e-Application Form

* denotes a mandatory field

Please don’t choose Government Body in case of an entity owned by a government body (e.g. companies, limited liability partnership, etc.)

Company Type*

How much is the estimated volume usage in liters in a year? (less or more than 30,000L)*

Are you applying for a subsidized fuel card?*
Yes No

Please provide your SKDS number*

Company Full Name/Government Agency Name*

Company Registration Number*

Tax Identification Number (TIN) *

Is your company a Sales and Service Tax (SST) registrant? *
Yes No

SST Number *

How many vehicles do you have?

Cars*

Vans*

Heavy Goods Vehicles 3.5t - 7t*

Heavy Goods Vehicles > 7t*

Salutation*

Prefix (Optional)

First name*

Last name*

Job Title*

Address:*

City*

State*

Kuala Lumpur Region*

Selangor Region*

Postcode*

Email*

Phone number :*

Type of business*

Are you the person who manages this account directly (e.g. card management, invoice management, etc.)?*
Yes No

Please provide details of the person who will manage this account for you:

Salutation*

Prefix (Optional)

First Name of the person*

Last Name of the person*

Job Title of the person*

Email Address of the person*

Phone Number of the person :*

Would you like to sign up for Direct Debit?*
Yes No

Please provide your bank name for or direct debit setup*

Are you referred by a Shell Fuel Card Account Manager?*
Yes No

Name of the Account Manager*

How did you hear about the Shell Fuel Card?*
Retailer (Shell Station) Reseller Existing Shell Fuel Card Customer Social Media Others (please specify)

ROID *

Enter the name of the Reseller*

Shell Card Account Number *

Would you be interested in any of the following products?

Telematics

CO2 Offset

Lubricants

Declaration and endorsement

I/We confirm that all the information provided is correct and authorise Shell Malaysia Trading Sdn Bhd to verify from whatever sources Shell Malaysia Trading Sdn Bhd may consider appropriate. I/We hereby acknowledge that the Card may only be used subject to the Terms and Conditions of the Shell Fuel Card Cardholder Agreement and agree to be bound by the Terms and Conditions listed in the Shell Fuel Card Cardholder Agreement. Shell Malaysia Trading Sdn Bhd shall reserve the absolute right to approve or reject this application as it deems fit without assigning any reason whatsoever.

Upon approval of this application, I/we hereby request Shell Malaysia Trading Sdn Bhd to set the Purchase Restriction on the Driver/Vehicle as indicated in the application form. We understand that the Purchase Restriction can only be monitored electronically. We will not hold Shell Malaysia Trading Sdn Bhd responsible if these cards are used at stations where the electronic devices are inoperable or out-of-order. I/We also understand that should the Purchase Restrictions be breached for any reason whatsoever, this shall not constitute grounds for us not to pay for the products/services purchased.

I/We also acknowledge that Shell will not return any documents pertaining to this application should the application not be successful.

I/We understand that payment of any amount owed shall be made directly by the Principal Cardholder. Any payment made by a third party other than the Principal Cardholder will not be accepted without a written request to Shell. The approval to allow such third party payments to be made on behalf of the Principal Cardholder is at Shell’s sole discretion.

By submitting this form

* I/We have read, understood and agree to the Shell Terms & Conditions obtained from Shell’s website.

For Terms & Conditions, visit www.shell.com.my/shellcard/termsandconditions New window indicator icon

Please select to confirm if you would like to receive marketing communications and/or materials relating to any products, services, promotions and/or offers such as fuel, snack and beverages, lubricant and/or carwash service.

For further information, please see the Shell Fleet Solutions privacy statement New window indicator icon

Please select to confirm * You are a manager or higher-level personnel in the company, business owner or partner. The Shell Fuel Card application can only be made if you have the right level of authority in the company.

Shell Fuel Card e-Application Form (for Malaysia businesses only)

How many vehicles do you have?

Shell Fuel Card e-Application Form
(for Malaysia businesses only)