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: amcard-csd@ambg.com.my Website: ambg.com.my

YOUR PERSONAL DETAILS/BUTIR-BUTIR PERIBADI ANDA

Full Name (as in I.C./Passport)/Nama Penuh (seperti dalam K.P./Pasport):

Mr/Encik Miss/Cik Madam/Puan Others (specify)/Lain-lain (nyatakan)

New I.C./K.P. Baru:

Passport No./No. Pasport:

Sex/Jantina: Male/Lelaki Female/Perempuan Nationality/Kewarganegaraan: Race/Bangsa:

Date of Birth/Tarikh Lahir: Day/Hari Month/Bulan Year/Tahun

Marital Status/Status Perkahwinan: Single/Bujang Married/Berkahwin Widowed/Balu/Duda Divorced/Bercerai

Occupation/Pekerjaan:

Mothers’ Maiden Name (This is compulsory for security purposes)/ Nama Ibu (Ini adalah wajib untuk tujuan keselamatan):

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 Office/Pejabat

Postcode/Poskod: State/Negeri: Tel No./No.Tel:(House/Rumah)

Tel No./No.Tel: (Office/Pejabat) (Mobile/Bimbit) Email/E-mel:

YOUR MAILING ADDRESS/ALAMAT SURAT-MENYURAT ANDA

DECLARATION/PENGISYTIHARAN

Total Household Income per month/Pendapatan Keluarga sebulan:

< RM 1,500 RM 1,500 to RM3,000 RM 3,000 to RM5,000

RM 5,000 to RM8,000 RM 8,000 to RM10,000 > RM 10,000

eCosway AmBank PrePaid MasterCard Application Form/Borang Permohonan

*FREE

RM10,000

Personal Accident

Insura

nce upon registra

tion

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.

FOR BANK USE/UNTUK KEGUNAAN BANK:

Captured by:

Checked by:

Cardmember’s Signature/Tandatangan Pemegang Kad Date/Tarikh

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.

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:

Ch/Br Code: Gift Code: Programme Code: Fee Code: 1N 0 4

6 June 2008

AmBank_eCosway_Application Form_FA(Front)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.

What do I need to do?1. Fill in the eCosway application form and attach together a photocopy of your NRIC (both side)/passport and send it to AmBank for processing2. Once you receive your card, sign your name on the signature panel on reverse of card3. Call AmBank to activate your card

How do I use it?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.

Where can I use it?Worldwide where MasterCard® is accepted.

Who can qualify for this card?Anyone. Unlike a regular credit card, there is no income qualification or age limit.

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 NexG™ 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

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 NexG™ 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.

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.

How do I keep track of my spending?Statement of Account is available via ambg.com.my

How much can I spend per transaction?You can spend up to RM2,000 per transaction.

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.

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 ORb. While the Card holder holds the card whichever is earlier.

Where can l get more details for the FREE PA Insurance?For details of cover and policy contract, please refer to 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).

Is there a helpline I can call?Call AmBank Contact Centre (24/7) at 1300 80 8888 (Domestic) or (603) 2178 8888 (Overseas).

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

Overseas Transactions: Foreign Exchange/Conversion Fee is determined by MasterCard® International plus an administration cost of 1% and a Retail Transaction Fee of RM1 per transaction

Card Replacement Fee: RM25

JOHORKota Tinggi Jalan LombongBatu Pahat Jalan RugayahJohor Bahru Metropolis Tower, Jalan Abdullah TahirJohor Bahru Melodies Garden, Jalan Meranti MerahJohor Bahru Jalan Wong Ah FookJohor Jaya Jalan Ros Merah 2/8 Muar Jalan SulaimanKluang Jalan Dato' Teoh Siew KhorSegamat Jalan AbdullahKulai Lorong DuaSkudai Taman Ungku Tun Aminah, Jalan Nakhoda 1 Petronas Seri Alam 2 Eidaman Enterprise, Bandar Seri Alam, Mukim PlentongPermas Jaya Bandar Baru Permas Jaya, Jalan Permas 4/3 KEDAHAlor Setar Wisma Landag, Jalan KotaSungai Petani Jalan Kampung BaruKulim Jalan Tunku PuteraKELANTANKota Bharu Jalan Sultan IbrahimWILAYAH PERSEKUTUANJalan Raja Chulan Bangunan AmBank GroupJalan Ipoh Bangunan Lim, Batu 4 1/2 Jalan Imbi Berjaya Times SquareKepong Baru Jalan Ambong 2 Medan Pasar Wisma Maran Jalan Yap Kwan Seng Menara AmBankBangsar Baru Jalan Telawi TigaOUG Jalan Hujan Rahmat 2Puchong Seksyen 1, Batu 7 1/2, Jalan PuchongCheras Taman Connaught, Jalan Cerdas Cheras Taman Maluri, Jalan Jejaka 2Wangsa Maju Pusat Bandar, Jalan 1/27F Sri Petaling Jalan Raden TengahMont Kiara Jalan Solaris 1 Setapak Taman Setapak Indah Jaya, Jalan 3/50C MELAKA Melaka Kompleks Munshi Abdullah, Jalan Munshi AbdullahNEGERI SEMBILAN Seremban Arab-Malaysian Business Centre, Jalan PasarSeremban Jalan Dato' Lee Fong YeeBahau Jalan MewahPERAK Ipoh Garden Jalan Dato' Lau Pak Khuan Ipoh Main Jalan Yang KalsomLangkap Lorong 1, Project Perumahan Awam LangkapSitiawan Jalan Raja OmarTaiping Jalan Taming SariTERENGGANU Kuala Terengganu Bangunan UMNO Terengganu, Jalan Sultan Ismail

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

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.

Apakah yang perlu saya buat?1. Lengkapkan borang permohonan eCosway dan hantar bersama dengan salinan kad pengenalan anda (depan/belakang)/pasport ke AmBank untuk diproses2. Tandatangan nama anda di panel tandatangan pada bahagian belakang kad apabila menerima kad anda3. Hubungi AmBank untuk mengaktifkan kad anda

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.

Di mana boleh saya menggunakannya?Di serata dunia di mana MasterCard® diterima.

Siapa yang layak untuk mendapatkan kad ini?Sesiapa sahaja. Tidak seperti kad kredit biasa, ia tidak mempunyai syarat pendapatan atau had umur.

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™ 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

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™ 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.

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.

Bagaimana cara saya memantau perbelanjaan saya?Penyata Akaun boleh didapati melalui ambg.com.my

Berapa jumlah wang yang boleh saya belanja untuk setiap urus niaga pembelian?Anda boleh berbelanja sehingga RM2,000 bagi setiap urus niaga pembelian.

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.

Bilakah tempoh jangka masa perlindungan PERCUMA bagi insurans PA ini?Tempoh jangka masa perlindungan percuma adalah:a. Maksimum 12 bulan daripada tarikh pendaftaranb. Sepanjang tempoh ahli Kad memiliki kad, tertakluk kepada yang mana lebih awal

Di manakah maklumat lanjut perlindungan Insurans PA PERCUMA ini boleh diperolehi?Untuk keterangan mengenai perlindungan dan polisi kontrak, sila rujuk di ambg.com.my

Bagaimana sekiranya kad saya telah hilang?Laporkan kehilangan kad anda serta-merta kepada AmBank di 1300 80 8888 (Tempatan) atau (603) 2178 8888 (Antarabangsa).

Apakah talian bantuan yang boleh saya hubungi?Hubungi Pusat Panggilan AmBank (24/7) di 1300 80 8888 (Tempatan) atau (603) 2178 8888 (Antarabangsa).

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

Urus Niaga Luar Negara: 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

Yuran Penggantian Kad: RM25

PAHANG Kuantan Jalan Haji Abdul AzizKuantan Jalan BeserahPULAU PINANG Bagan Ajam Jalan Bagan AjamLiang Court Jalan Sultan Ahmad ShahBukit Mertajam Jalan Padang LalangBayan Baru Jalan MahsuriJelutong Jalan JelutongPUTRAJAYA Putrajaya Alamanda Shopping Centre, Jalan Alamanda, Precinct 1SABAH Tawau Sabindo Square, Jalan DunlopKota Kinabalu Luyang Commercial Centre, Jalan Damai LuyangKota Kinabalu EON CMG Life Building, Jalan SeguntingSandakan Bandar Pasaraya, Miles 4, North Road SARAWAK Bintulu Bangunan BDA, Jalan SommervilleKuching Golden Court Commercial Centre, Bt 4½, Jalan PenrissenKuching Jalan Abell Bandar Tabuan Jaya Pusat Commercial Tabuan Stutong, Jalan Setia RajaSatok Wisma MBF, Section 8, Jalan Haji TahaSibu Jalan Tuanku OsmanMiri Boulevard Commercial Centre, KM 3, Jalan Miri-PujutMiri Beautiful Jade CentreSibu Tanamas Chinese Chamber Of Commerce Building, Jalan Klinik SELANGOR Petaling Jaya Jalan SS2/61Petaling Jaya New Town Centre, Road 52/4Selayang Pusat Bandar Utara, Off KM12, Jalan IpohBandar Puteri Puchong Jalan Puteri 1/1 Bandar Puteri Klang Lorong Sanggul 1F Setia Alam Seksyen U3, Jalan Setia Prima, RU 13R Klang Wisma SH NG, Persiaran Sultan IbrahimShah Alam Seksyen 15, Jalan Utas B/15BBanting Wisma Mutiara, Jalan Sultan Abdul SamadAmpang Point Ampang Point, 4 1/2 Miles, Jalan Mamanda 7 USJ Taipan Taipan Triangle, Jalan USJ 10/1A Damansara Utama Jalan SS21/35 Balakong Taman Indah, Batu 11Rawang Bandar Country Homes, Jalan Desa 1/1 Bandar Baru Bangi Seksyen 9, Jalan Medan PB2 Port Klang Persiaran Raja Muda MusaBandar Baru Rawang Jalan Ipoh, Batu 18 Subang Jaya Jalan SS15/4DKajang Seksyen 10, Jalan S10/1, Jalan Bukit

6 June 2008

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