borang pembatalan arahan auto debit / auto · pdf filearas 24, menara bank islam, no. 22...
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Pusat Kad Bank IslamAras 24, Menara Bank Islam, No. 22 Jalan Perak, 50450 Kuala LumpurEmail : [email protected] Fax : 03-2726 7606
Tandatangan Ahli Kad Utama / Signature of Principal Card MemberTarikh / Date : _______________________________________
Sila tandatangan di sini / Please sign here
BORANG PEMBATALAN ARAHAN AUTO DEBIT /AUTO DEBIT CANCELLATION FORM
Nama Ahli Kad / Cardmembers Name
____________________________________________________________________________________________
No. Kad Pengenalan / NRIC No. : ___________________________ (Baru / New ) ___________________________ ( Lama / Old )
Nombor Kad / Card Number Tarikh Luput Kad / Card Expiry Date
Saya dengan ini membatalkan arahan pembayaran secara autodebit kerana /I hereby wish to cancel autodebit payment order due to :
Membuat bayaran secara tunai / cek dan lain-lain / Paid by cash / cheque and etc.
Lain lain (sila nyatakan) / Others (please specify) :
_____________________________________________________________
_____________________________________________________________
Berikut adalah butir-butir Akaun Bank Islam saya / Please find details of my Bank Islam Account as below :
Nombor akaun / Account no. : ___________________________________________________________________________
Jenis akaun / Type of account : Semasa / Current Simpanan / Savings
MAKLUMAT AHLI KAD / INFORMATION OF CARDMEMBER
- - -
- - -
/B/M T/Y
/B/M T/Y
PEMBATALAN ARAHAN AUTO DEBIT / AUTO DEBIT CANCELLATION DECLARATION
MAKLUMAT AKAUN BANK ISLAM / BANK ISLAM ACCOUNT DETAILS
Kad Kredit-i Bank Islam
UNTUK KEGUNAAN PEJABAT / FOR OFFICE USE
Arahan / Instructions :________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Disediakan oleh / Prepared by Disahkan oleh / Verified by Diluluskan oleh / Approved by Tarikh / Date : Tarikh / Date : Tarikh / Date :