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Name

Name as per Mykad

Contact Number

Handphone No

E-mail address

MyKad Number

without (-)

Declaration

I hereby confirm that I have read and agree to the contents of Privacy Notice. I further acknowledge and agree that all personal data provided by me and/or acquired by Bank Muamalat Malaysia Berhad from the public domain as well as personal data that arises as a result of the provision of services to me will be subject to the Privacy Notice. I hereby agree and authorize the disclosure of my name(s) and other contact details to companies within Bank Muamalat Malaysia Berhad for marketing and for promotional purposes.