@ miaybamic AUTODEBIT DIRECT DEBIT INSTRUCTION APPLICATION FORM. “ARARANT Sia iskan borang in ol dalam HURUF BESAR dan kembaliannya ‘epecla cavangan Mayank cimana akaun anda abuka, Saya / Kem dlengan ini mambenarkan Bank mendebltskaun ayaa! tla ‘mele jumlah yan cletapkan apabla pial Bank menetina tnt bayaran deripada Perbadanan Penorima. Saya/Kamibersotju untuk ‘omituhl syarat-syarat dan peraluran porkhidmatan sepsrt yang {ezcalat ol helalan koa Borang permohonan pekhdeatan Aulodabit TmeraueTION Ploaso complet the form in BLOGK LETTERS and retunitto Maybank branch whore your account Is maltalned, Upon receipt of bing Inslraction from Payee Corporation, VW hereby authorsod the bank 2 process debit to mylour account each not exceeding the litinleated to ;ay tothe mentioned payeo corporation. Wo agree to abide by the Terms ‘anal condiion ofthe service as being spectod at tho Hid shoot ol application form. ‘BAHAGIAN A ~ MAKLUMAT PEMBAVARAN 'SEGTION A PAYMENT INFORMATION [FOR PAYEESIAGENT USE FAganey lcase ora! NOTES: Enpat nombor poll abana’ uu stan horeng prehonaniFour ples munborafe ‘ilo for ach apilention fr. ‘Nona Futon lah pombe post ‘au sotarang nomber yarg betkon Kopeda nage doh patedianpneina cebagamoter ‘kn marpmotan poniatn Ade ‘Reference eurtr she il zcout nae ‘ey mbar or any niin nubs osod byt Payeo Gororaton to estomrs fo ho U0 of ‘teers, * Noma paregarg tsb na ran ey yang fecal eda gid ol ft is Ua eae ha pteanearpay wih een "Sia yataan Rigg dalam peiatan dusngan ‘alan Pessare iapt amount ot nthe nat eainn. “Tagan a i kosong aint 00h ae BAFAGIAN B - MAKLUWAT AKAUN BANK SECTION B = BANK ACCOUNT INFORMATION NAMA SAYAIKAAT [MVIOUR NAME No. KPNo. Peod.Pamiagaan (BariNew) 1 No Business Rg, to. NomiborAkaun ‘Account Numbor COnwangan Mob ‘MB Branch ‘Alamat Skarang & PPoskod /Prosont ‘dares & Post Code, Cee Tar sl (Lama) Sinpanan/ Savings Alau/or Semasn Curent “Tendatangan Pemegang akaun / ‘fla pashan targa eda name gen ed Bak ‘Telephone No ——_—_— ‘ne ner yore eso ae rests UNTUK KEGUNAAN CAWANGAN BANIC BAHASA. FOR MOB BRANCH USE ~ VALIDATION OF TRANSACTION CODE 800510 FOR BRANCH USE FOR PAYMENT SERVICES CENTRE USE (HO) ata Processed $ Data Procossed + Date Recolved : Confined By Name & PF No Date Input Braich Autholy Saat Confined By Signature oot ‘uapen Bra Beas ‘andTIST OF AUTODEDIT PAYEE CORPORATIONS: AND ITS DEDUCTION DATES oo Sem 5 ite an Pa tes abcarees ha a, ‘TERIMS AND CONDITIONS Te Sanne yes Sing Sra ecnoey exponen a rei of an ro Mars ayn cl Tn Por, S050 ‘ae FSS tanpur een non ot ‘nna ns aed Peo Cn de ay un a ‘ayer Coan ‘scans cine la nko ui Ate {Acca ogre Stings Aen o Cost Azo ry aa a Societe ‘Mon Adode saee tend pops ord o Haba eyesore 1 Dect Dt mrs ty th tg fama ptm ain a on a open on oh An * aps lings oe on desl the tn old rt perted by boner ey ose eon eemetenoertnercooae Spa ‘irene ot ‘indigenes i ad oa, 10 PAYEE CORPORATION ‘SHCTION G: FOR PAYEE USE ONLY 1 treme ett tn ni ee Sepptegentteeniny 2 omer ceren a Bobet cL cata ‘lv to Br nda ol a ted ob Sg ss mi su esheets enews Seen career fon eat Gen Wing led fom fu Sh oo unacy Sie ryirsoanni saan ‘Corporaion, . «flr te pent ete Ser ose reermeaeceeas See aeaeenems tinaiaeadt emai iesespee meta vrata nmr une meaner rails Se Wa et mao sero see Sitesi me paemni + icecay arena mange ris mieten ear ve Omran oe mr eae Seeeeonen eres ‘htt ie ont mate, m rd a 2 Toten re ea pet praises arent dna al io er ee Shea sara a och ty We sa. onset th sty i eat ‘Ls SRivapne cnn con ood toh bese reso Bina cone li 1. Tyga attr my opti le cents Rens etir ae Sl baer et sa Sepadedate sortase ttceteoseoune aatoets {Sue usp ganoliote coroner 15: haan nico cnt tne Sls omen a “Sehr py et arc we Sa be ‘Ssfebasol on ho ar caren cso ernst 16 The esd ans grin in tra ol caer ha Du ‘Munroe sents aon son a 17 ie tr onan! ul Bagge ney mat mr Mbarttawsawuriecn te ethers ‘eta ben Gh nd shane ha Elsi hte ‘tas 80 aye tore expected dado cnmoncorent corpo NOTE: This ormlstobe submit oe Payee Corporation ate you havo frre the atechng DD orto your Ban. ist ech he Payee Camporsion at dedcten at mou azesunt aor T ] eee ie {oc payment of PrmniunPatyLoantS AMUN No| | 1 forays of Prin renihyiqustlyalyoaryieny. Anouk Name of Life Aesueaglored Subsea Name of Potey holder oer tan sve; 1 forpayen of plan: monbiuarotyhelyryhéa. Amount = “ano, Dre ecauthalars Siete + delte whichever not appa. ACKNOWLEDGEMENT FOR PAYEE CORPORATION USE Poly acount SAWM Acco Not No. ura: a ba; PT TT LT arti piitoon:- —— Commenceman Date. ‘We ecknowedgerevdptel your iol Dat sition (DD) fem Please flan tis chnonedgemen fr you telerene8, sneha Daa