Please complete part 1 and return two original copies to填好(ü)下表并寄两份至:

 Globe Telecom Pte. Ltd

1 Science Center Road #05-01A The Enterprise, Singapore – 609077  Tel: 62223071  Fax: 65649037

 

 

APPLICATION FORM FOR INTERBANK GIRO 财路表格

 

PART 1 : FOR APPLICANT’S COMPLETION (Fill in  the spaces indicated with ü ,  请在ü处填上完整资料)

 

 

 

 

 

Date 填表日期:

 

Name of Billing Organization (“BO”) :

ü

 

Globe Telecom Enterprise

 

 

 

 

 

 

To : (Name of Bank/Finance Company开户银行的名称)

 

Customer Name 用户姓名 :

ü

 

 

ü

 

 

 

 

 

 

Branch 用户的开户银行的分行名称:

 

Customer’s NRIC / Passport Number 用户身份证/护照号码:

ü

 

 

ü

 

 

 

 

 

 

(a)  We hereby instruct you to process the BO’s instructions to debit my/our account.

(b) You are entitled to reject the BO’s debit instructions if my/our account does not have sufficient funds and charge me/us

      a fee for this. You may also at your discretion allow the debit even if this results in an overdraft on the account and

      impose charges accordingly.

(c)  This authorization will remain in force until terminated by your written notice sent to my/our address last known to you

       or upon receipt of BO’s written revocation .

 

 

 

 

 

 

My/Our Name(s) as in Bank Account 用户在银行的名字

 

My/Our Company Stamp/Signature(s)/Thumbprint(s)* :

ü

 

用户签名/指印 或公司盖章 (必须与银行存底相同)

 

 

 

My/Our Account Number : 用户的银行帐号

 

 

ü

 

 

 

 

 

My/Our Contact (Tel/Fax) Number(s) :  用户联络号码

 

ü

ü

 

(As in Bank/Finance Company’s record)

* For thumbprints, please go to branch with your identification.

 

PART 2 : FOR BILLING ORGANISATION’S COMPLETION   以下部分用户不必填写

 

Bank

Branch

Billing Organisation’s Account No.

 

Customer Reference No.

7    3    3  9

5   2   7

0   5   2   0    3    9    -    0    0   1

 

 

 

 

Bank

Branch

A/C No. to be Debited

 

 

 

 

PART 3 : FOR BANK/FINANCE COMPANY’S COMPLETION   以下部分用户不必填写

To :  Globe Telecom Enterprise      

 

This Application is hereby REJECTED (please tick) for the following reasons(s) :

 

Signature/Thumbprint# differs from Bank/Finance Co’s records

 

Wrong account number

 

Signature/Thumbprint# incomplete/unclear#

 

Amendments not countersigned by customer

 

Account operated by signature/thumbprint#

 

Others : ___________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________________________

 

_____________________________

 

__________________________

 

Name of Approving Officer

Authorized Signature

Date

 

 

* Please delete where inapplicable.