The Annual Fee
  • Basic: RM35 annual fee - 2 Years FREE
  • Supplementary: RM15 annual fee - 2 Years FREE
MJ Privilege Fee
  • Basic: RM20 for 2 years
  • Supp: Nil
Card Service Tax per annum
  • Basic: RM50
  • Supp: RM25
 
Please complete ALL details & enclose a photocopy of your :
Requirements
•    Minimum Annual Income: RM24,000
•    Minimum Age: 21 – 55 years old
Mandatory
Documents required, non-returnable
    A photocopy of I/C (both sides)

For Salaried Earner
    Latest Salary Slip

For Commision Earner
    Latest 3 months Salary Slip

For Self-Employed
    Business Registration Certificate/Form 9, 24 & 49
    Latest 3 months Bank Statement
    Form J
 
Product Disclosure Sheet Fees & Charges
The Diners Club International - Metrojaya Cobrand Credit Card Application Form
YES! I wish to apply for the Diners Club International - Metrojaya Cobrand Credit Card.
Source Code
New Member:
 G
4 
-
0
2
 - 1 7
Existing MJ Member:
 G
1 
-
0
2
 - 1 7
Gift Code:
G
F
My Personal Particulars
Full Name as in IC/Passport:
(please underline Surname)
Date of Birth:
Sex:
Nationality:
Race: Chinese Indian
Malay Others:
 
Status: Bumiputra
Non-Bumiputra
Non-Resident
Marital Status:
New IC No.:
Old IC/Passport No.:
Local Home Address:
Postcode:
Home Phone No.:
Handphone No.:
Own Property Rented
Mortgaged Parents'/Relatives'
Permanent Home Address:
Postcode:
Email:
Mother's Maiden Name:
Primary School Name:
Please send my Billing Statement to: My Home My Office
My Family
Spouse's Full Name as in IC/Passport : (please underline Surname)
New
IC/Passport No.:
Hand Phone No.:
Name of Employer:
Office Phone No.: ext.:
Position Held:
My Emergency Contact
Name of Closest Relatives/Friend Not Living with me:
Relationship:
Home Phone No.:
Office Phone No.:
Hand Phone No.:
My Financial Particulars
Loan
(Please tick)		 Interest Rate p.a.
(%)		 Monthly Repayment
 Home Loan RM 
 Car Loan RM 
 Personal Loan RM 
 Other Loan /
Installment Loan		 RM 
 
I hold the following Credit/Charge Cards:
1. Name of Card:
A/C No.:
2. Name of Card:
A/C No.:
Please emboss my name on my Card as follows (maximum 23 spaces, to include initials of full name as well)
My Work
Name of Employer:
I am Self Employed Yes    No
Office Address:
Postcode:
Nature of Business:
Office Phone No.: ext.:
Position Held:
Year Joined: 19   20
Gross Annual Income:
 RM
(min. RM24,000/p.a)
SUPPLEMENTARY CARD
Please Approve A Supplementary Card To The Following Person (Above 18 Years Of Age)
 Please Submit :
Photocopy of I.C. (Both sides) or Passport non-for Malaysian.
Full Name as in IC/Passport:
(please underline Surname)
Date of Birth:
Sex:
Relationship:
Nationality:
Race: Chinese Indian
Malay Others:
 
Status: Bumiputra
Non-Bumiputra
New IC No.:
Old IC/Passport No.:
Local Home Address:
(if different from the Basic Cardmember)
Postcode:
Home Phone No.:
Hand Phone No.:
Name of Employer:
Office Phone No.: ext.:
Office Address:
Postcode:
Position Held:
Gross Annual Income: RM
Please emboss my name on my Card as follows (maximum 23 spaces, to include initials of full name as well)
   

Metrojaya Privilege Card
My Metrojaya privilege
Yes    No
Card No:
Expiry Date:
Type of Card: Principal Supplementary
Declaration
1. I/we request Diners Club (Malaysia) Sdn Bhd (3908-K) (“Diners”) to issue the above selected Card(s) (“the Card”) to me/us for my/our use.
2. I/we confirm I/we have read of the Product Disclosure Sheet and agree to the information, including the fees and charges, contained there. I agree to be bound by the Terms & Conditions applicable to the Card, its renewal and any replacement and any subsequent amendments thereto effected by notice unless I/we return the Card(s) cut into halves to Diners.
3. I/we further request Metrojaya (“Cobrand partners”) to issue their respective individual membership card(s) to me/us and I/we agree to be bound by the terms and conditions of the respective Cobrand partners. Please autobill the respective Cobrand partners membership fee (if any) to my Diners Club account;
4. I/we irrevocably authorise Diners to conduct credit check on me/us from any credit reference agencies, authorities and any other sources and shall permit Diners to verify, exchange, disclose and release any information so obtained or possessed at any time at Diners sole discretion with or to any such party without further reference to me/us. I/we hereby acknowledge that Diners shall not be liable to me/us or such party at all times regarding any matters arising from this consent and authorisation.
5. I/we further agree and authorise Diners to disclose information to Bank Negara Malaysia and/or any other authorities having jurisdiction over Diners regarding me/us, my/our membership with Diners, and my/our account with Diners as may required by law or otherwise.
6. I/we further agree that the Basic Cardmember shall be responsible for all liabilities and obligations of the Basic Cardmember as well as those of the Supplementary Cardmember(s). The Supplementary Cardmember however, shall only be responsible for his/her own liabilities and obligations
7. I am/we are not undischarged bankrupt/s and have no pending legal proceedings and/or execution against me/us.
8. I/we further irrevocably and unconditionally agree and authorise Diners to share the information (excluding information relating to my/our affairs or accounts with Diners) provided by me/us to its Cobrand partners, where necessary to operate the Diners Club-Cobrand Partners’ programme in order to provide me/us with services and to promote offers relating to its said programme.
Yes     No
9. I/we declare that all the above information given is true and correct and agree that Diners reserves the right to decline this application and/or withdraw or cancel the Card/s without assigning any reasons thereto
 
Send no money now. Upon approval, Diners Club will bill you for annual fees (if applicable), I/We have read this Membership Form, including it's Terms and Conditions listed above, and agree to its terms.
 
Signature of Basic Card Applicant Signature of Supplementary Card Applicant
Date: Date:
 
For more information, please call DINERS CLUB's Customer Service Personnel at : 03-2161 1055. Please complete this application form above and mail it together with the necessary documents to : DINERS CLUB (Malaysia) SDN BHD. (3908-k) P.O BOX 11095, 50990 KUALA LUMPUR

For security purposes, please DO NOT send account or confidential information via the Internet or e-mail as it will not be encrypted during transmission. For Malaysia Residents Only.
 
For Diners Club Use Only
APC1 APC2   R
Basic Card No:
Supplementary Card No:

Charge Card Terms & Conditions | Credit Card Terms & Conditions
  
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