Credit/Debit Card Auto Debit Agreement

Credit/Debit Card Debit Authorization

Name :
NRIC No.:

Part A : Credit/Debit Card Details

Credit/Debit Card No.

Card Expiry Date : (MM/YYYY) Issue By : _____________________________ Card Type : Credit / Debit / AMEX

Name on Card _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ /

Part B : Payment Details

1st to 12th Months 13th to 24th Months 25th to 36th Months 37th to 48th Months 49th to 60th Months 61st Onwards
Monthly Rental Fee

Declaration and Authorization

Any personal information collected or held by the Company (whether contained in this application or otherwise obtained) is provided and may be held, used, and
disclosed by the Company to individuals/organization related to and associated with the Company or any selected third party (within or outside of Malaysia) for the
purpose of processing this application and providing subsequent service for this and other products and service, cross marketing, direct marketing, and data matching,
and to communicate with me/us for such purposes. I/we understand that I/we have a right to obtain access to and to request correction of any personal information
held by the Company concerning me/us. Such request can be made to any of the Company’s Customer Service Centre.

Terms and Conditions of Credit/Debit Card

In consideration of your agreeing to accept my authorization for you to debit my Credit/Debit Card account to pay Cuckoo rentals fee(s), I expressly agree to the
following terms and conditions:
1. I authorize Cuckoo to debit my Credit/Debit Card account for payment of rental fee (s) under the given rental agreement.
2. The first debit shall commence any time from the date of submission of the Authorization Form. Subsequent debit will be made in accordance with the rental
agreement frequency as advised by Cuckoo.
3. I shall accept full responsibility for all transactions arising from the use of this Credit/Debit Card in payment of rental fee(s).
4. Cuckoo shall not be held responsible or liable for any claims, loss, damage, costs and expenses arising from the successful processing of the debit or the
unsuccessful processing of the debit due to exceeding credit limit, malfunction of system, electricity failure and any other factors beyond the control of
Cuckoo.
5. Cuckoo is only responsible for making arrangement to debit my Credit/Debit Card account through the Card Centre as authorized by me. Therefore,
for any problem or dispute arising from the processing/ debiting it will be my own responsibility to resolve it with my Credit/Debit Card Company.
6. I will ensure that Cuckoo is notified in writing of any changes, loss or replacement of my credit/debit card, or cancellation of this authorization at least one
month before the next rental fee(s) due. Such changes or cancellation will become only after Cuckoo has duly acknowledged receipt of such request.
7. Cuckoo may at its absolute discretion at any time terminate this Credit/Debit Card debit arrangement without assigning any reason by giving me one month’s
notice in writing.
8. Cuckoo reserves the right to change the Terms and Conditions set out herein at any time or from time to time when circumstances warrant without prior
notice to me.
9. I hereby agree to indemnify and keep Cuckoo indemnified against any claims, loss, damage cost and expenses which Cuckoo may suffer or incur arising
from my authorization to debit my Credit/Debit Card account as aforesaid.
10. Rental fees payments that are payable will be considered as paid only upon successful processing of the debit by the Card Centre.

Name:
NRIC:
Date: