Referral Rewards Program: Participation Form

I would like to participate in the Hong Leong Bank Berhad (193401000023 [97141-X]) (“HLB”) / Hong Leong Islamic Bank Berhad
(200501009144 [686191-W]) (“HLISB”) (hereinafter collectively referred to as “the Bank”) Referral Rewards Program (“Program”). I hereby
confirm and declare that I have read and understood the Terms and Conditions pertaining to this Program and I agree to be bound by the

* Name:

as per NRIC/Passport

* New NRIC No:

as per NRIC/Passport

* Correspondence Contact Number (Mobile):


Correspondence Contact Number (Office):

e.g. 03 xxxx xxxx

* Correspondence Email Address:

* Agency Name:

* REN Code:

e.g.REN/PEA/E xxxxx

Income Tax Number:

* Servicing Bank Staff Name:



Account Number:

e.g. 00xxxxxxxxx

To support your application, please upload the required documents:


  1. I hereby declare that all information furnished to the Bank is complete, true and correct.
  2. I am a valid registered agent with the Board of Valuers, Appraisers and Estate Agents Malaysia.
  3. In the event of any changes for the above information, I will contact the Bank immediately to update my information accordingly.
  4. Any inaccuracy or misrepresentation in the aforesaid information will waive all my rights of dispute and I will remain liable for all losses and expenses incurred by the Bank.
  5. I have read the Bank’s Privacy Notice and agree that all personal data provided to the Bank by me and/or acquired by the Bank from the public domain, as well as personal data that arises as a result of my participation in the Program will be subject to such Privacy Notice as may be varied from time to time. I hereby agree and authorise the disclosure of my name and other contact details to companies within the Bank and/or Hong Leong Financial Group Berhad group of companies for marketing and promotional purposes. Copies of the Privacy Notice are available upon request or from HLB’s website ( or HLISB’s website ( (hereinafter collectively referred to as “the Bank’s website”). “Privacy Notice” shall mean the Bank’s policies and principles pertaining to the collection, use and storage of personal information of existing and prospective individuals and entities dealing with HLB/HLISB as may be amended from time to time and made available at the Bank’s website or in such manner as the Bank deems appropriate from time to time.
  6. Anti-Bribery, Anti-Corruption and Whistleblowing Undertakings
    • 6.1 For the purposes of this clause, the following terms and expressions shall have the meanings specified below:
      “ABC Policy” means the HLBG Anti-Bribery and Corruption Policy which is available at the Bank’s website.
      “Anti-Bribery Laws” means the Malaysian Anti-Corruption Commission Act 2009 as amended from time to time, and the rules and regulations issued thereunder, and any other applicable laws, statutes, regulations, rules and orders that relates to bribery or corruption.
      “HLBG” means HLBB and/or its subsidiaries.
      “HLB/HLISB Whistleblowing Policy” means the Bank’s Whistleblowing Policy or such policies and/or procedures by whatever name called in relation to whistleblowing as may be amended from time to time, setting out the Bank’s commitment to good business ethics and integrity, pursuant to which employees of the Bank, as well as persons providing services to, or having a business relationship with the Bank, are required to raise any concerns about any improper conduct or wrongful act that may adversely impact the Bank, including but not limited to:
      (a) any criminal offences, including fraud, corruption, bribery and blackmail;
      (b) any failure to comply with legal or regulatory obligations; and
      (c) any concerns about malpractice. 
    • 6.2I hereby acknowledge confirm that I am aware that HLBG has a zero-tolerance position towards any form of bribery and corruption in line with its ABC Policy. 
    • 6.3I hereby acknowledge and undertake as follows:
      (i) that I have read and understood the ABC Policy;
      (ii) that I shall comply with the ABC Policy and Anti-Bribery Laws; and
      (iii) to notify HLBG of any non-compliance or attempted non-compliance with the ABC Policy and/or Anti-Bribery Laws by any employee of HLBG or persons associated with HLBG by reporting the same through the HLB/HLISB Whistleblowing Policy.
    • 6.4I declare that (*Select whichever applicable):
  • 6.5I declare that (*Select whichever applicable):

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