Customer Name  
    
 
 Contact Number  
 
 
 Products
 
 
 Amount   
 
 
 Preferred Branch
 
 
 
 
 Remarks / Notes
 
I hereby declare that all the above information given by me is correct and complete in compliance with the Personal Data Protection Act 2010, I hereby give my consent to the Bank to collect, process, and continue to use the information disclosed by me for a maximum period of one month from the date this form is submitted for the purpose of this application, cross selling, marketing, and promotions whatsoever including offers and competitions and disclosure my information within BIMB holding group of companies, subsidiaries, its agent, employees, trustee, and/or to any other person or entity which the Bank's deems appropriate in accordance with the Privacy Statement which is available at our branches and the Bank's website at www.bankislam.com.my.
I hereby acknowledge that I have read, understood, and agree with the terms, conditions, rules, guidelines, and regulations as stated in the product's Terms and Conditions and/or Product Disclosure Sheet (whichever is applicable) provided in the Bank's website at www.bankislam.com.my.