AIA Member Registration

Branch Select Branch SMJ PKP IPOH KELANTAN KLSP

NUBE Member Number

Member Status Select Status Non-Member Active Defaulter Struckoff Resigned

Full Name

Date of Birth

NRIC (New)

NRIC (Old)

Gender Select Gender Male Female

Occupation

Bank Name Select Bank THE ROYAL BANK OF SCOTLAND BERHAD ALLIANCE BANK MALAYSIA BHD AMBANK BERHAD BANK ISLAM MALAYSIA BERHAD BANGKOK BANK BANK MUAMALAT MALAYSIA BHD BANK OF AMERICA NT & SA CIMB BANK BERHAD BANK OF NOVA SCOTIA BHD BANK OF TOKYO-MITSUBISHI (M) BHD RHB BANK BERHAD CITIBANK BERHAD J.P. MORGAN CHASE BANK BHD DEUTSCHE BANK (M) BERHAD HONG LEONG BANK BHD HSBC BANK MALAYSIA BHD MAYBANK HONG LEONG BANK BERHAD OCBC BANK (M) BERHAD UNITED OVERSEAS BANK (M) BHD PUBLIC BANK BERHAD AFFIN BANK BERHAD SOUTHERN BANK BERHAD STANDARD CHARTERED BANK DUMMY BANK BANK OF CHINA AEON CREDIT SERVICE (M) SDN BHD I CIMB (MALAYSIA) SDN BHD RHB INVESTMENT MANAGEMENT S/B EONCAP ISLAMIC BANK BHD ALLIANCE INVESTMENT BANK BERHAD TEST BANK 01 MALAYSIA BUILDING SOCIETY BERHAD CIMB INVESTMENT BANK BERHAD CIMB ISLAMIC BANK BHD RHB ISLAMIC BANK BHD HSBC AMANAH (M) BHD MAYBANK ISLAMIC HONG LEONG ISLAMIC BANK OCBC AL- AMIN BANK BERHAD PUBLIC ISLAMIC BANK BHD AFFN ISLAMIC BANK BHD

Bank Branch Select Branch

Bank Address

Bank Account Number

Bank Email

Home Address

Country Select Country United States Canada Malaysia Maldives Singapore United Kingdom

State Select State

City Select City

Postcode

House Phone

Office Phone

Mobile Phone

Email Address

Amount Type Select Type Individual Family

Amount (RM)

Consent Letter

IC Copy

Application Form

Other Attachment

Digital Signature
Clear

Name in Capital Letters

ID Card No

Date