Reflex Application Form 2010

Application:
Reflex Simplified Cash Management Application Form
Basic Password Package
(please tick at the box)
Please print the Reflex Cash Management New Application Form.
Super ID Package
DOCUMENTS SUBMISSION:
CHECKLIST BEFORE SUBMISSION TO BANK:
1. Completed Application Form
- duly signed by Current Account Authorized Person(s)
2. Photocopy of NRIC of your appointed System Administrators
(for Basic Password Package)
3. Photocopy of NRIC of Super ID user (for Super ID Package)
4. Photocopy of SSM Form or Form 49 (for Super ID Package)
5. Letter of Authorization/ Board Resolution
(for Super ID Package)
6. *Board Resolution and / or Form 49 of Subsidiary Companies
*Optional for Basic Password Package customers who wish to link
additional accounts
Kindly send the original forms and supporting documents (refer to adjacent
checklist) to the address below:
Address :
Tel :
Email address :
Officer-in-Charge
Operation & Support
Group Cash Management Solutions
RHB Bank Berhad
Level 3, Tower 3
Jalan Tun Razak
50400 Kuala Lumpur
1300888028
[email protected]
Part A – Company Details * Compulsory to fill in.
* Company Registered Name :
* Business Registration No :
* Company Address
Please provide your correspondence address
should it differ from your Current Account
address. Please be advised a P.O Box address is
not acceptable
* Contact Person Name (as per NRIC) :
* Fax Number :
* Office Number :
* Postcode :
* City :
* Company Email Address :
* Mobile Number :
* State :
Part B – Account Information Note: All accounts registered under same business registration number will be given access.
Do you have the following facilities with us?
Trade Facilities :
Yes
No
Credit Card Merchant : Yes
No
Your merchant number : ___________________ (If you answered Yes above)
Main Current Account Number :
Account Name :
Part C – Statutory Body Details Note: Applicant for Basic Password Package to skip this part.
Only applicable for Super ID Package who wish to perform statutory body contributions through Reflex Cash Management.
Tax No: E____________________
EPF No : _____________________
SOCSO No : ________________________
Part D –Basic Password Package : Appointment of SysAdmin1 (or System Administrator) and SysAdmin2 (or System Authorizer)
* Compulsory to fill in.
By filling in Part D, I/We agree to appoint the persons named below to receive the PIN Mailer as the SysAdmin1 or SysAdmin2 to activate the Reflex Cash Management
Services (CMS) on behalf of the Company/ Association/ Club/ Society/Partnership to create the user profile and accessibility. Such persons shall be fully responsible for the
use of the said CMS.
SysAdmin1 / System
Administrator
* Name (as per NRIC) :
* NRIC / ID Number :
(please submit photocopy
of NRIC)
* Mobile Number :
* SysAdmin1’s Signature:
SysAdmin2 / System
Authorizer
* Name (as per NRIC) :
* NRIC / ID Number :
(please submit photocopy
of NRIC)
* Mobile Number :
* SysAdmin2’s Signature:
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* Company Email Address :
* Company Email Address :
1
Part E – Appointment of Inquiry User or “Inquirer”
* Compulsory to fill in.
Only applicable for Basic Password Package. Applicant for Super ID Package to skip this part.
Note: Additional Inquiry Users can be created by System Administrator once Reflex Corporate ID is activated.
* Name (as per NRIC):
* NRIC / ID Number :
* Mobile Number :
* Email Address:
USER ID: INQUIRER (By default)
Part F – Appointment of Super ID User Details (only 1 user)
* Compulsory to fill in.
Only applicable for Super ID Package. Details to be filled in as per current account signatory.
Note: Super ID is ONLY applicable to Current Account with single authorize signatories.
* Name (as per NRIC):
* NRIC / ID Number :
* Email Address:
* Authorized Signature:
* Mobile Number :
Part G – Linking of Subsidiary / Related Accounts (Optional)
If you would like to link your subsidiary/related accounts, please provide us the Board Resolutions and Form 49 from the subsidiary/related companies
allowing the Principal Applicant to view/transact their accounts. Sample of the Board Resolution to link the subsidiary/related companies accounts can be
downloaded from http://www.rhb.com.my/business_banking/reflex_how.html
Part H - Declaration by Principal Applicant
1.
2.
3.
4.
5.
6.
7.
I/We hereby apply for the service of Reflex Cash Management provided by RHB Bank Berhad.
I/We hereby authorize the Bank to debit the following principal account with the relevant service charges ie, subscription service charge, service charge and/or token charge.
Notes on the relevant service charges
a.
The subscription and service charges above shall be debited from your account upon issuance of your Corporate ID/Organization ID.
b.
The service fee shall be debited from your account upon processing of your payment files. It is charged based on per transaction basis.
c.
The subscription fee is charged based on the number of applicant / company’s account to be used for the service.
d.
The subscription, token and service charges above are non-refundable.
e.
Token charge is applicable for replacement of lost or damaged tokens.
f.
Effective 1st Apr 2015 all fees/charges incurred will be subjected to 6% GST (where applicable).
g.
For more details on the terms and conditions and service charges applicable, please visit www.rhb.com.my. At your request the Bank may provide you with information on the service charges
applicable to the Transactional Services.
I/We accept and acknowledge that the Bank may in its absolute discretion accept or reject the application..
I/We note that the Terms and Conditions and this Form submitted to the Bank shall govern our access and/or use of the Services. Any other Forms and/or the Application Form previously submitted by
us to the Bank shall be deemed to apply to both the existing services obtained by us and the additional Services applied for hereunder.
I/We hereby confirm that I/We are authorized to act for and on behalf of the Company/Association/Club/Society/Partnership to apply for the Reflex Cash Management Services provided by the
Bank.
I/We hereby confirm that all information provided is true and accurate to the best of my/our knowledge as at the date of this application.
I/We hereby confirm that I/We have read, understood and agreed to the terms and conditions of the Reflex Cash Management Services, this Application Form and the Terms and Conditions made
available on www.rhb.com.my and agree irrevocable and unconditionally to be bound by such terms and conditions.
* FOR REFLEX CASH MANAGEMENT APPLICATION
** FOR TRADE SERVICES IF APPLICABLE (optional – only applies to customers
with Trade facility)
_________________________________________________________
Authorized Signatory (ries) * and Company Stamp (Chop)
Date
: ____________________________________________
Name
: ____________________________________________
Designation : ____________________________________________
NRIC No
: ____________________________________________
_________________________________________________________
Authorized Signatory (ries) ** and Company Stamp (Chop)
Date
: ____________________________________________
Name
: ____________________________________________
Designation : ____________________________________________
NRIC No
: ____________________________________________
*Authorized Person(s) signature as per Letter of Authorization & SSM Form
**Authorized Person(s) signature as per) Letter of Authorization & SSM Form for operation of existing trade facilities/services as furnished to the Bank, if different from * above .
For Bank Use Only
For Bank@Work, please tick (√) in the check box:
Reflex Registration Centre
Signature and
other particulars
verified
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Officers' signature & name
stamp (chop)
Corporate ID:
Verified by:
Corporate
Commercial
Trade
Credit Card
Merchant
Approved by:
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