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    ServiceRequestForm - Template

    Uploaded by

    H ZK

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    ServiceRequestForm - Template

    Uploaded by

    H ZK
    30 views1 page

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    30 views1 page

    ServiceRequestForm - Template

    Uploaded by

    H ZK

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Send your request to / Sila hantar borang kepada:

    FINEXUS Cards Sdn Bhd


    P.O. Box 11695, 50754 Kuala Lumpur
    Or fax to / Fax ke +6 03 8318 0761
    Email to / Emel kepada [email protected]

    Service Request Form / Borang Permintaan Perkhidmatan


    Please fill in the following details / Sila isikan butir-butir berikut

    Cardholder’s Name / Nama Pemegang Kad :

    Card Number / Nombor Kad :

    ID Number / Nombor ID :

    Type of Request (Please [ √ ] in allocated boxes) / Jenis Permintaan (Sila [ √ ] dalam kotak )

    Change of personal details / Penukaran butir – butir peribadi.

    Residential / Kediaman Mailing / Surat-Menyurat


    Address / Alamat :

    Postcode / Poskod : City / Bandar : State / Negeri :

    Email / Emel :

    Passport Number / Nombor Pasport : Passport Expiry Date / Pasport Tarikh Tamat :

    Mobile No /
    No Tel Bimbit :

    Note / Nota:
    Please provide copy of IC, passport (for non-Malaysian), TM bill or TNB bill or mobile phone bill as proof of address / identity.
    Sila kemukakan salinan IC, passport (untuk bukan warganegara Malaysia), bil TM atau bil TNB atau bil telefon bimbit untuk pengesahan alamat / identiti.

    Statement request from / Permintaan penyata dari mm/yyyy to / hingga mm/yyyy

    Send by post/ Send by fax/ Send by email/


    Hantar melalui pos Hantar melalui fax Hantar melalui emel

    Card Replacement / Penggantian kad

    Card lost or stolen / Card damaged / Non receipt of card /


    Kad hilang atau dicuri Kad rosak Kad tidak diterima

    Change of name on card/


    Pertukaran nama di atas kad

    Others (Please specify reason) /


    Lain-lain (Sila nyatakan sebab)

    Note/ Nota:
    For lost or stolen card, please provide a copy of police report / Untuk kad hilang atau dicuri, sila kemukakan salinan laporan polis.

    Card Cancellation / Pembatalan kad

    Card features not attractive / Expensive monthly fee / Too many cards /
    Ciri-ciri kad kurang menarik Yuran bulanan mahal Terlalu banyak kad

    Others (Please specify reason) /


    Lain-lain (Sila nyatakan sebab) no longer using

    Waiver of Fees / Caj dikecualikan

    Card replacement / Others (Please specify reason) /


    Penggantian kad Lain-lain (Sila nyatakan sebab)

    Other Requests (Please Specify) / Lain-lain jenis permintaan (Sila nyatakan)

    Kindly transfer balance funds to my bank account: Account Name:


    Bank A/C No: Bank Name:

    Cardholder’s signature / Tandatangan pemegang kad For office use only / Untuk kegunaan pejabat sahaja

    Declaration – I declare that all the information provided herein is true, correct
    and complete.
    Pengakuan – Saya mengaku bahawa semua maklumat yang diberikan di dalam
    borang ini adalah benar, tepat dan lengkap.

    Parent's Signature insert date

    Signature / Tandatangan Date / Tarikh Approved by : Processing Officer :


    (Name, Date, Signature) (Name, Date, Signature)

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