MPIS Partner - Individual Form | Alliance Bank Malaysia

Personal Details

Full Name (as per NRIC)*

Email Address*

ID Type*

NRIC*

Date Of Birth* (In DD/MM/YYYY format e.g. 01/01/2001)

Mailing Address*

Nature of Business*

Name of Employer/ Company*

Contact Number (HP)*

Tel Number (Optional)

Bank Name* (For referral fee payment purpose)

Saving Account/Current Account No.* (For referral fee payment purpose)

Required Document

NRIC Card (Front and Back)*
(PLEASE UPLOAD IMAGE FILE ABOVE 200KB)

Upload

Business Card (Front and Back)*
(PLEASE UPLOAD IMAGE FILE ABOVE 200KB)

Upload

Who referred you to this MPIS referral program?

(Please select Alliance Bank staff who refer you MPIS program from drop down list below)

Preferred Sales staff*

Do you have relationship with any of the Bank's director/shareholder/employee or their close relatives? If yes, kindly fill in the details of the Bank's director/shareholder/employee or their close relatives as below.

(Close relatives is referred to spouse and dependents of the spouse, child (including step children and adopted children) and spouse of the child, parent; brother or sister and their spouses and financial dependents of the individual/spouse - this refers to any person who is financially dependent on the individual or his spouse for his livelihood, e.g. a person who receives financial assistance on a regular basis from the individual/spouse)

Name (as per NRIC)

NRIC

Relationship

Terms and Conditions

I, hereby confirm that I have thoroughly read and fully understood all the terms and conditions contained hereinabove and unequivocally accept the same and also expressly acknowledge that the acceptance herein shall be irrevocable and be fully binding upon me and my heirs, successors-in-tile, beneficiaries, executors, administrators and personal representatives including other party whosoever claiming any rights and/or interests whatsoever under and/or through me.

Registration Form (Individual)

Personal Details

Required Document

Who referred you to this MPIS referral program?

Do you have relationship with any of the Bank's director/shareholder/employee or their close relatives? If yes, kindly fill in the details of the Bank's director/shareholder/employee or their close relatives as below.

Terms and Conditions

Insert OTP To Complete Registration