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Lawyer
Financial Institution
Adjuster
Service Provider
Others
(Please specify)
Telephone No:
Handphone No.
Contact Person 1:
Email:
Contact Person 2:
Email:
Bank Code
I/We hereby declare that the above is my personal account/our company account, NOT joint account and the information given is true and accurate to the best of
my/our knowledge and record.
I/We shall indemnify TMIM for any loss, damage or claims incurred as consequence of acting on such reliance.
I hereby give my consent to TMIM to disclose my Personal Data provided in this E Payment Registration Form to TMIM, TMIM's service providers and bankers and
such service providers and bankers have my consent to process my Personal Data for the purpose of effecting and administrating the electronic payments to me
(including without limitation, my name, personal identification number, contact details and any other personal data obtained hereafter collectively known as
Personal Data).
I understand that I have the right, upon payment of a prescribed fee, to request access to my Personal Data that is being processed by TMIM and to request
correction of my Personal Data. Such request shall be submitted to the Head of Finance, TMIM; and
I understand that the supply of my Personal Data herein is voluntary and it is necessary for TMIM to process my Personal Data for effecting and administrating the
electronic payments to me.
Authorised Signatory
Name
Position
Date
Company/Agency Stamp
MO Code
Agent Code
Signature/Date
Signature/Date
Signature/Date
APPENDIX A
LIST OF BANKERS
Bank Account Number (please ignore all dashes:'-')
Banker
.
Bank Code
PHBM
AGOB
MFBB
RJHI
AMBANK BERHAD
ARBK
BIMB
BKRM
BMMB
BANK OF AMERICA
10
BOFA
BOTK
11
BSNA
12
CIBB
13
CITIBANK BERHAD
CITI
(10)
14
DEUSTCHE BANK
DEUT
(10)
15
HLBB
16
HBMB
17
CHAS
18
KFHO
19
MBBE
20
OCBC
(10)
21
PBBE
(10)
22
RHBB
23
ABNA
24
SCBL
25
SMBC
26
UOVB
(12)
(17)
(15)
(15)
(13)
(14)
(12)
(14)
(12)
(6)
(16)
(14)
(11)
(12)
(10)
(12)
(12)
(14)
(7 to 9)
(12)
(8)
(11)