EXCIMBISLAMIC ERICIMBBANK — REMITTANCE APPLICATION FORM 90099334
Cimento INN eB Den) Alleformaton i rected nies oterwise spettecs Branch: ioryira._YorL
COMPUTER VALIDATION (for dabit account only
[APPLICATION FOR [-] Telegraphic Tanster (TT) __[] RENTAS Transfer Ti interbank RO (8G)
Banker's Onecue 5) Fereign Demand Drat
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RM Account No. for charges to Ue ey acoount Co (SHA) for Shared
[House Creaue No. | Payable to Ot BanicBerhad CID ilamsc Bank Berhad |] (OUR) for Reiter
Cash for Non-CIMB Account Hold Ory). ny wth ofa approve)
& x Recent Heide ;
BR/AP/0031 (04/18) - BOF
‘Goods [1] Services & investment income _[
Please spect for at _ Fact Mack cee Bea
Relationship betwoen Applicant and Beneficiary [| Related, please specy Dh Wet Rated
Foreign Worker Remittances [| Non-Resident whe werksin Malaysia less thant yeer [| Non-Resident who werks in Malaya for 1 year & mor
+ VWe hereby declare that Ye have ec and understood the tr and cnaitons ea forth onthe revert ofthis fom and agraeto comply with and bo boul
bythe provisions of tho ald terme andl condone.
+ Ve declare and confirm that al the information herein is true and correct and in compliance withthe Foreign Exchange Administration Rules made pursuant
to the Financial Services Act 2019/lslamic Financlel Services Act 2013 and the Contra Bank of Malaysia Act 2008. Io shall be fully responsible for
‘Transter {J Capita Investment Transaction”
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258 [Dm approved by Oca
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