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  • GIRO Authorisation Form For Claimant

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    irqim
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    This document is a direct credit authorization form submitted by Lim Siew Chon to AXA Affin General Insurance Berhad. It authorizes AXA Affin to credit any payments due to Lim Siew Chon directly to his bank account at HongLeong Bank ending in 34450080504. This authorization will remain in effect until revoked in writing 30 days in advance of any change. Lim Siew Chon must also inform AXA Affin in writing within 7 days of any change to his bank account details. The form is signed by Lim Siew Chon.

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    This document is a direct credit authorization form submitted by Lim Siew Chon to AXA Affin General Insurance Berhad. It authorizes AXA Affin to credit any payments due to Lim Siew Chon directly to his bank account at HongLeong Bank ending in 34450080504. This authorization will remain in effect until revoked in writing 30 days in advance of any change. Lim Siew Chon must also inform AXA Affin in writing within 7 days of any change to his bank account details. The form is signed by Lim Siew Chon.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    8 views1 page

    GIRO Authorisation Form For Claimant

    Uploaded by

    irqim
    This document is a direct credit authorization form submitted by Lim Siew Chon to AXA Affin General Insurance Berhad. It authorizes AXA Affin to credit any payments due to Lim Siew Chon directly to his bank account at HongLeong Bank ending in 34450080504. This authorization will remain in effect until revoked in writing 30 days in advance of any change. Lim Siew Chon must also inform AXA Affin in writing within 7 days of any change to his bank account details. The form is signed by Lim Siew Chon.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    DIRECT CREDIT (GIRO) AUTHORISATION FORM

    Name : LIM SIEW CHON


    Company Registration No
    (Non-individual)
    NRIC No (Individual) 660705-05-5030
    Address: 19/21 JALAN SJ 8/8A, TAMAN SEREMBAN JAYA, 70450
    SEREMBAN, NEGERI SEMBILAN
    Contact Person /
    Designation: Lim Siew Chon
    Telephone No: 0186607471
    Emails address limsiewchon0705@gmail.com (For transmission of payment advice)

    Bank Details

    We hereby authorize AXA Affin General Insurance Berhad to credit all payment(s) due and payable by
    AXA Affin Insurance Berhad to my /our company bank account as stated below:

    Name of Bank: HongLeong Bank


    Account Name: Lim Siew Chon
    Account No: 34450080504
    Bank Address:
    Bank Branch:
    GIRO Code:

    Amounts credited to the above-mentioned bank account would constitute valid discharge of obligations
    due to me/us in relation to all such payments. This authorisation will remain in force until expressly
    revoked by notice in writing 30 days in advance before the change. In the event of a change in bank
    account, we shall inform you in writing no later than 7 days after the change.

    Authorised Signature Name : LIM SIEW CHON

    Company’s Stamp Date

    Note: Please enclose a photocopy of the top portion of the latest bank
    statement with bank account details /relevant page of the savings

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