Direct Debit 5 American Express Form

DIRECT DEBIT SERVICE For maximum convenience your Card Account balance can be directly paid for by deducting from your bank account Letter of Consent Please indicate the Bank at which you have your account. How to Enroll Bangkok Bank PCL You may nominate the following banks to participate in this Direct Debit system Siam Commercial Bank PCL TMB Bank PCL UOB PCL The Bank of Tokyo-Mitsubishi UFJ Limited Sumitomo Mitsui Banking Corporation 2. If you have previously applied for the Direct Debit Service on your American Express Charge Card or Credit Cards and now wish to apply for the Direct Debit Service on your American Express Card please complete this application form again* 3. We will immediately notify your nominated Bank which will confirm your participation in the Direct Debit system* Please continue to pay your bill by cash or cheque by the date specified on your monthly statement until you see the Direct Debit message on your statement. Krung Thai Bank PCL KASIKORNBANK PCL 1. Simply fill in the form and return it to American Express. This form will authorize your nominated Bank to debit your bank account for the amount due on your American Express Card Account. The Hongkong and Shanghai Banking Corporation Limited Date To Branch Manager of TMB Bank Public Company Limited United Oversea Bank Thai Public Company Limited If documents of evidence and the account number mentioned in the first paragraph have changed for whatever reason this letter of consent for debiting the account shall remain in effect in all respects with respect to the account number of which has changed* Therefore please be advised accordingly and proceed in accordance with this Letter of Consent as of the date of this letter until otherwise instructed in writing by me to the Bank and Amex Thai provided that such written instruction shall be given to the Bank and Amex Thai at least 30 days in advance. Please fill in your Card Account Number I hereby certify that the Bank s debiting my account pursuant to this letter is in accordance with my request as if I have withdrawn the monies from the account by myself* If there is any damage or error affecting the Bank and/or Amex Thai I agree to fully indemnify the Bank and/or Amex Thai against all actual damages. Bank Sincerely Branch I owner of the savings account current account Account Number Specify fully Signed Grantor of Consent Account Name Signature of the Owner of the Account as in the sample given to the Bank Current Address How the Service Works 1. We will send you your monthly statement just as before. All you have to do is check your monthly statement and make sure you have sufficient funds in your bank account to cover your expenditure. The statement will specify the date your bank account will be debited which is approximately 10 days from date of statement. 2. The Bank will usually deduct the payment from your bank account before the beginning of its working hours. If you need to make additional deposits to your bank account to cover the full payment please allow clearing time before the direct debit date For cash deposits 1 day Bangkok cheques 3 days upcountry cheques please check with your bank any other deposits please check with your bank Please contact our Customer Service if you have any enquiries or questions about this Direct Debit service at The Platinum Card Tel* 0 2273 5599 The Gold Card and Business Card Telephone hereby submit this letter of consent to the Bank hereinafter called Bank as set forth below For American Express Participating Bank Use only Certified true copy Certified correct account and signature of grantor of consent I consent to the Bank s paying to American Express Thai Co. Ltd. Amex Thai the amounts for purchases of goods and services by using the expenses collectively Charges by debiting my above mentioned account and crediting the same amounts to the account of Amex Thai at the Bank. Amex Thai will notify the Bank of the amounts of such payment. I consent to the Bank s charging fees for carrying out such transaction in accordance with the practices of the Bank. This consent is effective immediately and continues in effect until withdrawn by me. In debiting my account to pay to Amex Thai as mentioned above the Bank shall debit my account only when there are monies remaining in the account and/or the overdraft limit is then sufficient for debiting. If it appears later that the amounts which Amex Thai has notified to the Bank are incorrect and the Bank has debited the amounts as appeared in the statement of account from my account I agree to demand directly such amounts from Amex Thai. I waive any and all rights to demand or sue the Bank for indemnification by the Bank with respect to the monies the Bank has credited to the account of Amex Thai including the right to claim any damages from the Bank.