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 documents :
Requirements
•    Minimum Annual Income: RM24,000
•    Age: Basic: 21 – 55 years old
             Supplementary: 18 years old
Mandatory
Documents required, non-returnable
    Photocopy of NRIC (both sides), including Supplementary applicants; AND

For Salaried Earner
    Latest 3 months salary slip

For Commision Earner
    Latest 6 months salary slip

For Self-Employed
    Business Registration Certificate/Form 9,24 & 49
    Latest 3 months Company bank statement
    Form B
 
Product Disclosure Sheet Fees & Charges
The Diners Club - AAM Application Form
YES! I wish to apply for the Diners Club - AAM International Credit 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 
 
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
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:-
1. Diners Club (Malaysia) Sdn Bhd (3908-K) (“Diners”) to issue the Diners Club-AAM International Credit Card(s) (“the Card”) to me/us for my/our use.
2. I/we further request Automobile Association Malaysia (“AAM”) to issue AAM membership card(s) to me/us and I/we agree to be bound by the terms and conditions of the AAM.
3. I/we request that my/our AAM Annual Membership Fee(s) and/or other AAM product and services to be billed under the Diners Club Autobilling Service and agree to be bound by the terms and conditions of the Service.
4. I/we confirm that I/we have been given a copy of the Product Disclosure Sheet and agree to the information, including the fees and charges, contained there.
5. I/we agree to accept and be bound by the Terms & Conditions which accompany the Card, its renewal and replacement and any other subsequent amendments thereto unless I/we return the Card/s cut into halves to Diners
6. I/we agree that similarly, should the AAM for whatever reasons terminate my AAM membership, my/our DC-AAM Card membership will be automatically cancelled.
7. I/we hereby authorize Diners to verify and/or make any checks, confirmation and/or obtain information from any credit reference agencies, financial institutions, authorities on me/us and/or from any other sources as Diners deems fit. I/we hereby acknowledge that Diners at all times shall not be liable to me/us or any party regarding any matters arising from this consent and authorization.
8. I/we further agree and authorise Diners to disclose information to Bank Negara Malaysia regarding my/our credit facilities and my/our account with Diners as may required by law or otherwise and make the relevant credit references with any external parties including but not limited to CCRIS and any credit reference agencies.
9. I/we further agree that the Basic Cardmember shall be responsible for all liabilities and obligations of the Basic Cardmember as well as those of the Supplementary Cardmember(s). The Supplementary Cardmember however, shall only be responsible for his/her own liabilities and obligations.
10. I am/we are not an undischarged bankrupt/s and have no pending legal proceedings and/or execution against me/us.
11. I/we declare that all the above information given is true and correct and agree that Diners reserves the right to decline this application and/or withdraw or cancel the Card/s without assigning any reasons thereto.
12. I/we hereby agree to receive SMS, promotional materials, mailers and telemarketing from Diners and its business partners. I/we hereby give my/our consent for Diners to share my/our information (excluding information relating to my/our affairs or accounts) with Cobrand Partners and/or third parties and/or Diners’ strategic alliance as Diners deems fit for marketing and promotional purposes
Yes     No
 
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:

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