(Tarikh)

* TYPE OF REQUEST (√) * Jenis Permohonanan (√)

*CARDHOLDER'S NAME (SKDSxxxxxxxxxx) / CARD NO(Max 22 characters)

*Nama Tertera Pada Kad (SKDSxxxxxxxxxx) / Nombor Kad Shell(Maksimum 22 huruf)

*VEHICLE REGISTRATIONNUMBER

*Nombor PendaftaranKenderaan

PURCHASE RESTRICTION (LITRES) Had Nilai Kad (Liter)

UPD

ATE

CA

RD L

IMIT

Pe

rtuk

aran

Had

Kad

DAILY LIMIT (LITRES)Had Nilai

Seharian (Liter)

MONTHLY LIMIT (LITRES)Had Nilai

Bulanan (Liter)

1)

2)

3)

*SKDS / DS NO :

STEP 1 – FILL IN YOUR COMPANY / INDIVIDUAL DETAILS (MARKED * IS COMPULSORYLangkah 1 - Sila Isi Butiran Syarikat / Individu (Bertanda * Wajib Diisi)

STEP 2 – CHOOSE TYPE OF REQUEST (WRITE CLEARLY IN BLOCK LETTERS) Langkah 2 - Pilih Jenis Permohonan (Sila Tulis Menggunakan Huruf Besar)

STEP 3 - AUTHORIZATION (COMPULSORY) Langkah 3 - Pengesahan (Wajib Diisi)

Cop Rasmi Syarikat (Jika Perlu)

STEP 4 – SEND TO USLangkah 4 - Hantar

* I/C NO (No Kad Pengenalan) : _____________________________

SHELL SUBSIDIZED CASH CARD REQUEST FORMBORANG PERMOHONAN KAD SHELL BERSUBSIDI

SHELL MALAYSIA TRADING SDN. BHD. 196501000279 (6087-M)Customer Service Tel No: 1300-22-8181

*CONTACT NO (No Telefon) :

IMPORTANT NOTES / Nota-Nota Penting

* FULL NAME (Nama Penuh) : _____________________________

* SIGNATURE (Tandatangan) : _____________________________

* NAME/COMPANY NAME :(Nama Atau Nama Syarikat)

* PERSON IN CHARGE NAME(Pegawai Bertanggungjawab)

CAN

CEL

& R

EPLA

CE

Peng

gant

ian

Kad

RE-S

END

PIN

Isu

Pin

ADD

NEW

CAR

D Ka

d Ba

ru

CAN

CEL

ON

LY

Pem

bata

lan

Kad

EMAIL / E-mel: generalcardrequests-my@shell.com

FAX / Faks: 1300-82-8283OFFICIAL COMPANY STAMP (If Applicable)

1. Incomplete form will not be processed / Borang yang tidak lengkap tidak akan diproses2. For any changes of mailing address, please fill up the Shell Subsidized Cash Card Update Form (Refer page 2) / Untuk sebarang pertukaran alamat surat-menyurat, sila isi Borang Kemaskini

Kad Shell Bersubsidi (Rujuk muka surat 2)3. For data privacy, please visit / Untuk privasi data, sila layari http://www.shell.com.my/pdpa

_____________________________________

_____________________________________

CHANGE OF MAILING ADDRESS Pertukaran Alamat Surat - Menyurat

* NAME/COMPANY NAME :(Nama Atau Nama Syarikat)

* PERSON IN CHARGE NAME :(Pegawai Bertanggungjawab)

*SKDS / DS NO :

*CONTACT NO (No Telefon) :

DATE:

SHELL SUBSIDIZED CASH CARD UPDATE DETAILS FORM BORANG KEMASKINI KAD SHELL BERSUBSIDI

STEP 1 – F ILL IN YOUR COMPANY / INDIVIDUAL DETAILS (MARKED * IS COMPULSORY)Langkah 1- Si la Is i But iran Syarikat / Individu (Bertanda * Wajib Diis i )

STEP 2 – UPDATE INDIVIDUAL DETAIL (WRITE CLEARLY IN BLOCK LETTERS)Langkah 2 - Kemaskini Maklumat Individu (Si la Tul is Menggunakan Huruf Besar )

Address (Alamat) : _____________________________________________

_____________________________________________

: _____________________________________________

: _____________________________________________

: _____________________________________________

City (Bandar)

State (Negeri)

Postal Code (Poskod)

CHANGE OF CONTACT DETAILS Pertukaran Maklumat Untuk Dihubungi

House/Office Phone (Tel Rumah/Pejabat)

Mobile Phone(Tel Bimbit)

Fax Number(No Faks)

: +60________________________

: +60________________________

: +60________________________

: _______________________________________________

STEP 3 - AUTHORIZATION (COMPULSORY) Langkah 3 - Pengesahan (Wajib Diisi)

STEP 4 – SEND TO USLangkah 4 - Hantar

* I/C NO (No Kad Pengenalan) : _____________________________

* SIGNATURE (Tandatangan)

* FULL NAME (Nama Penuh)

: _____________________________

: _____________________________

IMPORTANT NOTES / Nota-Nota Penting

1. Incomplete form will not be processed / Borang yang tidak lengkap tidak akan diproses2. For data privacy, please visit / Untuk privasi data, sila layari http://www.shell.com.my/pdpa

EMAIL / E-mel: generalcardrequests-my@shell.com

FAX / Faks: 1300-82-8283

Email Address(Alamat E-mel)

Cop Rasmi Syarikat (Jika Perlu)OFFICIAL COMPANY STAMP (If Applicable)

SHELL MALAYSIA TRADING SDN. BHD. 196501000279 (6087-M)Customer Service Tel No: 1300-22-8181

(Tarikh)

_____________________________________

_____________________________________