PERSONAL DATA ACCESS REQUEST FORM

The Personal Data Access Request is made to Public Bank Berhad (PBB)/Public Islamic Bank
Berhad (PIBB) *
GENERAL INFORMATION

 A Data Subject is an individual who is requesting access to his/her personal data maintained at
PBB/PIBB.
 A Relevant Person is a person other than the Data Subject as defined under Section 1B - Item C that is
requesting access to the personal data of the Data Subject.
 The Requestor (Data Subject or Relevant Person) is to be present at the account-holding branch to
submit this form and for verification of identity, information and documents required.

Sections to Fill

 Sections applicable to requests made by a Data Subject: 1A, 2, 3 and 4.

 Sections applicable to requests made by a Relevant Person: 1B, 2, 3 and 4.

 For a joint account with mandate of both to sign or all to sign, the other signatory(ies) is to execute and
sign a separate form i.e. Appendix A.
 For the Requestor requesting access to multiple accounts with the branch, complete a separate form for
each account.

The Bank has the right to refuse to comply with your request under Section 36 of the Personal Data
Protection Act 2010 (PDPA), if the Requestor for example:
 Fails to furnish sufficient, reliable and valid identification documentation/information to establish the
Requestor’s identity.
 Provides insufficient, incorrect, inaccurate and non-specific information to locate the personal data.

Supporting Documents Required

 Data Subject is to furnish a copy of his/her Identification Card (IC) for a Malaysian e.g. MyKad, MyPR,
MyKAS, MyTentera etc.; or Passport or other certified documentary proof of identity. Data Subject’s
identity must be verified vide the Biometrics Reader for MyKad/MyPR/MyKAS/MyTentera holder.
 Relevant Person is to furnish proof by way of an authorisation letter from the Data Subject or any
document evidencing the right of the Relevant Person, where applicable to access the personal data of
the Data Subject and a copy of the Relevant Person’s IC, Passport or other certified documentary proof
of identity.

Processing Time Frame Required

 This request will be processed within 21 days from the date the request is received.
 In line with Section 31(3) of the Personal Data Protection Act 2010 (PDPA), a notification for the delay, if
any, will be sent to the Data Subject/Relevant Person, 3 days prior to the due date to inform of a 14-day
extension period.

*Delete whichever is inapplicable.

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PUBLIC ISLAMIC BANK BERHAD (14328-V)
GENERAL INFORMATION, cont.

Processing Fee

 A processing fee which will depend on the type of request being made as per Table 1 below, is payable
and should be submitted with this form.
Table 1:
Item Type of Data Access Request (DAR) Fees (RM)
1 DAR for Data Subject’s personal data with a copy 10
2 DAR for Data Subject’s personal data without a copy 2
3 DAR for Data Subject’s sensitive personal data** with a copy 30
4 DAR for Data Subject’s sensitive personal data** without a copy 5

Note: For statement requests, the Bank will advise the Requestor on the prevailing fees other than those
stated under Table 1.

Contact Us

 If you have any queries or require any guidance in completing this form, you may contact any of our
branch Officers or our Customer Service Department at 1-800-22-5555.

** Sensitive personal data encompasses sensitive personal information which relates to information
relating to your health, political opinion, religious beliefs or other beliefs of a similar nature and the
commission or alleged commission of an offence.

SECTION 1A: DATA SUBJECT

(To be completed by a Data Subject making this data access request)

I am a customer of Public Bank Berhad/Public Islamic Bank Berhad* and I would like to access my personal
data.
Data Subject’s Particulars

Name of Individual Customer : _____________________________________________________

IC/Passport* No. : ___________________________
CIS No. : ___________________________ (for Bank use only)
Mailing Address : _____________________________________________________
_____________________________ Postcode: ___________
Telephone No. (House) : _____________________________
Telephone No. (Office) : _____________________________
Mobile Phone No. : _____________________________
Email address (if any) : _____________________________

Note: To fill in Appendix A (FORMS/PDP006) for the other joint account holder(s) according to the mode of
operating the account.

*Delete whichever is inapplicable.

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PUBLIC ISLAMIC BANK BERHAD (14328-V)
SECTION 1B: RELEVANT PERSON
(To be completed by a Relevant Person making this data access request on behalf of the Data Subject)

A. Relevant Person’s Particulars

Name of Relevant Person (Individual/Entity*): _____________________________________________

Name of the Representative of the :
Relevant Person (where applicable) ________________________________________________
IC/Passport* No. : _____________________
CIS No. : _____________________ (for Bank use only)
Mailing Address : ________________________________________________
_____________________ Postcode: ______________
Telephone No. (House) : _____________________
Telephone No. (Office) : _____________________
Mobile Phone No. : _____________________
Email address (if any) : _____________________

B. Data Subject’s Particulars

Name of Individual Customer : ________________________________________________

IC/Passport* No. _____________________

Please tick [√ ] the appropriate box.

I/The entity* am/is* making a request as a Relevant Person to access the personal data of the Data Subject.

C. Access Personal Data of Person Maintaining the Account with the Branch.

This personal data access request is made on behalf of the Data Subject:

I/The entity am/is the parent/legal guardian/legal representative of the Data Subject (who is
below the age of 18) for a minor/on behalf account.
The Data Subject is incapable of managing his/her own affairs and I/the entity* have/has been
appointed by the Court to manage his/her affairs.
I/The entity am/is under the Data Subject’s authorisation/mandate/Power of Attorney to make
this data access request on his/her behalf.
Other reasons, please specify: ___________________________________________________
____________________________________________________________________________

D. As proof of the above, I/the entity* hereby enclose the following documents:

Copy of my IC/Passport (original to be produced for verification);and

Original Warrant/Court Order/Power of Attorney
Original letter of authorisation from the Data Subject
Other documents, please specify:_________________________________________________
____________________________________________________________________________

*Delete whichever is inapplicable.

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PUBLIC ISLAMIC BANK BERHAD (14328-V)
SECTION 2: DESCRIPTION OF PERSONAL DATA REQUESTED

A. I/The Relevant Person* would like to request for the personal data of the following account by
indicating below the relevant account number:

Account Type [ ] Savings Account [ ] Current Account

(Please tick [√ ] one Account only) [ ] FCY Current Account [ ] Fixed Deposit Account
[ ] FCY Fixed Deposit Account [ ] Loans/Financing Account
[ ] Credit Card Account [ ] Unit Trust Account
[ ] Other products/services (please specify)

_________________________________________________

Account No.

Note: For the Requestor requesting access to multiple accounts with the branch, complete a
separate form for each account.

B. Personal Data includes one or more of the following:-

Please tick [√ ] the appropriate box.

Specified Account Information
( ) Balance Inquiry (Execute the “Request for Balance” Form)
1
( ) Statement Request
( ) Mode of Operating the Account
( ) Mandatee, if applicable
( ) Image of the Signature(s) of the account-holder(s) i.e. (specify the name)
_______________________________________________________________________

[ ] Name [ ] IC/Passport/Other Identification Documentation*

[ ] Residence/Mailing* Address [ ] Contact Details
[ ] Gender [ ] Race
[ ] Nationality [ ] Country of Tax Residence
[ ] Name of Employer [ ] Customer’s Consent
[ ] Others, please specify: __________________________________________________________

C. Please:-

[ ] Confirm whether the personal data as specified under items A and/or B of Section 2 is held by
the Bank; and I/the Relevant Person* do(es) not require a copy of the Personal Data.
[ ] Supply me/the Relevant Person* with a copy of the personal data for the account(s) maintained
with the Bank as specified under items A and/or B of Section 2.
1
Note : For statement request, the Requestor is required to personally collect the Statement at the account-
holding branch.

*Delete whichever is inapplicable.

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PUBLIC ISLAMIC BANK BERHAD (14328-V)
SECTION 3: PREFERRED MANNER OF DELIVERY (To be completed by the Requestor)

Please tick [√ ] the appropriate box

Please furnish the Requested Data as follows:-

[ ] Verbally inform me/us/the Entity* when the result of the requested data is ready at the telephone
number given in this form.
1
[ ] Send by registered mail a copy of the Requested Data at the mailing address given in this form.
1
[ ] Send by normal mail a copy of the Requested Data at the mailing address given in this form.
[ ] Allow me/us/the Entity* to collect a copy of the Requested Data from your branch once it is ready.
1
Note : Not applicable for Statement request as the Requestor is required to personally collect the Statement
at the account-holding branch.

SECTION 4: DECLARATION BY REQUESTOR

I/We/The Entity* hereby certify(ies) that the information given in this form and any enclosed documents
submitted are true and accurate. I/We/The Entity* understand(s) that:

i) It will be necessary for the Bank to verify my/our/the Entity’s* identity(ies), and
ii) The Bank may contact me/us/the Entity* for more detailed information in order to locate the personal
data requested.

I/We/The Entity* also understand(s) that any and/or all personal data provided by me/us/the Entity* in this
Personal Data Access Request Form will be collected and processed by the Bank as personal data in
accordance with the Personal Data Protection Act 2010.

________________________________________________ _____________________
[Authorised Signature of Data Subject(s)/Relevant Person(s)* Date
and Rubber Stamp of Relevant Person (where applicable)]
(To be signed by all joint account holders according to the mode
of operating the account, if applicable)

FOR BANK USE ONLY

Acknowledgement of Data Access Request Form (Appendix 1) given to Requestor by:

___________________________________ _____________________
(Officer’s Signature and Name Chop) Date and Time

*Delete whichever is inapplicable.

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PUBLIC ISLAMIC BANK BERHAD (14328-V)
 APPENDIX 1
ACKNOWLEDGEMENT BY THE BANK UPON RECEIPT OF PERSONAL DATA ACCESS REQUEST

To: _________________________________________________________________________________
(Name of Data Subject/Relevant Person)

IC/Passport* No.: ________________________________________

We acknowledge receipt of your Personal Data Access Request dated ____________________.

We shall revert to you in due course on the outcome of your request.

Should you require further clarification on the matter, kindly contact ________________________________
at __________________.

Received by:

____________________________________
(Signature of Attending Officer)
Name:
Designation:

Branch : __________________________________ ___________________________________

Date : ________________________ Official Branch Rubber Stamp
Time : ________________________

(REQUESTOR’S COPY)

*Delete whichever is inapplicable.

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