Select Product * Basic Requirements Minimum Age: 18 Years Maximum Age: 65 Years Nationality: Malaysian / Permanent Resident of Malaysia Minimum Salary (West Malaysia): RM 1000 Minimum Salary (East Malaysia): RM 920 Required Documents Employed Applicant Copy of MyKad/MyPR (front and back portion) Latest One (1) Month Payslip OR Latest EPF Statements Self Employed Applicant Copy of MyKad/MyPR (front and back portion) Latest SSM printout or Form 9/24/49 or Section 32/Section 78/Section 58 (subject to business ownership) Latest 3 months company's bank statements / Latest Tax Return with IRB receipt

We Need Your Consent To Proceed Further *

1. I/We hereby acknowledge that I/We have accessed and / or read the Privacy Notice issued by AEON Credit (which is available at all AEON Credit branches as well as at AEON Credit website at www.aeoncredit.com.my or has otherwise been made available to me/ us) and confirm my / our agreement to the same.
2. I/We hereby authorize AEON Credit to amend he cash price / interest rate / finance amount / installment period & monthly installment accordingly should the cash price / interest rate / finance amount / monthly installment be lower or installment period change on the date of settlement. Notice of Assignment: The Retailer hereby gives notice to the Purchaser that this account has been assigned to AEON Credit Service (M) Berhad ("AEON"). Only payment to AEON shall constitute valid and lawful discharge to the debts.
3. I/We hereby declare and warrant that the information furnished to AEON Credit Service (M) Berhad is true, complete and accurate in all respects and I/We have not withhled any information which might prejudice my/our application.
4. I/We understand AEON Credit may verify information and the application will not be accepted until I/We complied with all necessary requests.
5. I/We understand that AEON Credit reserves the right to decline this application at their sole discretion without stating any reason(s) and documents submitted will be destroyed and not return to me/us.
6. I/We hereby authorize and consent AEON Credit to obtain any other information from any sources including but not limited to CCRIS, FIS, CTOS or any financial institution, Director General of Inland Revenue Authorities and by whatever means and at any time as AEON Credit considers appropriate.
7. I/We understand and fully agree to the terms and conditions stated above and on the back of this Agreement.
8. I/We further agree that the Retailer shall be absolutely entitled to assign the benefit of this Agreement or any of the Retailer's rights hereunder.
9. I/We hereby consent and authorize AEON Credit to process any of my/our information and to release the same to any related and/or associate company within the AEON Group, AEON Credit existing or future business partners or strategic alliances and/or 3rd party as AEON Credit may in its absolute discretion deem necessary or expedient for the purpose of marketing and promotion of products and services.
10. I/We hereby confirm that no further permission or consent from me/us is/are necessary or required in relation thereto and this hall constitute the consent required under the Personal Data Protection Act 2010 and any other contractual consent for such disclosures of information.

GUARANTEE & INDEMNITY - In consideration of the Retailer agreeing at my request to sell above Merchandise to the Purchaser on credit and/or by installment payments. *

1. I agreed as principal and not merely as surely to be responsible to the Retailer for the easy payment price, late charges and other monies that the Purchaser may be liable to pay the Retailer for their Merchandise if the Purchaser fails to pay the same or breaches any of the conditions herein and my liability shall not be affected by any time or indulgence the Retailer may grant to the Purchaser. I also agree to indemnify the Retailer fully against any loss, damage or liability or whatever kin incurred or sustained by the Retailer (including the Retailer's solicitors client cost) resulting from the failure by the Purchaser to make any payment of any sum payable under this Agreement and to pay to the Retailer the amount of such loss, damages or liability whether or not the Retailer have attempted to enforce any rights against the Purchaser. This indemnity constitutes a separate and independent obligation from the other obligations of my guarantee, and shall give rise to a separate and independent cause of action and shall apply irrespective of any indulgence granted by Retailer or any disability or the part of the Purchaser. This guarantee and indemnity shall bind my estate and personal representative.

Contact Details

Title *

Name as in NRIC / Passport *

Email Address

Mobile Number *

Are you an AEON Express Member? *

Are you an AEON Credit Card holder? *

Personal Details

NRIC No. *

Other Identification? (Optional)

Old IC / Passport / MyTentera / MyPolis No. * This field is only enabled when an 'Other Identification' is selected.

Date of Birth *

Gender *

Race *

If Others, please specify. * This field is enabled when 'Race' is 'Others'.

Residency Status *

BUMIPUTERA
NON-BUMIPUTERA

Marital Status *

How many dependents do you have? * This field is enabled when Marital Status is 'Married' / 'Widowed' / 'Divorce'.

Identity Authentication (e-KYC) *

Permanent Address

Please add Permanent Address as per NRIC

Address Line 1 *

Address Line 2

Address Line 3

Postcode *

City *

State *

Is your residential address the same as permanent address? *

Residential Address

Address Line 1 *

Address Line 2

Address Line 3

Postcode *

State *

Please select your residence's ownership status. *

If Others, please specify: * This field is enabled when 'Residential Ownership' is 'Others'.

House Phone Number *

How long have you stayed at current residence? *

Emergency Contact

Title *

Name *

Relationship *

House Address Line 1 *

House Address Line 2

House Address Line 3

Postcode *

City *

State *

Mobile No *

Employment Details

Occupation Type *

Employment Type *

Position *

Position (Others) * This field is enabled when 'Position' is 'Others'.

Department *

Department (Others) * This field is enabled when 'Department' is 'Others'.

Business Nature *

Business Nature (Others) * This field is enabled when 'Business of Nature' is 'Others'.

How long have you worked at your current company? *

Employer Name *

Address Line 1 *

Address Line 2

Address Line 3

Postcode *

City *

State *

Office Phone No. *

Ext

Financial Details

Gross Monthly Salary (RM) *

Net Monthly Salary (RM) *

Which day of the month do you receive salary?

Source of Other Income

For Others Specify * This field is enabled when 'Source of Other Income' is 'Others'.

Other Income * This field is enabled when 'Source of Other Income' is 'Insurance'/'Direct Selling'/'Business'/'Others'.

Do you have any other existing Loans from Non-Bank Financial Institutions? *

YES
NO

Total Monthly Repayment (RM) * This field is enabled when "Do you have any other existing Loans from Non-Bank Financial Institutions?' is 'Yes'.

Source of Repayments * This field is enabled when "Do you have any other existing Loans from Non-Bank Financial Institutions?' is 'Yes'.

Are you applying with a Joint applicant/Income? *

AEON Credit Application Form

Contact Details

Personal Details

Permanent Address

Residential Address

Residential Address

Emergency Contact

Employment Details

Financial Details

Thanks for getting in touch!

Thanks for getting in touch!

Panasonic EW-DM81-W451 Rechargeable Toothbrush Ultra Fine Bristle Micro Vibration