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TO: The Manager, Singapore Airlines Limited (hereafter known as “SIA”)

In consideration of SIA accepting the purchase of this Booking Reference where

I have authorized this purchase using my Credit Card but I am NOT a Travelling Party of the Booking Reference
Others (Please Specify)

for the below-mentioned Ticket(s) and agreeing to carry the passenger(s) as indicated on the Ticket(s) for
travel on Singapore Airlines flight(s), including but not limited to the itinerary mentioned below,
Ticket Number Passenger Name Flight Number / Date / Itinerary

I, Name: , of Passport / Identify Number: ,

Contact Number: , Residential Address:

, and

Email Address: , do hereby declare and agree to indemnify SIA for the

Total Price of the above-mentioned Ticket(s) as reflected on the Ticket(s)

(Specify Transaction Type, Currency and Amount)

by the following form of payment method forthwith

Authorizing SIA to charge my Alternative Credit Card:
(Specify Card Type, Card Number & Expiry Date)

Payment in Cash &/or Cheque &/or Bank Transfer *

upon notification by SIA through reasonable attempts &/or communication channels of the non-acceptance of
the original charge(s) for the purchase of the above-mentioned Ticket(s) made to the Purchasing Credit Card.

Name & Signature of Purchasing Credit Card Holder / Travelling Passenger * Date
* Delete As Appropriate
1. This document is to be signed ONLY in the presence of an SIA staff.
2. The signatory of this document is required to present the Purchasing Credit Card &/or Alternate Credit Card, a photo identity, &/or proof of contact
number, residential address &/or email address as appropriately required by an SIA staff.
3. The signatory of this document acknowledges and understands that by signing this document, the signatory agrees to use his/her own credit card, debit
card or direct debit account, which is held in his/her name, and in consideration of SIA accepting the signatory’s payment for the above purposes, to
indemnify and hold harmless SIA from any loss arising from the non-acceptance or rejection by the relevant payment account issuer (for any reason) of
the original transaction, and to forthwith upon demand by SIA pay the whole amount owing for the transaction in whatever form SIA shall require.
4. The information in this document is strictly confidential and will be securely stored by SIA for a period no longer than is deemed required by SIA.

For Official Use

This document is verified and approved by:

Name / Designation Signature Stamp Date