AUTO DEBIT

pembatalan arahan auto debit / auto debit cancellation declaration maklumat akaun bank islam / bank islam account details kad kredit-i bank islam...

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Kad Kredit-i Bank Islam

BORANG PEMBATALAN ARAHAN AUTO DEBIT / AUTO DEBIT CANCELLATION FORM MAKLUMAT AHLI KAD / INFORMATION OF CARDMEMBER Nama Ahli Kad / Cardmember’s Name

____________________________________________________________________________________________ No. Kad Pengenalan / NRIC No. : ___________________________ (Baru / New ) ___________________________ ( Lama / Old ) / Nombor Kad / Card Number Tarikh Luput Kad / Card Expiry Date B/M T/Y / B/M T/Y

PEMBATALAN ARAHAN AUTO DEBIT / AUTO DEBIT CANCELLATION DECLARATION Saya dengan ini membatalkan arahan pembayaran secara autodebit kerana / I hereby wish to cancel autodebit payment order due to : Membuat bayaran secara tunai / cek dan lain-lain / Paid by cash / cheque and etc. Lain – lain (sila nyatakan) / Others (please specify) : _____________________________________________________________ _____________________________________________________________

MAKLUMAT AKAUN BANK ISLAM / BANK ISLAM ACCOUNT DETAILS Berikut adalah butir-butir Akaun Bank Islam saya / Please find details of my Bank Islam Account as below : Nombor akaun / Account no. : ___________________________________________________________________________ Jenis akaun / Type of account :

Semasa / Current

Simpanan / Savings

Sila tandatangan di sini / Please sign here

Tandatangan Ahli Kad Utama / Signature of Principal Card Member Tarikh / Date : _______________________________________

UNTUK KEGUNAAN PEJABAT / FOR OFFICE USE Arahan / Instructions : ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Disediakan oleh / Prepared by Tarikh / Date : Pusat Kad Bank Islam Aras 24, Menara Bank Islam, No. 22 Jalan Perak, 50450 Kuala Lumpur Email : [email protected] • Fax : 03-2726 7606

Disahkan oleh / Verified by Tarikh / Date :

Diluluskan oleh / Approved by Tarikh / Date :