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CREDIT CARD CANCELLATION REQUEST FORM DATE: CARDHOLDER’S DETAILS PRINCIPAL’S NAME: CONTACT NO: (H) (OFF) (HP) CARD CANCELLATION PRINCIPAL’S CREDIT CARD: (1) (2) SUPPLEMENTARY’S NAME: SUPPLEMENTARY’S CREDIT: (1) CARD NO (2) Please complete this form and return to: CANCELLATION REASON (PLEASE TICK): GOVERNMENT SERVICE CHARGE ANNUAL FEE TOO HIGH TOO MANY CARDS NO USAGE PAYMENT INCONVENIENCE OTHERS Fax: 03 – 2383 6666 Mail: Citibank Berhad Customer Correspondence Unit P.O Box 11725 50754 Kuala Lumpur Please call if you have any inquiries: CitiPhone: 03- 2383 0000 Important Note: Citibank will take a minimum of 5-7 working days to block your account upon receiving the credit card cancellation request form..