2 year AAM Annual Membership Fee
Entrance Fee: Waived
Principal Card: RM120 for 2 years(savings of RM30)
Supplementary Card: RM60 for 2 years

Diners Club Annual Fee
Principal Card: RM78 - 2 years FREE
Supplementary Card: RM40 - 2 years FREE
 
Please complete ALL details & enclose a photocopy of your :
Requirements
•    Minimum Annual Income: RM24,000
•    Minimum Age: 21 – 55 years old
Mandatory
Documents required, non-returnable
    A photocopy of I/C (both sides)

For Salaried Earner
    Latest Salary Slip

For Commision Earner
    Latest 3 months Salary Slip

For Self-Employed
    Business Registration Certificate/Form 9, 24 & 49
    Latest 3 months Bank Statement
    Form J
 
 
The Diners Club - AAM Application Form
YES! I wish to apply for the Diners Club - AAM International Charge Card & enjoy 2 years of Free Diners Club Cardmembership
Source Code:
HZ
02
 17
My Personal Particulars
Full Name as in IC/Passport:
(please underline Surname)
Date of Birth:
Sex:
Nationality:
Race: Chinese Indian
Malay Others:
 
Status: Bumiputra
Non-Bumiputra
Non-Resident
Marital Status:
New IC No.:
Old IC/Passport No.:
   
Local Home Address:
Postcode:
Home Phone No.:
Handphone No.:
Own Property Rented
Mortgaged Parents'/Relatives'
Permanent Home Address:
Postcode:
Email:
Mother's Maiden Name:
Primary School Name:
Please send my Billing Statement to: My Home My Office
My Family
Spouse's Full Name as in IC/Passport : (please underline Surname)
New
IC/Passport No.:
Hand Phone No.:
Name of Employer:
Office Phone No.: ext.:
Position Held:
My Emergency Contact
Name of Closest Relatives/Friend Not Living with me:
Relationship:
Home Phone No.:
Office Phone No.:
Hand Phone No.:
My Financial Particulars
Loan
(Please tick)		 Interest Rate p.a.
(%)		 Monthly Repayment
 Home Loan RM 
 Car Loan RM 
 Personal Loan RM 
 Other Loan /
Installment Loan		 RM 
 
I hold the following Credit/Charge Cards:
1. Name of Card:
A/C No.:
2. Name of Card:
A/C No.:
Please emboss my name on my Card as follows (maximum 23 spaces, to include initials of full name as well)
My Work
Name of Employer:
I am Self Employed Yes    No
Office Address:
Postcode:
Nature of Business:
Office Phone No.: ext.:
Position Held:
Year Joined: 19   20
Gross Annual Income:
 RM
(min. RM24,000/p.a)
My AAM Membership Particulars
Current AAM Member
Non-AAM Member
AAM Membership No:
Expiry Date:
Registration of vehicle(s) [up to 2 cars FREE]
No.
 Car Registration No.
1.
2.
For additional vehicles – RM30 per car* (maximum 2 cars)
No.
 Car Registration No.
3.
4.
*Upon registration of additional car, the fee will be automatically billed to your Cobrand Card..
MY SUPPLEMENTARY – AAM Member
Yes No
SUPPLEMENTARY CARD
Please Approve A Supplementary Card To The Following Person (18 years to 21 years old)
 Please Submit :
Photocopy of I.C. (Both sides) or Passport non-for Malaysian.
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)
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
By signing below, I/we hereby request : (a) Diners Club (M) Sdn Bhd (Diners) to issue a Diners Club-AAM Card (DC-AAM Card) to me/us; (b) Automobile Association of Malaysia (AAM) to grant me/us AAM Membership upon its Rules and Regulations of the Association (AAM Rules). I/we hereby:-
1.
 irrevocably give consent and authorise Diners to conduct credit checking on me/us from any credit reference agencies, authorities and any other sources and shall permit Diners to obtain, verify, exchange, disclose and release any information so obtained or possessed at any time and from time to time at Diners sole discretion to any party without further reference to me/us. I/we hereby acknowledge that Diners shall not be liable to me/us or any party at all times regarding any matters arising from this consent and authorization
2.
 declare that I am/we are not undischarged bankrupt/s and have no pending Creditor’s Petitio n/s against me/us;
3.
 agree to be bound by the said Terms and Conditions of the DC-AAM Card and the AAM Rules unless I/We return to you the DC-AAM Card cut into halves;
4.
 undertake to pay all sums charged to the DC-AAM Card/s and to be jointly and severally liable for each other for the same;
5.
 request that my/our AAM Annual Membership Fee(s) and/or other AAM product and services to be billed under the Diners Club-AAM Autobilling Service and agree to be bound by the terms and conditions of the Service.
6.
 agree that Diners reserves the right to withdraw, cancel or terminate the DC-AAM Card/s at any time without assigning any reason thereto and that *AAM may also correspondingly terminate my AAM membership or benefits;
7.
 *agree that similarly, should the AAM for whatever reasons terminate my AAM membership, my/our DC-AAM Card membership will be automatically cancelled.
8.
 *agree that in the event of any inconsistencies and/ or conflict between Terms and Conditions of the DC-AAM Card and the AAM Rules, the Terms and Conditions of the DC-AAM Card shall prevail over the AAM Rules to the extend of the inconsistencies and/or conflicts and all the other Terms and Conditions of the DC-AAM Card as well as the other AAM Rules shall remain valid and binding on me/us.
9.
 declare that all the above information given is true and correct;
 
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:
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

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.
 
For Diners Club Use Only
APC1 APC2   R
Basic Card No:
Supplementary Card No:

Charge Card Terms & Conditions | Credit Card Terms & Conditions
  
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