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  • Cheque and Credit Card Payment Form - tcm1030-284967

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    Balenciaga Land
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    PAYMENT SLIP Please tick : r By Cheque payable to Chartis Singapore Insurance Pte. Ltd. By Credit Card. Please charge the amount of S$ _______________ to my MasterCard / Visa Card / Amex : card No. Expiry Date name of insure : ________________________. Please sign and return this Payment Slip Advice to us via fax at 6415 3723 (for immediate processing if paid by credit card) or by mail enclosed in the

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    Cheque and Credit Card Payment Form_tcm1030-284967

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    PAYMENT SLIP Please tick : r By Cheque payable to Chartis Singapore Insurance Pte. Ltd. By Credit Card. Please charge the amount of S$ _______________ to my MasterCard / Visa Card / Amex : card No. Expiry Date name of insure : ________________________. Please sign and return this Payment Slip Advice to us via fax at 6415 3723 (for immediate processing if paid by credit card) or by mail enclosed in the

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    13 views1 page

    Cheque and Credit Card Payment Form - tcm1030-284967

    Uploaded by

    Balenciaga Land
    PAYMENT SLIP Please tick : r By Cheque payable to Chartis Singapore Insurance Pte. Ltd. By Credit Card. Please charge the amount of S$ _______________ to my MasterCard / Visa Card / Amex : card No. Expiry Date name of insure : ________________________. Please sign and return this Payment Slip Advice to us via fax at 6415 3723 (for immediate processing if paid by credit card) or by mail enclosed in the

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Chartis Singapore Insurance Pte. Ltd.

    CHARTIS Building
    78 Shenton Way #07-16
    Singapore 079120

    Hotline: 6419 3000


    Fax Number: 6419 3723
    www.chartisinsurance.com.sg

    PAYMENT SLIP
    Please tick :

    By Cheque payable to Chartis Singapore Insurance Pte. Ltd. Cheque No: ______________
    Bank : __________________ Date : __________________ Amount : ________________

    By Credit Card. Please charge the amount of S$ _______________ to my MasterCard/Visa


    Card / Amex :
    Card No.

    Expiry Date

    Name of Insured : ________________________

    NRIC No. : ________________ ______

    Motor Policy No. : _________________________

    Vehicle Number : __________________

    Signature

    Date : ___________________

    : __________________________

    Please sign and return this Payment Slip Advice to us via fax at 6415 3723 (for immediate processing if
    paid by credit card) or by mail enclosed in the Business Reply Envelope provided.

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