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Type of Application: Post-Paid X-Fleet CardPrepaid X-Fleet CardX-Fleet Diesel Subsidy CardDiesel Subsidy Cash Card
Company Name:
Company Registration No.:
Type of Business: ---Sole ProprietorPartnershipSdn. Bhd.Bhd.
Authorised Personnel / Managing Director's / Owner's Name:
Correspondence Address:
Postcode:
City:
State: ---JohorKedahKelantanMelakaNegeri SembilanPahangPulau PinangPerakPerlisSelangorTerengganuWilayah PersekutuanWP Putrajaya
Phone:
Facsimilie:
Email:
Note: For access to BHPetrol X-Fleet Web Portal and Mobile App.
Nature of Business:
Date of Incorporation:
Current Fuel / Fleet Card Acc.: CaltexPetronasShellEsso/Mobil/Petron
Estimated Monthly Petrol Consumption (litre):
Estimated Monthly Diesel Consumption (litre):
Billing Address (if different from correspondence address):
Department: ---Account DepartmentCard AdministratorAccount Department & Card Administrator
Salutation: Mr.Mrs.MadamMs.
Name:
Handphone:
Upload Documents: ---For Sdn. Bhd. or Bhd.For Sole Proprietor or Partnership
I agree to the declaration:
I/We hereby undertake to inform BHPetrol if I/we am/are identified as a politically exposed person (PEP) and/or I/we and/or my/our immediate family members (parents, spouses and children) and/or close associates are related to any PEP.
I/We expressly consent to and authorize BHPetrol to disclose and report to Bank Negara Malaysia, if any of my/our cash transactions exceed Ringgit Malaysia Twenty-Five Thousand (RM25,000-00) only, at any time and without liability, any information and particulars (financial or otherwise) relating to my/our affairs and accounts, financing and conduct thereof for such purposes as BHPetrol deems fit or appropriate.
The option of the transaction, daily and monthly limit available in this application form is strictly only an estimate/ indicative/ restricted limit amount. Therefore BHPetrol reserves all rights to adjust, change and/ or revise the said figures to the nearest Ringgit Malaysia limit based on the figures available in BHPetrol's fleet card system. BHPetrol shall not held responsible for any loss or damage whatsoever incurred in the event of any different in BHPetrol's control limit as stated in BHPetrol's fleet card system and the limit as stated/ chosen in this application form. We accept and confirm that Boustead Petroleum Marketing Sdn Bhd ("BHPetrol") reserves the right to decline my/our application without giving any reason(s) thereto. I/We hereby irrevocably and unconditionally consent to BHPetrol conducting a credit background verification exercise pursuant to my application.
Provided that my/our application herein has been approved by BHPetrol I/We accept and confirm that on my/our signing on the BHPetrol X-Fleet/Cash Card or on my/our use of the BHPetrol X-Fleet/ Cash Card, I/We shall be bound by the terms and conditions governing the use of the BHPetrol X-Fleet/ Cash Card contained in the BHPetrol X-Fleet/ Cash Card Member Agreement that is sent/given to me/us together with the BHPetrol X-Fleet/Cash Card.
Consent to processing of personal data: By providing my/our personal information above and by signing below l/we also acknowledge that I/we consent to the processing of my/our personal data in the manner as set forth in the Boustead Petroleum Marketing Sdn. Bhd.'s ("BHPetrol") Personal Data Protection Notice ("Privacy Notice") which has been made available to me at www.bhpetrol.com.my/privacy.html.
Please download the declaration form and sign with company stamp and upload the file with the button below:
