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APPLICATION FORM FOR INTERBANK GIRO PART 1 FOR APPLICANT S COMPLETION Please fill in the all fields. Incomplete forms may not be processed Date Name of Billing Organisation BO NPS INTERNATIONAL SCHOOL PTE LTD To Name of Financial Institution Billing Organisation s Student Name Grade Branch --------------------------------------------------a b c d I/We hereby instruct you to process the BO s instructions to debit my/our account. APPLICATION FORM FOR INTERBANK GIRO PART 1 FOR APPLICANT S COMPLETION Please fill in the all fields. Incomplete forms may not be processed Date Name of Billing Organisation BO NPS INTERNATIONAL SCHOOL PTE LTD To Name of Financial Institution Billing Organisation s Student Name Grade Branch --------------------------------------------------a b c d I/We hereby instruct you to process the BO s instructions to debit my/our account. 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. 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. It is the BO s responsibility to inform banks upon the expiry of this authorisation and to ensure no deductions are made thereafter. Note BOs should print and make clear whether this option is applicable or available to their customers. My/Our Names s My/Our Contact Tel/Fax Number s PART 2 FOR BILLING ORGANISATION S COMPLETION Bank Account No* To be Debited REASON FOR REJECTION PART 3 FOR FINANCIAL INSTITUTION S COMPLETION SIGNATURE S VERIFIED BY APPROVED BY Signature Name. Incomplete forms may not be processed Date Name of Billing Organisation BO NPS INTERNATIONAL SCHOOL PTE LTD To Name of Financial Institution Billing Organisation s Student Name Grade Branch --------------------------------------------------a b c d I/We hereby instruct you to process the BO s instructions to debit my/our account. 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 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. You may also at your discretion allow the debit even if this results in an overdraft on the account and impose charges accordingly. 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. 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. It is the BO s responsibility to inform banks upon the expiry of this authorisation and to ensure no deductions are made thereafter.

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