S-13138-DBS Recurring Form

It’s time to say goodbye to writing separate
cheques and making alternative payments for
your bills. With DBS Recurring Bill Payment, all
you need is one account to manage everything!
1. Name of Policy Owner:
NRIC/ Passport:
Relationship:
Prudential Policy No.:
2. Name of Policy Owner:
DBS Recurring Bill Payment
Combine multiple bills
in one payment.
Benefits at a glance:
✓
✓
✓
✓
NRIC/ Passport:
One payment for all your bills
No more long queues
Be on time for your bill payment
Earn DBS Rewards points
Relationship:
DBS Recurring Bill Payment Terms and Conditions:
Prudential Policy No.:
1.
2.
3. Name of Policy Owner:
3.
4.
NRIC/ Passport:
Relationship:
5.
Prudential Policy No.:
6.
I hereby authorise Prudential to charge the premium(s)
of the above policy(s) to my DBS/POSB Credit Card.
7.
1. You can apply for Regular Premium Payment** (”RPP”) and charge the premium(s)
of the policy(s) belonging to you and your Family Members^^ to your DBS/POSB
Credit Card.
2. Upon the approval of your application, the premium(s) will be charged to your
DBS/POSB Credit Card on the due date of the premium(s) and your DBS/POSB Credit
Card statement will show the proposal/policy number(s) and the amount deducted. No
renewal premium notices or official receipts will be issued. The relevant entries in your
DBS/POSB Credit Card statement will be recognised as evidence of your payments.
3. If you are not the owner of a policy, you shall have no right under the Contracts
(Rights of Third Parties) Act, Cap 53B, to enforce any of the Terms and Conditions of
such policy. This is regardless of whether or not you have made premium payments
on the policy.
** Terms and Conditions of Regular Premium Payment (”RPP”) apply. You may obtain a
copy of these Terms and Conditions from Prudential by calling the Customer Service
Hotline at 1800 333 0 333. The following policies are not eligible under this (”RPP”):
Prushield policies, US Dollar policies, single premium policies, recurring single
premium policies, top-up premiums and policies purchased under CPF Investment
Scheme and Supplementary Retirement Scheme.
^^ Family members: Spouse, children, parents, parent-in-laws, brothers and sisters.
L5CCRN
DBS Bank Ltd Co. Reg. No.: 196800306E
This section is applicable to customers applying for eligible Prudential products and third
party Family Member payors.
Jul 2016
8.
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10.
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14.
15.
You warrant that the information you have provided is true and correct.
Your DBS Credit Card (“Card”) must be in good standing, valid for at least 3 months
from the date of this application and remain valid for the monthly bills to be debited
successfully.
The processing of this application may take up to 8 weeks.
You should continue to pay your bill(s) to the relevant billing organisation(s) until the
payment amount shown on the invoice/bill issued by the billing organisation(s) is
reflected on your monthly Card statement.
The Bank may inform you on the status of your application if the Bank is
correspondingly notified by the billing organisation(s), but the Bank is not liable for
any failure to notify you of the status.
All applications are subject to approval from the Bank and relevant billing
organisation(s), and the Bank and/or relevant billing organisation(s) reserves the right
to reject/decline any application at its sole discretion without giving any reason.
Should you cancel or lose your Card, please make alternative payments arrangements
to the relevant billing organisation(s).
In the event of any change in your Card number or change in Card expiry date for
either the main card or supplementary card used for the recurring payment(s), you
must notify the relevant billing organisation(s) of the same and the Bank is not
obliged to notify on your behalf.
Should there be any changes in your personal details provided in this application,
you must update the relevant billing organisation(s).
If your existing account(s) with the billing organisation(s) is/are paid by GIRO, the
GIRO payment arrangement(s) will be terminated.
You must contact the relevant billing organisation(s) to make alternative payment
arrangement(s) should you wish to terminate this payment arrangement and the
Bank is not obliged to contact the relevant billing organisation(s) on your behalf.
If any payment charged to your Card is unsuccessful for any reason whatsoever, you will
be responsible for arranging payment to that billing organisation(s) by other means.
All correspondence between the Bank and you regarding your application will be
sent to your last known address on the Bank’s records.
The Bank will not be liable for any loss, expenses, delays, mistakes, neglect or
omission in the transmission of payment under this bill recurring payment facility or
for any unsuccessful payment.
The Bank reserves the right to amend these Terms and Conditions without giving any
reasons.
DBS/POSB CREDIT CARD RECURRING BILL
PAYMENT APPLICATION FORM
TOWN COUNCILS#
Please indicate your choice of Town Council(s) by ticking (
any of the boxes below.
Yes, I would like to pay my bills with my DBS/POSB Credit
Card.
Name:
Aljunied-Hougang-Punggol East Town Council
–
–
–
Reference No.:
I hereby authorise M1 to charge my monthly M1 bills for the
above-stated Account No.(s) to my DBS/POSB Credit Card.
Mailing Address:
NRIC/Passport No.:
Home Tel No.:
MSIG*
6
Mobile Tel No.:
DBS/POSB Credit Card No.:
Card Expiry Date:
(MMYYYY)
By submitting this form, I confirm that I have read and agree to the Terms and
Conditions. I consent to DBS’ collection and use of my personal data and the use
and disclosure of my personal data by/to third parties (including the billing
organisation(s)) for the purposes of this application. I agree to the terms of the DBS
Privacy Policy and I hereby authorise the respective billing organisation(s) to charge
the bills/fees/charges/premiums to my DBS/POSB Credit Card. The approval of this
authorisation will supercede existing payment instructions with the respective billing
organisations listed on this form. My account name with the relevant billing
organisations is the same as the name shown on my DBS/POSB Bank Credit Card
statement, unless otherwise specified. DBS will not notify me separately with regards
the status of this application.
I hereby authorise MSIG to charge the premium(s) of
the above policy(s) to my DBS/POSB Credit Card.
This Facility is available to customers applying for/who currently have MSIG Insurance
(Singapore) Pte Ltd Products purchased through DBS Bank.
1. You can charge the recurring premium(s) of the policy(s) belonging to you to your
DBS/POSB Credit Card.
I hereby authorise SP Services to charge my monthly SP Services bills
for the above-stated Account No.(s) to my DBS/POSB Credit Card.
Important note: This authorisation will remain in full force until terminated in
writing by me to SP Services or the account with SP Services is closed whichever
is earlier. I understand that this is applicable only to accounts under the name of
Main or Supplementary Cardholder.
)
Ang Mo Kio Town Council
–
Reference No.:
Bishan-Toa Payoh Town Council
–
Reference No.:
–
–
–
–
I pledge (please tick):
Donation amount:
S$10
Frequency:
Monthly
–
Jalan Besar Town Council
–
Reference No.:
–
–
Marine Parade Town Council
–
Reference No.:
–
–
Pasir Ris-Punggol Town Council
–
Reference No.:
How Your Donation Helps
S$10 allows one special education student with multiple disabilities to receive
therapy for a week, such that the student can feed and dress himself or
herself.
S$30 allows one child below 6 years old with learning disabilities to undergo
early intervention training for a week to help him or her walk and climb.
Holland-Bukit Panjang Town Council
–
–
Reference No.:
Nee Soon Town Council
–
Reference No.:
STARHUB LTD
Town Council
StarHub Ltd Account No.(s):
•
•
–
–
Sembawang Town Council
–
Reference No.:
–
–
3. If you are not the owner of a policy, you shall have no right under the Contracts
(Rights of Third Parties) Act, Cap 53B, to enforce any of the Terms and Conditions of
such policy. This is regardless of whether or not you have made premium payments
on the policy.
Tampines Town Council
–
Reference No.:
–
–
*Not applicable for DBS American Express/Corporate/Debit Cards.
Tanjong Pagar Town Council
–
Reference No.:
–
–
West Coast Town Council
–
Reference No.:
–
–
I hereby authorise the above selected Town Council(s) to charge my monthly
Service and Conservancy Charges (S&CC) to my DBS/POSB Credit Card.
Not applicable for DBS American Express Cards.
Other: S$
Important note: If a donation is authorised with incomplete information, the default
pledge amount to Community Chest will be S$10 on a monthly basis payable with your
DBS/POSB Credit Card.
–
2. Upon the approval of your application, the premium(s) willl be charged to your
DBS/POSB Credit Card on the due date of the premium(s) and your DBS/POSB Credit
Card statement will show the proposal/policy number(s) and the amount deducted. No
renewal premium notices or official receipts will be issued. The relevant entries in your
DBS/POSB Credit Card statement will be recognised as evidence of your payments.
#
S$30
One-time
I hereby authorise Community Chest to charge my
donation to my DBS/POSB Credit Card. I understand
that my details may be submitted to Community
Chest to facilitate the relevant tax deduction for my
donation.
Nee Soon
–
Do your bit for our children by pledging a donation
through the Community Chest.
•
I hereby authorise StarHub Ltd to charge my monthly StarHub Ltd
bills for the above-stated Account No.(s) to my DBS/POSB Credit Card.
This arrangement will supercede existing payment arrangement that
I have made with StarHub Ltd. I agree to StarHub Ltd collecting,
using and disclosing my personal data for the purposes of processing
this recurring payment arrangement, payments and refunds.
Important note: Please complete and attach your original StarHub Ltd Payment Slip
(at the bottom of StarHub Ltd bill), sign and mail it with this application form.