Finance

Bank Details Request Form

Please ensure all details are completed and signed.
Return via fax to 082-423594

SECTION 1 – Company Details

Company Name Company No.
Address GST/VAT No.
Postcode
Email Contact Person
Phone Fax Mobile
How would you like to receive correspondence (including payment paperwork)? Please tick your preference.
Options Email Fax Mail
If any details have changed, please update them with Swinburne, Account Payable - via fax to 082-423594 or
Email: finau@swinburne.edu.my
SECTION 2 – Bank Account Details
Account Name
Account Number
Name of Bank Swift Code

Bank Address Postcode

City State

SECTION 3 – Declaration
The information collected on this form is for payment to supplier. The information is processed in accordance with the Personal Data Protection Act (PDPA) 2010. It is only
disclosed to third parties with your consent or to meet statutory obligations.

For more information, please refer to the University’s Privacy Collection Notice at http://www.swinburne.edu.my/privacy/.

By signing this form, you agree to be subject to the Privacy Collection Notice of the University and have consented to the processing and disclosure of your personal data for the
fulfilment of this contract.

I understand that by signing this form, I am subject to the University’s Privacy Collection Notice and give the University consent to process my personal data for fulfilment of this
contract.

Swinburne Sarawak Sdn Bhd shall not be responsible for payment errors or delays caused by incorrect or illegible bank account details.

Our Governing Conditions state that:

Swinburne Sarawak Sdn Bhd is under no obligation to verify the bank account details provided by you. The bank account details provided by you are deemed to be correct.

If there are any changes to your bank account details, Swinburne Sarawak Sdn Bhd must be notified in writing immediately. You bank account details are deemed correct
until receipt by Swinburne Sarawak Sdn Bhd of notice of change.

Swinburne Sarawak Sdn Bhd shall not be responsible for any delays or errors in payment due to factors outside the control of Swinburne Sarawak Sdn Bhd such as but not limited to delays
or errors in the banking system caused by errors in the account details provided by you.

Swinburne Sarawak Sdn Bhd has the sole discretion to terminate or suspend this direct credit payment system at any time without notice and opt for any other mode of payment which
Swinburne Sarawak Sdn Bhd deems fit and proper.

The Supplier shall refund to Swinburne Sarawak Sdn Bhd any payments credited to the Supplier in error upon notification in writing by Swinburne Sarawak Sdn Bhd failing
which Swinburne Sarawak Sdn Bhd shall have the right to commence legal actions for recovery of the payments credited to the Supplier in error.

Swinburne Sarawak Sdn Bhd reserves the right to apply any overpayments to the Supplier to set off any future or existing debt owed by Swinburne Sarawak Sdn Bhd or request for refund of
the overpayments. Upon written request for refund of overpayments having been made by Swinburne Sarawak Sdn Bhd the Supplier shall refund the overpayments to Swinburne Sarawak Sdn
Bhd accordingly failing which Swinburne Sarawak Sdn Bhd shall have the right to commence legal actions for recovery of the overpayments.

SECTION 4 – Acknowledgement
I/We have read and accept the Governing Conditions in Section 3 above.
Signed Print Name
Date

SECTION 5 – Office use only

Created by Date Verify Date

Finance – Bank Details Request Form

Version 2.1, Feb 2015