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APPLICATION FOR INTERBANK GIRO |
PLEASE MAIL OR COURIER THIS
FORM TO CRIMSONLOGIC PTE LTD (ATTN: CUSTOMER ADMIN). FAX
SUBMISSION WILL NOT BE ACCEPTED. |
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* Mandatory field |
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(a) |
I/We herby instruct you to
process the BO's instruction to debit my/our account. |
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(b) |
You are entitled to reject the BO's
debit instruction if my/our account does not have sufficient
funds and charge this. You may also at your discretion allow
the debit even if this results in overdraft on the account and
impose charges accordingly. |
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(c) |
This authorisation will remain in
force until terminated by your written notice sent to my/our
address last known to you or upon receipt of my/our written
revocation through the BO. | |
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Bank |
Branch |
Billing
Organisation's Account No. |
7 |
1 |
7 |
1 |
0 |
1 |
2 |
0 |
1 |
2 |
0 |
0 |
5 |
4 |
6 |
8 |
8
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To : Billing
Organisation |
This Application is
hereby REJECTED (please tick) for the following reason(s) :
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Signature/Thumbprint# differs from
Financial Institution's records |
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Signature/Thumbprint#
incomplete/unclear# |
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Account operated by
signature/thumbprint# | |
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Wrong account
number |
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Amendments not
countersigned by customer |
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Others :
________________________________________
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_______________________________
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_____________________________
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_____________________________ |
Name of Approving Officer |
Authorised Signature |
Date | |
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* For thumbprints, please go to the branch with
your identification.
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