APPLY FOR ADDITIONAL DINERS CLUB CARDS*
that give you MORE REWARDS, BENEFITS AND PRIVILEGES
 
 
Please complete ALL details & enclose a photocopy of your:-
I/C (front & back) for Basic and/or Supplementary Card applicant
Passport for non-Malaysian;
Credit / Charge Card (front); OR
Latest salary slip; and
Additional documents as may be required during card processing.
   
For more information, please call our Diners Club Customer Service Personnel at Tel: 03-2161 1055.

* A Basic Cardmember is allowed to hold a maximum of 2 Diners Club Cards.
 
Diners Club International Cobrand Card Application Form

Please attach: Basic & Supplementary applicant’s I/C (front & back)
YES! I/we would like to apply for the following Cobrand Card

Diners Club-Metrojaya Card
(Please attach photocopy of Metrojaya Privilege Card (both sides), if any)

Source Code: G1/G4 - 03 - 17
Diners Club-Sushi King Card Source Code: FA - 03 - 17
Diners Club-Secret Recipe Card Source Code: S1 - 03 - 17
     
Basic Cardmember's Details
Name :
New I/C No:
Old I/C No:
Office Phone:
Home Phone:
HandPhone:
Card Account Number: - -
Supplementary Cardmember Details
Name :
New I/C No:
Old I/C No:
Office Phone:
Home Phone:
HandPhone:
Card Account Number: - -
Declaration
1. I/We request Diners Club (Malaysia) Sdn Bhd (3908-K) (“Diners”) to issue the above selected Card(s) to me/us for my/our use upon the Terms and Conditions which accompany the Card(s), its renewal and replacement and any subsequent amendments thereto, unless I/we return the Card(s) cut into halves to Diners.
2. I/we further request Secret Recipe/ Metrojaya/ Sushi King/ The Manhattan Fish Market (“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;
3. I/we irrevocably give consent and authorize 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 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;
4. I am/we are not undischarged bankrupt(s) and have no pending legal proceedings and/or executions against me/us;
5. I/we undertake to pay all sums charged to the Card(s) and agree to be jointly and severally liable for each other for the same;
6. I/we agree that in the event of any inconsistency and/or conflict between the Terms and Conditions of above Card(s) membership and the terms and conditions of the Cobrand partners, the Terms and Conditions of the above Card(s) shall prevail over the terms and conditions of the Cobrand partners to the extent of the inconsistency and/or conflict and all the other terms and conditions of the Cobrand partners shall remain valid and binding on me/us;
7. I/we agree that Diners reserves the right to decline this application or withdraw, cancel or terminate my/our Card(s) at any time without assigning any reasons thereto;
8. I/we declare that the above information given by me/us is true and correct.
Signature of Basic Cardmember Signature of Supplementary Cardmember
Date: Date:
Please MAIL your completed Application Form together with the necessary document to Diners Club (Malaysia) Sdn Bhd (3908-k); P.O. BOX 11095, 50990 Kuala Lumpur OR FAX to: 03-21612706.
 
For Diners Club Use Only
APC1 APC2   R
Basic Card No:
Supplementary Card No:
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.

Charge Card Terms & Conditions | Credit Card Terms & Conditions
  
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