AKPK Day Customer Information Form

Maybank-AKPK: Your Path to Financial Freedom

This form is to be completed by customers registering for Maybank-AKPK: Your Path to Financial Freedom event. The information collected will be used to update the customer’s latest personal, employment, income and household dependency status for assessment and follow-up purposes.

Customer Details

Name

NRIC Number

Mobile Number

Email Address

Facility

Property Address

Status of Property

Additional Remarks for Status of Asset (House/Vehicle)

Emergency Contact No 1

Relationship

Emergency Contact No 2

Relationship

Latest Occupation / Employment Status

Current Employment Status

Gross Monthly Income

Reason for financial Difficulty

Household and Dependents

Marital Status

Number of Dependents

Preferable Date and Slot (Please ✓ where Applicable)

Available Dates

Available Slots

Refresh

I hereby confirm that the information provided in this form is true, accurate and complete to the best of my knowledge. I consent to the Bank using this information for the purpose of updating my profile, assessing my financial position, and facilitating any necessary follow-up in relation to Maybank-AKPK: Your Path to Financial Freedom event registration and related assistance.

yes Maybank-AKPK: Your Path to Financial Freedom 19 Sending ... weassist@maybank.com field_0 text Name Mandatory field_1 text NRIC Number Mandatory field_2 text Mobile Number Mandatory number field_3 text Email Address Mandatory email field_4 dropdown Facility Mandatory field_5 textarea Property Address field_6 text Status of Property field_7 textarea Additional Remarks for Status of Asset (House/Vehicle) field_8 text Emergency Contact No 1 field_9 text Relationship field_10 text Emergency Contact No 2 field_11 text Relationship field_12 dropdown Current Employment Status field_13 text Gross Monthly Income field_14 textarea Reason for financial Difficulty field_15 dropdown Marital Status field_16 text Number of Dependents number field_17 dropdown Available Dates Mandatory field_18 dropdown Available Slots Mandatory

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Thank you

Maybank-AKPK: Your Path to Financial Freedom