Baiduri Bank Group

Personal Details

Title

Mr	Ms	Dr

Mobile Phone Number

*

Name (as appears on IC / Passport)

*

Occupation

I.C. / Passport No

*

Brunei I.C Colour

*

Date of Birth
(dd / mm / yy)

*

Telephone

(Office)

E-mail Address

*

(Home)

Home Address

(Maximum characters: 200)

You have characters left.

Mother's Maiden Name

*

Employer / Business Name

Designated Account Details

Please select any ONE of the following boxes and specify the account number to be used in this service.

Baiduri Bank / Finance Account Number
(xx-xx-xxx-xxxxxx)

Baiduri Bank Credit / Debit / Prepaid Card Number
(xxxx-xxxx-xxxx-xxxx)

CVV2/4DBC:	(xxxx)
Expires on	(mm / yyyy)

Other Bank Credit Card Number
(xxxx-xxxx-xxxx-xxxx)

CVV2/4DBC	(xxxx)
Expires on	(mm / yyyy)
Issuing Bank
Country of issuing bank
Cardholder Name (as it appears on credit card)

Other Details

Set Daily limit

BND

(If you do not specify your preferred daily limit here, the daily limit will be automatically set to BND5,000.00)

Language

English	Malay	Chinese

Bill Payee

Note: Mobile phone number is required for B.Mobile bill payment

Biller Name
(i.e., Baiduri HP, Baduri Credit Card, DST, B.Mobile & etc)

Billing Account Number

Baiduri Hire Purchase

1.

2.

3.

4.

Baiduri American Express

1.

2.

3.

4.

Baiduri Visa Card

1.

2.

3.

4.

Baiduri MasterCard

1.

2.

3.

4.

DST

1.

2.

3.

4.

B.mobile

1.

2.

3.

4.

TelBru

1.

2.

3.

4.

Top up Baiduri MasterCard Cash Card

1.

2.

3.

4.

Collection of PIN Mailer

I would like to collect my PIN Mailer at * Branch.

Agreement

I hereby confirm that I have read, understood and agree to be bound by:

1)	The Baiduri FAST Terms & Conditions and the Baiduri FAST Banking Service User Guide issued to me upon application.
2)	The Bank's standard Terms & Conditions governing account(s) maintained with the Bank in respect of all my existing or future accounts opened or to be opened with the Bank.

I am aware that the Baiduri FAST Terms & Conditions and the Terms & Conditions for the accounts maintained with the Bank are available for viewing on the Bank's website.

I further confirm and agree that the Bank reserves the right, without prior notice to me, to change, revise or modify the Baiduri FAST Terms & Conditions and I agree to be bound by all changes made or modified at any time and from time to time.

I hereby warrant and represent to you that all the information provided in this form are true and correct in all respects.

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