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Enjoy 2 years’ annual fee waiver* when you apply Citibank Credit Card and get:

  1. FREE

    • Mini Fridge/Warmer
    • 2-year annual fee waiver
    when TWO Citibank Credit Cards are approved. Or,

  2. FREE
    • Rechargeable Wireless Mouse
    • 2-year annual fee waiver*

    when ONE Citibank Credit Card is approved.


Introducing the Citibank Choice Card with automatic Flexi Payment Plan. And it's free for life.


Just swipe 2 times any amount (retail purchases or cash advance) per month including transactions on your supplementary card(s). Otherwise a RM5 monthly fee will be charged to your principal card only.

Only for Citibank Gold, Clear, Silver and Cash Back card.

*Annual fee waivers are subject to a minimum spending of RM300 per credit card within 60 days of card approval.



Complete this form in English or Bahasa Malaysia and enclose:

a) Photocopy of IC (both sides)

b) Photocopy of your credit card (which you have had for 18 months or more)


a) Photocopy of IC (both sides)

b) Latest tax return or salary slip

c) Business registration (for self employed)

Mail it to:
Citibank Berhad (297089-M),
Internet Sales Unit
(TM Net Programme)
Level 35, Menara Citibank
165, Jalan Ampang,
50450 K.L

or Fax to: 03-2383 9090

Questions? Call us at 03-2383 4088
(Mon – Fri, 9am – 6pm).


Card application Requirements
Two Citibank credit cards

Annual income of RM36,000; or

Existing credit card owned for 18 months or more, with a credit limits of RM6,000 and above

One Citibank credit card

Annual income of RM18,000; or

Existing credit card owned for 18 months or more


Terms and Conditions
Please allow 8 weeks for delivery of gifts · This promotion is not applicable in conjuction with other ongoing promotions · Citibank reserves the right to cancel, terminate or suspend this programme without prior notice · Citibank reserves the right to replace with items of similar value where necessary.

Gift Selection
Mini Fridge/Warmer Rechargeable Wireless Mouse
For bank's use    
PV B06 B25 B35 B44 B55 B88 Incomp
  IN ID PR IT PP    
  RJ D      
S 680   G 780   P 880   (For Cash Back Card only)

Please type or print throughout. Complete the form in full. Please tick both cards if you are applying for more than one card. *Delete whichever not applicable. I wish to apply for

Silver VISA Cash Back VISA Clear MasterCard
Gold VISA Choice VISA
Silver MasterCard
Clear VISA Gold MasterCard
Choice MasterCard
For choice application. Enrol FlexiPayment Plan?
Yes (minimum RM500/12months) No  
Full name as in *NRIC/Passport (Underline surname): Mr. Mrs. Ms.
SEX: Male Female  
Name to appear on card (not more than 19 letters):
Date of birth:
(MM) (DD) (YY)
New I.C.: - -
Old I.C.
Home address (Even if same as principal cardmember)  
E-mail Home tel. no Handphone no
Permanent home address  
Marital status
Single Married Widowed Divorced
Send Bill to Office Home
†If you are applying for your second Citibank credit card, kindly be advised that the monthly statement will be sent to the address as specified for your first Citibank credit card.
Send Card to Office Home
Residence is
Owned Parents' Home
Employer's Rented Mortgaged
5 yrs 10 yrs yrs.
Mother's name ( This security feature is required for your protection ) :
For Citibank Clear credit card applicant, please tick where appropriate
Diploma Degree Masters Doctorate
Name of spouse (Underline surname): Mr. Mrs
Name of employer or firm & dept., if any
(Office tel.) Ext.
Name of *employer or firm
Office address  
Nature of business Position
General line Ext. *Date joined or date established if self employed
Office direct tel. If own business, business registration no.
Name of previous employer (if less than 2 years in present employment) Position
Office tel. Years there
Annual salary or income Sources of other income if any, and amount (Please enclose supporting documents)
Bank :  Type of card  Card no.  Member since
month year
EMERGENCY CONTACT PERSON (Relative not staying with you)
Name: Relationship
Home tel. no. Office tel. no.
Handphone no.  
Home address Postcode:  
Bank Name Branch Type of account



Senior public office (eg. ministerial or diplomatic positions)


Yes, I/my immediate family members:
  currently hold
  have held
  are actively seeking
  are being considered for


senior public office

  Position held _________________________________
  Period held from: _____________ to _____________
                             (dd/mm/yy)          (dd/mm/yy)
No, I/my immediate family members do not hold, have never held, are not actively seeking and are not being considered for senior public office.



I/We certify that all the above information is true and valid. I/We hereby authorise the bank to verify from whatever sources the bank may consider appropriate including Inland Revenue. I/We acknowledge that the card may only be used subject to the terms and conditions of the Citibank Card Agreement. I/We agree to be bound by the terms and conditions which accompany the card(s). Upon approval, I/we agree to pay prevailing annual fees. I/We agree to accept full liability for all my/our card account(s) with you notwithstanding any credit limits imposed on the use of my/our Cards. The principal cardholder shall additionally be liable for all amounts and charges incurred in respect of the use of any supplementary card. I/We understand that the bank reserves the absolute right to reject or approve my/our application(s) as the bank deems fit without assigning any reasons thereof. I/We confirm that my/our borrowings (other than for financing immovable property in Malaysia) from all sources within Malaysia do not exceed in aggregate RM200,000. (Applicable to non-Malaysians only). I/We understand that the card, when issued, shall remain the property of Citibank Berhad and shall be subject to cancellation without notice. By signing and/or using the card, I/we agree to be bound by the terms and conditions specified in the Citibank Card Agreement and all future amendments thereto.

I/We hereby give the Bank an irrevocable and unconditional consent to disclose any information pertaining to this credit card application and/or all advances, credit or banking facilities granted by the Bank to me/us and/or any banking facilities or other account otherwise which I/we may have with the Bank and without prejudice to the foregoing any information relating to me/us to such extent as the Bank may at the Bank's sole and absolute discretion deem necessary ("the Information") for any purpose whatsoever to the Bank's branches, Citicorp subsidiaries and affiliates, Bank Negara Malaysia ("BNM"), the Central Credit Unit, the Central Credit Reference Information System, the Biro Maklumat Cek and such other authority or body established by BNM or any other authority having jurisdiction over the Bank, permitted assignees and other persons authorised by the Bank.


I/We hereby confirm that no further permission or consent from the undersigned is necessary or required in relation thereto and this shall constitute the consent required pursuant to Section 99(1)(a) of the Banking and Financial Institutions Act 1989 and any other contractual consent for such disclosures.
I/We hereby agree that any disclosure by the Bank of the Information will not render the Bank liable to me/us for any claim, loss, damage (including direct or indirect damages or loss of profits or savings) or liability howsoever arising whether in contract, negligence, or any other basis arising from or in relation to:-
(i) the release or disclosure of the Information by the Bank; and/or
(ii) the Information being incorrect, erroneous or misstated; and/or
(iii) reliance of the Information, whether caused by the Bank or other third party's omission, misstatement, negligence or default or by technical, hardware or software failures of any kind, interruption, error, omission, viruses, delay in updating or notifying any changes in the Information or otherwise howsoever.

I/We certify that all information furnished in support of this application is true and valid.


NOTE: In the event of any conflict or discrepancy between the English text and any translation thereof, the English text shall prevail.




Signature of principal applicant
  (MM) (DD) (YYYY)
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