Supplementary International Charge Card¹ : UP TO 2 YEARS FREE  Subsequent Annual Fee : RM70
 
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
 
Supplementary Card applicants must be at least 18 years old and above.
 
The Diners Club Supplementary Charge Card Application Form
YES! I wish to apply for the Diners Club Supplementary Charge Card
PLEASE TICK YOUR BASIC CARD TYPE:
Source Code:
SC
02
17
3,000 Club Rewards Points:
L
2
Diners Club Car Sunshade:
B
8
Corporate Card
Cobrand Card
YOUR ACTIVATION GIFT:
3,000 Club Rewards Points OR
Diners Club Car Sunshade
   
   
Basic Cardmember's Details
Name :
Office Phone:
Home Phone:
HandPhone:
Card Account Number: - -
SUPPLEMENTARY CARD
Please Approve A Supplementary Card To The Following Person (Above 18 Years Of Age)
 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)
Email :
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, we hereby request Diners Club (Malaysia) Sdn Bhd (3908-K) (Diners) to issue a Diners Club Supplementary Charge Card* to the Supplementary Applicant named here. We agree to accept and be bound by the Terms and Conditions which accompany the Supplementary Card, its renewal and replacement, and any other subsequent amendments thereto unless we return the Supplementary Card cut into half to Diners. I further request Automobile Association of Malaysia/Courts Malaysia/Metrojaya/Secret Recipe/Sushi King/Delifrance/Victoria Station (“Cobrand Partners”) to issue their respective individual membership card(s) to me and I agree to be bound by the terms and conditions of the respective Cobrand partners. Please autobill the respective Cobrand partners membership fee (if any) to my Diners Club account. We hereby irrevocably give consent and authorize Diners to conduct credit checking on 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 us. We hereby acknowledge that Diners shall not be liable to us or any party at all times regarding any matters arising from this consent and authorization. We agree to be jointly and severally liable for each other for all sums charged to both the Basic Card and the Supplementary Card. We are not undischarged bankrupts and have no pending legal proceedings and/or executions against us. 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 Supplementary Card without assigning any reasons thereto. To be determined by Diners Club based on the type of Cards issued to the Basic Cardmember.
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:
NOTE:
¹ Supplementary Cardmember’s fee waiver will expire at the end of the second year of the Basic Cardmembership. It will be determined by Diners Club based on the type of Cards issued to the Basic Cardmember.

**Upon first transaction charged to the Supplementary Card within 60 days from the month of cardmembership, the activation gift of your choice will be delivered to the billing address or the 3,000 Club Rewards Points will be credited to yourAccount. The gift mentioned is subject to stock availability and Diners Club reserves the right to replace the gift of the same value.		  
   
For Diners Club Use Only  
APC1 APC2   R
 
Supplementary Card No:
 
 

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
or fax it at 03-2161 2706

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.

Charge Card Terms & Conditions | Credit Card Terms & Conditions
  
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