Supplementary International Credit Card
Diners Club Annual Fee: RM70 - up to 2 years free Cardmembership*
Service Tax per annum: RM25
 
Please complete ALL details & enclose a photocopy of your document
Requirements
•    Minimum Age: 18 years and above

Mandatory
Documents required, non-returnable
    A photocopy of I/C (both sides)
 
The Diners Club Supplementary Credit Card Application Form
YES! I wish to apply for the Diners Club Supplementary Credit Card
PLEASE TICK YOUR BASIC CARD TYPE:
Source Code:
SC
02
17
3,000 Club Rewards Points:
L
2
Diners Club Car Sunshade:
B
8
Corporate Card
Cobrand Card
Personal International Card
YOUR ACTIVATION GIFT:
3,000 Club Rewards Points OR
Diners Club Car Sunshade
   
   
Basic Cardmember's Details
Name :
Office Phone:
Home Phone:
HandPhone:
Card Account Number: - -
SUPPLEMENTARY CARD
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)
Email :
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)
Declaration
1. By signing below, we hereby request Diners Club (Malaysia) Sdn Bhd (3908-K) (Diners) to issue a Diners Club Supplementary Card to the Supplementary Applicant named here.
2. We confirm that we have been given a copy of the Product Disclosure Sheet and agree to the information, including the fees and charges, contained there.
3. We agree to accept and be bound by the Terms and Conditions which accompany the Supplementary Card, its renewal and replacement, and any other subsequent amendments thereto unless we return the Supplementary Card cut into half to Diners.
4. We further request Automobile Association of Malaysia/Courts Malaysia/Metrojaya/Secret Recipe/Sushi King/Delifrance/Victoria Station (“Cobrand Partners”) to issue their respective individual membership card(s) to the Supplementary Card and we agree to be bound by the terms and conditions of the respective Cobrand partners.
5. Please autobill the respective Cobrand partners membership fee (if any) to our Diners Club account.
6. We hereby authorize Diners to verify and/or make any checks, confirmation and/or obtain information from any credit reference agencies, financial institutions, authorities on us and/or from any other sources as Diners deems fit. We hereby acknowledge that Diners at all times shall not be liable to us or any party regarding any matters arising from this consent and authorization.
7. We further agree and authorise Diners to disclose information to Bank Negara Malaysia regarding our credit facilities and our account with Diners as may required by law or otherwise and make the relevant credit references with any external parties including but not limited to CCRIS and any credit reference agencies.
8. 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. The Supplementary Cardmember however, shall only be responsible for his/her own liabilities and obligations.
9. We declare that we are not an undischarged bankrupt/s and have no pending Creditor’s Petition/s against us.
10. 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.
11. We hereby agree to receive SMS, promotional materials, mailers and telemarketing from Diners and its business partners. We hereby give our consent for Diners to share our information (excluding information relating to our affairs or account) with third parties and/or Diners’ strategic alliance as Diners deems fit for marketing and promotional purposes.

Yes     No
 
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:
NOTE:
¹ Supplementary Cardmember’s fee waiver will expire at the end of the second year of the Basic Cardmembership. It will be determined by Diners Club based on the type of Cards issued to the Basic Cardmember.

**Upon first transaction charged to the Supplementary Card within 60 days from the month of cardmembership, the activation gift of your choice will be delivered to the billing address or the 3,000 Club Rewards Points will be credited to yourAccount. The gift mentioned is subject to stock availability and Diners Club reserves the right to replace the gift of the same value.		  
   
For Diners Club Use Only  
APC1 APC2   R
 
Supplementary Card No:
 
 

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
or fax it at 03-2161 2706

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.

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