JALAN BESAR TOWN COUNCIL
    APPLICATION FOR INTERBANK GIRO
 
 PART 1: FOR APPLICANT'S COMPLETION (FILL IN THE SPACES INDICATED WITH •)
 
Date:
• 		Name of Billing Organisation ("BO"):
JALAN BESAR TOWN COUNCIL
To: Name of Financial Institution:
•

Billing Organisation's Customer's Name:
•

Branch:
• 		Billing Organisation's Customer's Reference No.:
•C
 
PARTICULARS OF REGISTERED TENANT/LESSEE
Name:
Address:
Singapore:
 
(a) I/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 instruction 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 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.
My/Our Name(s):
•
My/Our Contact (Tel/Fax) Number(s):
•
My/Our Account Number:

•
My/Our Company Stamp/Signature(s)/
Thumbprint(s)*:
•
(As in Financial Institution's records)
 
 PART 2: FOR BILLING ORGANISATION'S COMPLETION
 
Bank
7375
Branch
332
Billing Organisation's Account No.
9323426380
Billing Organisation's Customer Ref No.
C
Bank
 Branch
 A/C No. To Be Debited
 
 PART 3: FOR FINANCIAL INSTITUTION'S COMPLETION
  To: Billing Organisation

This application is hereby REJECTED (please tick) for the following reason(s):
 
Signature/Thumbprint# differs from
        Financial Institution's records 		Wrong account number
Signature/Thumbprint# incomplete
        /unclear# 		Amendments not countersigned by customer
Account operated by signature/
       thumbprint# 		Others:___________________________
 
_____________________
Name of Approving Officer
_____________________
Authorised Signature
_____________________
Date
 
 *For thumbprints, please go to the branch with your identification. #Please delete where applicable