Diners Club Malaysia

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

YES! I wish to apply for the Diners Club International - Metrojaya Cobrand Charge Card.

Source Code

New Member:

Existing MJ Member:

Gift Code:

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:

Name of Closest Relatives/Friend Not Living with me:

Relationship:

Home Phone No.:

Office Phone No.:

Hand Phone No.:

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

By signing here I/we hereby request: -

Diners Club(Malaysia) Sdn Bhd (Diners) to issue a Diners Club-Metrojaya International Cobrand Charge Card (DC-MJ Card) to me for my use upon the Terms and Conditions which accompany the DC-MJ Card(s) and any susbsequent amendments thereto; and

MJ Department Stores Sdn Bhd (MJ) to grant me Metrojaya Card Membership Account based on MJ Terms and Conditions (MJ Terms).

Irrevocably give consent and authorise Diners to conduct credit checking on me/us from any credit reference agencies, authorities and any other sources and shall permit Diners to obtain, verify, exchange, disclose and release any information so obtained or possessed at any time and from time to time at Diners sole discretion to any party without further reference to me/us. I/we hereby acknowledge that Diners shall not be liable to me/us or any party at all times regarding any matters arising from this consent and authorization;

Declare that I am not undischarged bankrupt and have no pending legal proceedings against me;

Undertake to pay all sums charged to the DC-MJ Charge Card(s) and to be jointly and severally liable for each other for the same;

Agree to be bound by the Terms and Conditions of the DC-MJ Charge Card and the MJ Terms unless I return to you the DC-MJ Card cut into halves;

Agree that in the event of any inconsistency and/or conflict between the Terms and Conditions of the DC-MJ Card and the MJ Terms, the terms and conditions of the Card shall prevail over the MJ Terms to the extent of the inconsistency and/or conflict and all the other Terms and Conditions of the DC-MJ Charge Card as well as all the other MJ Terms shall remain valid and binding on me;

Request that my MJ Privilege Membership Account annual fees to be billed to the DC-MJ Charge Card of the said Autobilling System and agree to be bound by the terms and conditions of the said Autobilling System.

Agree that Diners reserves the right to decline this application or withdraw, cancel or terminate my DC-MJ Charge Card membership at any time without assigning any reasons thereto;

10.

Declare that the information given in the application form by me is true and correct.

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

Basic Card No:
Supplementary Card No:


Charge Card Terms & Conditions \| Credit Card Terms & Conditions @ Copyrights by Diners Club (Malaysia) Sdn Bhd (3908-K). All rights reserved.