Card Fees and Charges · RM30 for first 4 years · Thereafter RM30 per annum Please complete all your personal details below clearly and send it to AmBank (M) Berhad via mail to AmBank Card Centre, Level 26 Menara AmBank, No. 8 Jalan Yap Kwan Seng, 50450 Kuala Lumpur or fax to 03-2164 0497, along with the required document(s). Affix one copy of the following before faxing: · For Malaysians/Permanent Residents - NRIC (front & back) · For Non-Malaysians - Passport

Note: Applicant will not be registered, if form is incomplete and without the required documents attached or if documents are illegible and/or found to be tampered with and/or if applicant is adjudged to insolvency.

Please allow 4 working days for registration.

* Log on to ambg.com.my for terms and conditions.

eCosway ID No./Cosway Acc. No. to appear on Card/No. ID eCosway/No. Akaun Cosway yang akan tertera pada kad

Card No./No. Kad:

Expiry Date/Tarikh Luput:

YOUR PERSONAL DETAILS/BUTIR-BUTIR PERIBADI ANDA

Full Name (as in I.C./Passport)/Nama Penuh (seperti dalam K.P./Pasport): Mr/Encik New I.C./K.P. Baru: Passport No./No. Pasport: Sex/Jantina: Male/Lelaki Female/Perempuan Day/Hari Single/Bujang Nationality/Kewarganegaraan: Month/Bulan Married/Berkahwin Year/Tahun Widowed/Balu/Duda Divorced/Bercerai Race/Bangsa: Miss/Cik Madam/Puan Others (specify)/Lain-lain (nyatakan)

Date of Birth/Tarikh Lahir: Marital Status/Status Perkahwinan: Occupation/Pekerjaan:

Mothers' Maiden Name (This is compulsory for security purposes)/ Nama Ibu (Ini adalah wajib untuk tujuan keselamatan): Total Household Income per month/Pendapatan Keluarga sebulan: < RM 1,500 RM 5,000 to RM8,000 RM 1,500 to RM3,000 RM 8,000 to RM10,000 RM 3,000 to RM5,000 > RM 10,000

YOUR MAILING ADDRESS/ALAMAT SURAT-MENYURAT ANDA Your PIN will be mailed to this address in approximately 3 weeks upon registration/Selepas pendaftaran, Nombor PIN anda akan di hantar ke alamat ini dalam masa 3 minggu.

Present Home/Rumah Sekarang Postcode/Poskod: Tel No./No.Tel: (Office/Pejabat)

Office/Pejabat State/Negeri:

(Mobile/Bimbit)

Tel No./No.Tel:(House/Rumah) Email/E-mel:

DECLARATION/PENGISYTIHARAN

I confirm that all information given above is true and complete. I hereby authorise AmBank (M) Berhad (8515-D) to verify the information from whatever source and by whatever means that the respective companies may consider appropriate. I confirm and agree that the Bank is at liberty to disclose my information, obtained during the process of this registration from any source whatsoever, to any AmBank Group members and/or Cosway (M) Sdn Bhd or any person as the Bank may deem fit. Further, the recipient of such information from both the respective companies are allowed to store and use such information for such purposes as they may deem necessary. I further confirm that any Card issued to me shall not be used by me in connection with any unlawful activity or purpose (including without limitation to online gambling), whether in whole or in part. I hereby declare that I am not a bankrupt and AmBank reserves the absolute right not to accept this registration. I hereby declare that by using the Card offered to me for making purchases of goods and/or services at MasterCard/Visa Merchants with prepayment made by me. I agree to be bound by the respective Terms and Conditions of AmBank, MasterCard/Visa which may from time to time be varied at their absolute discretion. I hereby authorise AmBank to deduct the prevailing Card fees from the pre-payments made by me. I hereby undertake and confirm that the transactions to be effected using the Card account(s) and monies or funds to be used for "Top-up" of the PrePaid Card account(s) are neither from any unlawful activities as defined under the Anti-Money Laundering Act 2001 and Anti-Terrorism Financing Act 2001. Saya mengesahkan bahawa segala maklumat yang diberikan di atas adalah benar. Saya membenarkan AmBank (M) Berhad (8515-D) dan untuk mengesahkan maklumat tersebut dari sebarang sumber dan dengan apa jua cara yang dianggap sesuai oleh mana-mana pihak. Saya mengesahkan dan bersetuju bahawa pihak Bank bebas untuk mendedahkan maklumat saya, yang diperolehi dari sebarang sumber semasa proses pendaftaran ahli AmBank Group yang lain dan/atau mana-mana pihak yang dianggap sesuai oleh pihak Bank. Seterusnya, penerima maklumat dari kedua-dua pihak dibenarkan untuk menyimpan maklumat dan menggunakan maklumat tersebut untuk sebarang tujuan yang dianggap perlu. Saya mengesahkan bahawa kad yang dikeluarkan tidak akan digunakan untuk sebarang tujuan atau aktiviti berkaitan dengan sebarang kegiatan yang menyalahi undang-undang (termasuk perjudian online tanpa had) sama ada sepenuhnya atau sebahagian darinya. Saya mengesahkan bahawa saya bukan muflis dan kelulusan pendaftaran adalah pada budibicara mutlak AmBank. Saya mengisytiharkan bahawa dengan menggunakan kad yang ditawarkan kepada saya untuk membeli barangan dan/atau perkhidmatan di peniaga-peniaga MasterCard/Visa dengan prabayaran yang telah dibuat, saya bersetuju untuk terikat dengan Syarat & Peraturan AmBank dan MasterCard/VISA yang berkaitan yang mungkin berubah dari masa ke semasa mengikut budibicara mutlaknya. Saya membenarkan AmBank untuk menolak yuran semasa kad daripada amaun prabayaran yang telah dibuat oleh saya. Saya bersetuju dan mengesahkan bahawa urus niaga melalui akaun kad dan wang atau dana yang akan digunakan untuk menambah nilai akaun kad prabayar tidak diperolehi sama ada daripada sumber yang menyalahi undang-undang atau berkaitan dengan aktiviti-aktiviti yang menyalahi undang-undang seperti yang diterangkan di bawah Akta Anti Penyelewengan Wang dan Anti Pembiayaan Pengganas 2001.

Cardmember's Signature/Tandatangan Pemegang Kad Date/Tarikh

FOR BANK USE/UNTUK KEGUNAAN BANK: Captured by: Checked by:

AmBank Card Centre, Level 26 Menara AmBank, No. 8 Jalan Yap Kwan Seng, 50450 Kuala Lumpur. AmBank Contact Centre: 1300 80 8888 (Domestic) or (603) 2178 8888 (Overseas) E-mail: [email protected] Website: ambg.com.my

6 June 2008 AmBank_eCosway_Application Form_FA(Back) F4 Size: h39.3cm x w21cm

Frequently Asked Questions

What is eCosway AmBank PrePaid MasterCard ® all about?

This is a PrePaid MasterCard ® that you can use to purchase goods just like a credit card but with spending limited to the amount of money you place on the card - like your prepaid phone card.

Soalan-soalan Lazim

Apakah eCosway AmBank MasterCard ® Prabayar?

Ia adalah sekeping kad MasterCard ® Prabayar yang boleh digunakan untuk membeli barangan, sama seperti kad kredit tetapi dengan perbelanjaan yang terhad kepada jumlah wang yang dimasukkan ke dalam kad - sama seperti kad telefon prabayar anda.

What do I need to do?

1. 2. 3.

Fill in the eCosway application form and attach together a photocopy of your NRIC (both side)/passport and send it to AmBank for processing Once you receive your card, sign your name on the signature panel on reverse of card Call AmBank to activate your card

Apakah yang perlu saya buat?

1. 2. 3.

How do I use it?

Lengkapkan borang permohonan eCosway dan hantar bersama dengan salinan kad pengenalan anda (depan/belakang)/pasport ke AmBank untuk diproses Tandatangan nama anda di panel tandatangan pada bahagian belakang kad apabila menerima kad anda Hubungi AmBank untuk mengaktifkan kad anda

Just present it to the outlets where MasterCard ® cards are accepted and it will be inserted into an EDC terminal (credit card terminal) for approval, just like a normal credit card transaction.

Bagaimana cara saya menggunakannya?

Cuma tunjukkan kad di cawangan yang menerima kad MasterCard ® dan ia akan dimasukkan ke dalam terminal EDC (terminal kad kredit) untuk kelulusan, sama seperti urus niaga kad kredit biasa.

Where can I use it?

Worldwide where MasterCard ® is accepted.

Di mana boleh saya menggunakannya?

Di serata dunia di mana MasterCard ® diterima.

Who can qualify for this card?

Anyone. Unlike a regular credit card, there is no income qualification or age limit.

Siapa yang layak untuk mendapatkan kad ini?

Sesiapa sahaja. Tidak seperti kad kredit biasa, ia tidak mempunyai syarat pendapatan atau had umur.

Where and how can I "Top-up"?

· · · · ·

Using cash at AmBank Branches: - Over-The-Counter or - Cash Deposit Machines - locations listed below AmAssurance Branches "Top-up" centres where you see the NexGTM Recharge logo (over 5,000 participating e-pay outlets) Fund transfer (if you have an AmBank account) via ATM, Phone Banking or online at ambg.com.my InterBank Giro from your other bank accounts

Di mana dan bagaimana boleh saya menambah nilai?

· · · · ·

Gunakan wang tunai di Cawangan AmBank: - Di kaunter atau - Mesin Deposit Tunai-lokasi tertera di bawah Cawangan AmAssurance Pusat tambah nilai dengan logo NexG TM Recharge (lebih daripada 5,000 cawangan e-pay yang mengambil bahagian) Pindahan dana (sekiranya anda mempunyai akaun AmBank) melalui ATM, Perbankan Telefon atau online di ambg.com.my InterBank Giro daripada bank akaun anda yang lain

How much can I "Top-up"?

You can "Top-up" in denominations of RM30, RM50, RM100, RM200, RM300, RM400 and RM500 at any location where you see the NexGTM Recharge logo (participating e-pay outlets), via AmBank Cash Deposit Machines and Internet Banking. You can reload up to a maximum available balance not exceeding RM10,000 at anytime given. Note: The minimum "Top-up" is RM100 over the counter at AmBank Branches.

Berapakah jumlah yang boleh saya tambah nilai?

Anda boleh menambah nilai dengan denominasi RM30, RM50, RM100, RM200, RM300, RM400 dan RM500 di lokasi di mana logo NexG TM Recharge kelihatan (cawangan e-pay yang mengambil bahagian), melalui Mesin Deposit Tunai AmBank dan Perbankan Internet. Anda boleh menambah nilai sehingga had maksimum yang tidak melebihi RM10,000 pada satu-satu masa. Nota: Jumlah tambah nilai minimum adalah RM100 di kaunter Cawangan AmBank.

Can I withdraw cash from the Card?

Yes. A PIN will be sent to you approximately 3 weeks upon registration which will allow you to withdraw cash FREE with no fee imposed, from any AmBank ATMs at over 180 branches nationwide.

Bolehkah saya mengeluarkan wang tunai daripada kad?

Ya. PIN akan dihantarkan kepada anda dalam masa 3 minggu selepas pendaftaran yang akan membolehkan anda mengeluarkan wang tunai PERCUMA tiada sebarang yuran dari mana-mana ATM AmBank di lebih 180 cawangan seluruh negara.

How do I keep track of my spending?

Statement of Account is available via ambg.com.my

Bagaimana cara saya memantau perbelanjaan saya?

Penyata Akaun boleh didapati melalui ambg.com.my

How much can I spend per transaction?

You can spend up to RM2,000 per transaction.

Berapa jumlah wang yang boleh saya belanja untuk setiap urus niaga pembelian?

Anda boleh berbelanja sehingga RM2,000 bagi setiap urus niaga pembelian.

What other benefits can I enjoy?

Besides the cash free convenience, you will be rewarded with Real points, discount vouchers, FREE RM10,000 Personal Accident (PA) Insurance and other privileges.

Apakah kelebihan lain yang boleh saya nikmati?

Selain daripada kemudahan tanpa tunai, anda juga akan mendapat mata Real, baucer diskaun, Insurans Kemalangan Peribadi (PA) RM10,000 PERCUMA dan pelbagai lagi kelebihan.

What is the period of FREE coverage for this PA Insurance?

The free coverage period is for: a. Maximum period of 12 months from the date registered OR b. While the Card holder holds the card whichever is earlier.

Bilakah tempoh jangka masa perlindungan PERCUMA bagi insurans PA ini?

Tempoh jangka masa perlindungan percuma adalah: a. Maksimum 12 bulan daripada tarikh pendaftaran b. Sepanjang tempoh ahli Kad memiliki kad, tertakluk kepada yang mana lebih awal

Where can l get more details for the FREE PA Insurance?

For details of cover and policy contract, please refer to ambg.com.my

Di manakah maklumat lanjut perlindungan Insurans PA PERCUMA ini boleh diperolehi?

Untuk keterangan mengenai perlindungan dan polisi kontrak, sila rujuk di ambg.com.my

What happens if I lose my Card?

Report loss of card immediately to AmBank at 1300 80 8888 (Domestic) or (603) 2178 8888 (Overseas).

Bagaimana sekiranya kad saya telah hilang?

Laporkan kehilangan kad anda serta-merta kepada AmBank di 1300 80 8888 (Tempatan) atau (603) 2178 8888 (Antarabangsa).

Is there a helpline I can call?

Call AmBank Contact Centre (24/7) at 1300 80 8888 (Domestic) or (603) 2178 8888 (Overseas).

Apakah talian bantuan yang boleh saya hubungi?

Hubungi Pusat Panggilan AmBank (24/7) di 1300 80 8888 (Tempatan) atau (603) 2178 8888 (Antarabangsa).

Fees and Charges

Cash Withdrawal: FREE with no fee imposed, through AmBank ATMs. RM10 or 2% whichever is higher through the CIRRUS/PLUS network worldwide Foreign Exchange/Conversion Fee is determined by MasterCard ® International plus an administration cost of 1% and a Retail Transaction Fee of RM1 per transaction RM25

Yuran dan Caj

Wang Pengeluaran: PERCUMA tiada sebarang yuran melalui ATM AmBank. RM10 atau 2%, yang mana lebih tinggi, melalui rangkaian CIRRUS/PLUS seluruh dunia Yuran Tukaran Asing/Konversi adalah seperti yang ditetapkan oleh MasterCard ® International serta kos pentadbiran sebanyak 1% dan Yuran Urus Niaga Runcit sebanyak RM1 bagi setiap urus niaga RM25

Overseas Transactions:

Urus Niaga Luar Negara:

Card Replacement Fee:

Yuran Penggantian Kad:

Where are the AmBank Cash Deposit Machines located for "Top-up"?/Di manakah lokasi Mesin Deposit Tunai AmBank yang boleh tambah nilai?

JOHOR Kota Tinggi Batu Pahat Johor Bahru Johor Bahru Johor Bahru Johor Jaya Muar Kluang Segamat Kulai Skudai Petronas Seri Alam 2 Permas Jaya KEDAH Alor Setar Sungai Petani Kulim KELANTAN Kota Bharu WILAYAH PERSEKUTUAN Jalan Raja Chulan Jalan Ipoh Jalan Imbi Kepong Baru Medan Pasar Jalan Yap Kwan Seng Bangsar Baru OUG Puchong Cheras Cheras Wangsa Maju Sri Petaling Mont Kiara Setapak MELAKA Melaka NEGERI SEMBILAN Seremban Seremban Bahau PERAK Ipoh Garden Ipoh Main Langkap Sitiawan Taiping

TERENGGANU Kuala Terengganu

Jalan Lombong Jalan Rugayah Metropolis Tower, Jalan Abdullah Tahir Melodies Garden, Jalan Meranti Merah Jalan Wong Ah Fook Jalan Ros Merah 2/8 Jalan Sulaiman Jalan Dato' Teoh Siew Khor Jalan Abdullah Lorong Dua Taman Ungku Tun Aminah, Jalan Nakhoda 1 Eidaman Enterprise, Bandar Seri Alam, Mukim Plentong Bandar Baru Permas Jaya, Jalan Permas 4/3 Wisma Landag, Jalan Kota Jalan Kampung Baru Jalan Tunku Putera Jalan Sultan Ibrahim Bangunan AmBank Group Bangunan Lim, Batu 4 1/2 Berjaya Times Square Jalan Ambong 2 Wisma Maran Menara AmBank Jalan Telawi Tiga Jalan Hujan Rahmat 2 Seksyen 1, Batu 7 1/2, Jalan Puchong Taman Connaught, Jalan Cerdas Taman Maluri, Jalan Jejaka 2 Pusat Bandar, Jalan 1/27F Jalan Raden Tengah Jalan Solaris 1 Taman Setapak Indah Jaya, Jalan 3/50C Kompleks Munshi Abdullah, Jalan Munshi Abdullah Arab-Malaysian Business Centre, Jalan Pasar Jalan Dato' Lee Fong Yee Jalan Mewah Jalan Dato' Lau Pak Khuan Jalan Yang Kalsom Lorong 1, Project Perumahan Awam Langkap Jalan Raja Omar Jalan Taming Sari

Bangunan UMNO Terengganu, Jalan Sultan Ismail

PAHANG Kuantan Kuantan PULAU PINANG Bagan Ajam Liang Court Bukit Mertajam Bayan Baru Jelutong PUTRAJAYA Putrajaya SABAH Tawau Kota Kinabalu Kota Kinabalu Sandakan SARAWAK Bintulu Kuching Kuching Bandar Tabuan Jaya Satok Sibu Miri Miri Sibu Tanamas SELANGOR Petaling Jaya Petaling Jaya Selayang Bandar Puteri Puchong Bandar Puteri Klang Setia Alam Klang Shah Alam Banting Ampang Point USJ Taipan Damansara Utama Balakong Rawang Bandar Baru Bangi Port Klang Bandar Baru Rawang Subang Jaya Kajang

Jalan Haji Abdul Aziz Jalan Beserah Jalan Bagan Ajam Jalan Sultan Ahmad Shah Jalan Padang Lalang Jalan Mahsuri Jalan Jelutong Alamanda Shopping Centre, Jalan Alamanda, Precinct 1 Sabindo Square, Jalan Dunlop Luyang Commercial Centre, Jalan Damai Luyang EON CMG Life Building, Jalan Segunting Bandar Pasaraya, Miles 4, North Road Bangunan BDA, Jalan Sommerville Golden Court Commercial Centre, Bt 4½, Jalan Penrissen Jalan Abell Pusat Commercial Tabuan Stutong, Jalan Setia Raja Wisma MBF, Section 8, Jalan Haji Taha Jalan Tuanku Osman Boulevard Commercial Centre, KM 3, Jalan Miri-Pujut Beautiful Jade Centre Chinese Chamber Of Commerce Building, Jalan Klinik Jalan SS2/61 New Town Centre, Road 52/4 Pusat Bandar Utara, Off KM12, Jalan Ipoh Jalan Puteri 1/1 Lorong Sanggul 1F Seksyen U3, Jalan Setia Prima, RU 13R Wisma SH NG, Persiaran Sultan Ibrahim Seksyen 15, Jalan Utas B/15B Wisma Mutiara, Jalan Sultan Abdul Samad Ampang Point, 4 1/2 Miles, Jalan Mamanda 7 Taipan Triangle, Jalan USJ 10/1A Jalan SS21/35 Taman Indah, Batu 11 Bandar Country Homes, Jalan Desa 1/1 Seksyen 9, Jalan Medan PB2 Persiaran Raja Muda Musa Jalan Ipoh, Batu 18 Jalan SS15/4D Seksyen 10, Jalan S10/1, Jalan Bukit

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