SINGAPORE POOLS (PRIVATE) LIMITED

APPLICATION FOR DIRECT DEBIT PAYMENT AUTHORISATION

PART 1: FOR APPLICANTS COMPLETION (Fill the spaces indicated with )
Date: To:
D D M M Y Y Y Y q
DBS Bank Ltd (Company Registration No. 196800306E)
q
Overseas-Chinese Banking Corporation Limited
Name of Billing Organisation (BO): (Company Registration No. 193200032W)

Singapore Pools (Private) Limited q

United Overseas Bank Limited / Far Eastern Bank Limited
(Company Registration No. UOB 193500026Z / FEB 195800116D)

My Instruction(s) To Above-Mentioned Bank:

(a) By signing below, i hereby instruct you to process the BOs instructions to debit my account specified below.
(b) I agree to be bound by the direct debit payment conditions set out in the Account Opening and Operating Terms and Conditions.
(c) I acknowledge and agree that this authorisation shall not take effect until I receive your written notification that my application for Direct Debit Payment Authorisation
has been approved.
(d) I agree that you have the absolute discretion to amend the per transaction limit (where applicable) or maximum daily total limit (limits) that I have applied for herein,
or to decline my application without giving any reason and also to retain any document I have submitted pursuant to this application as your property. Any changes
proposed to be made by me to any of the limits may only be effected with your approval. For the avoidance of doubt, any changes or modifications to the limits shall
only take effect from the date of your letter to me.
(e) I agree to the prevailing prescribed rate of S$0.20 for each debit request, and I also agree the Bank shall have the right to make such changes or adjustments to this
prescribed rate as the Bank in its sole discretion deems fit.

My Name: My Account Type:

q
Savings Account q
Current Account
(As in Banks Records) (Personal Account in Single Name ONLY - No Joint Account)

My Account Number to be Debited: My Contact Number(s):

Home Tel:

Office Tel:
My Per Transaction Limit^ is:

Mobile Tel:
(Applicable to DBS & OCBC Accounts Only)

My Maximum Daily Total Limit is: My Signature / Thumbprint*:

q $5,000 q $25,000 q $50,000

My Instruction to Singapore Pools:

Please Transfer the Funds from My Betting Account to My Bank Account.
q Daily q Weekly q Monthly (As in Banks Records)

* For thumbprint, please proceed to branch of bank with your identification card / passport. ^ For DBS accounts only: If left blank, $5,000 will be used.

PART 2: FOR SINGAPORE POOLS (PRIVATE) LIMITEDS COMPLETION

SWIFTBIC Singapore Pools (Private) Limiteds Account No. Singapore Pools (Private) Limiteds Customers DDA Reference No.

Name of Approving Officer Authorised Signature (Approving Officer) Date

PART 3: FOR BANKS COMPLETION

To: Singapore Pools (Private) Limited
This application is REJECTED for the following reason(s): Please tick () and please delete where inapplicable #
q Signature / Thumbprint # Differs from Banks records q Wrong Account number
q Signature / Thumbprint Incomplete / Unclear
# #
q Amendments not countersigned by Customer
q Account not operated by Signature / Thumbprint #
q Others:__________________________________________

Name of Approving Officer Authorised Signature (Approving Officer) Date

Sep16

Private & Confidential (Company Registration No. 196800202G)

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addressee. For
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Singapore only.

BUSINESS REPLY SERVICE

PERMIT NO. 07761
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Attention: Customer Support
Bras Basah Post Office
P.O. Box 299
Singapore 911810

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Have you
completed and signed the form?

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