CcucKOO )DirectDebit AUTHORIZATION FORM OcBC IMPORTANT NOTE: ALL FIELDS WITH () ARE MANDATORY, PLEASE USE CAPITAL LETTERS, BLACK INK AND JON THE RELEVANT BOXES. ([FORACCOUNT HOLDER'S COMPLETION “Type of Appheatont [J] Now Apoicaion [|] Maintenance _[/] Termination Account Holder's Name (Pamary)™ ronuner - E]Newic[] Passpo fwtnout or 7) Floue — Ci gusress ‘Saving of Current ‘Revout (thou "or 7)* Bank Abbreviation* ‘Telephone Number [Reterto Guideline for abbreviation list) E-Mail Purpose of Payment® Maximum amount to debit per {Sudjct to maximum in specified by transaction (RM)" 5]0/0} -|O}0} edo operation Maximum . ci Mexour, 0/2] tires Mode of frequency vaiy [Vv] weoxy [| monty |] veany Efecve Date Exp Date iomnvy) ob) Declaration: 8, lWe hereby acknowledge that the information inthis form willbe disclosed or released tothe Corporation, Corporation's bank and the Direct Debit Operator forthe purpase ofthe Direct Debit collection, b.lWe heraby agroe forthe Bank to debt feos/charges from myfour account as a consequence of insuifciot funds. €' We nereby confirm that we have chacked the accuracy and correctness ofthe datal fumished inthis application and are aware of land the scope f the services provided 4. We hereby declare that all formation provided isto the best of mylour knowledge true and correct. © IWe hereby agroe tobe bound by the Terms and Conaltons specified in this form {ts autorzaton wi remain n fore un teminteé by the Banks writen nae sont to my/our adress fst known othe Bank upon receipt ‘of mylour witten revocaton. 9. le heraby authorize the Sank to debit mylour account fo the above payment instuction(s) including the relevant transaction feesicharges nol payable by the Corporation content Signature / Company Stamp" Daten ‘Aeoount Holders Signature as per Banks record (ODMmyy) (For Joint Account Signatures as per Barks signing condition) [FORCORPORATION'S COMPLETION seterio* | S]E] 0]0/0]2|1/3/4|2 (Gomuyy) Payment Reference No cay Paley Nov! Membership No, thst be uniques , NOTE : THIS SECTION/PORTION IS CUSTOMIZEABLE BY CORPORATION Propared By (Namo) Signature ‘DDA-RS-0007 09/08/2014.Version 1.1‘Terms and Conditions (to Account Hold 1. Inthi terms and conditions: ‘a. The expresion "IWe" refer tothe individual, sole proprietonip, partnership, company or entity named in the Dect Debt Authorization Form overleaf who apples forthe Direc Debit Service rom the Bonk. 'b. The expreion "Banik refers tothe Account Holder's bank. The exprenion "Direct Debit Serica” or ~DDS" refers to cect debit payments sevice whereby an Account Holder's account debited once the paymentideduction instruction reosved from the Corporation, <4. The exprosion of "Direct Debit Operator” refers to Malayion Electronic Clearing Corporation Sd. Bh. (MyClea) asthe operator or sevice provider of DDS. ‘The expresion "Corpeation” refers toa company, private anit, private corporation, publi cerporaion or government body incorporated and registered in Meoysia that subrrbes othe DDS. 4. The exprosion "Terms and Conditions” refers tothe terms and conditions ofthe direct debit payment serices between the Account Holder and the Bank as specif in this form. ‘9: The expresion *rgiteed holder” refers to the name ofthe penonicompany which is stated inthe bil [h The expresion "Payment/Deduction Instruction” refers tothe paymentideducton Instruction bythe Aecount Helder for the DDS os authorized by the Account Helder cond specie in ths orm of which application b approved by the Bank 2. We have read ond understand the Terms and Conelions ofthis form before submitting this form tothe Corporation. IW have completed and signed on this form for the purpose of Direct Debit Service application. 3: An authorized Direct Debit Mandate given by lWe doesnt incude any fraudulent intent bythe Account Holder or any person acting on beh ofthe Account Holder. 4. MylOur fst Direct Debt payment tothe Corporation shall commence only upen recein ofthe fst paymentIdeduction struction from the Corporation subject to the ‘paymentideducton instruction beng accepted and approved by the Bant and the Corporation, 5. We shall ste any outstanding payment forthe account under the paymentideduction struction stated in this form uni the ist paymentideducton instruction Direct Debit offocted 6, Ie adenowiedge that lve are responsbe to ensure that the name ofthe registered holder ofthe lin the Corporation's record is the some namin the bil We ‘edenouledge thatthe Bank shall not be held response the name Inthe bil s diferent from the one tated in the Corporation's record. Note: Registered helder of the bill the name of the peron/ company which stated in the iL 7 te undertaite to ensure that there are sufficient funds in myleur account to meet the Payment/Deducton Instruction The Bank is under no obligation to affect the [DDS if thoresinsuffcont funds in mylour account to mest the PaymentiDeduction struction, my/our account overdrawn us to isufient fund lve shall Immediately make good any amount everdraun pls any late payment interest payable thereon, upan demand by the Bank 18, Where there sufient funds available n mylour account ut the tot! funds available in mylour accounts isuicent to pay onal the PaymentiDeduction Irstucion() the Banke may ins absolute diction hos the option net to proceed with the PaymentiDeduction Instruction iniucted by meus otto proceed with the Payment;Deduction instruction. Inthe event the Bank elects otto proceed with the PaymentiDeduction Instruction, the Bait under no obigation to notiy melus of such decision or provide melus with any reasons fr such deci. Inthe evert the Banik decides to proceed with the Payment/Deducton Instruction, the Bank sll termine the ordor of priority of the Boymont/Deduction Instruction es the Baik dooms ft In these cumstances, Uwe acknowledge and agroe that Uwe sal be responsible to pay the any austanding balance amount a the bil due tthe Corporation dirty. For the purpose of future Poyment/Deducton Instruction, UWe ‘quest and authorae the Bank to resattempt to debt the amount due from myfour account on any ether date) subject to further struction) fem the ‘Corporation ater Wl have crelted sucient amount into mylour account 9. The Bank shall nt be held responsible or lable to melus fr any claims, los, damages, cost and expenses (cluding consequential incidental general special and Indirect ess or damage or aims made on melus or by any thrd par) arking from any parson giving the Payment/Deduction Instruction purpertedly in my/our name, ‘the succesful or unsuccessful Baymant/Deduction instruction dus to any reason whatsoever and urongfl deb of account due to Inaccurate information provided by ‘els or the Corpration and other factors beyond the cntrl ofthe Bank, Under uch crcurstance lle shall sk recourse or reslve the aims directly withthe ‘Corporation {0.The Banke may at its dbilute dcretion, at any time terminate the applation for Payment;Deducton Initucton for future payments by notice in wring to melt ‘or without tie aftr being adused by the abovernentioned Corporation that no further payment required, o without assigning any reason therefore ‘his application and authorization for Payment/Deduton Instruction wil main effective (forthe protection ofthe Bank in respect of payments made in good faith) notwithstanding mylour death or bankruptcy or dsluton or winding up or the revocation of the Paymont/Deduction instruction by any ether means unt further ‘tie of rylour death or Bankruptcy or tuch revocation &receved by the Bank. Notwithstanding the aforesaid, n the even Uwe terminate the Paymert/Deducton ‘ia written notice, Live hereby agree thot al charges and amount due from my/our bil incurred prior tothe date of termination shal be borne by melts, 12 The Bank reserves the right ats absolute dicetion to ley a service charge foreach successful DDS transaction by debiting myjour account. We further understand thatthe Bank ented to vary such charges rom time t time or Impose other charges as deemed appropriate for proving the DDS by giving melus twenty one (2) calendar days pr notice, that by displaying the new service charge atthe Bank's premises and Banw's website. 13,.We must notify the Bank and the Corporation by giving 21 doys prior nai of termination of the DDS by mel or changes in myfour account number andor the Bling Account Number. In any event, such notice wil only take effect onthe date of receipt bythe Banke Ary notice sent bythe Bank to your lst reghtered ‘dre with the Banke & deemed to have been received by mel, 14. PaymentiDeduction Instruction amount which exceed the mit amount or frequency paymentideducton as authorized by melus, shall be rejected by the Bak in ‘which event tate shal be response to settle the outstanding amount direct with the Corporation In ths respec, we authorize the Bonk to dicose deta of ‘ylour account os ated this form tothe Corporation, the Corporations bank and the Direct Dabit Operator. The dlosure of such information to the aforesaid ‘thre partes is forthe purpose of ebtainng detals of ay outstanding Payment/Declcton Instruction due tothe Corporation We further comet to such dione to the oforeiaid parte forthe afraid purpose and declare thot the Bank shall be under nobly fer diosing such information. [We alo understand and ‘cknowledge that ve have the right to withdraw mylour consent to the we ofthe tid information by contacting the Bark and the right to incorrect the id Information nthe event the sold information incorrect. INiehereby adknouledde that, nthe event (hue withdraw out consent fer such use ofthe said information, ‘the Banle will not be able to proces the PaymentDeduton Instructors 15. The Bank resors the right at any time: 181 With prior nts te dicontinue, Intupt, withdraw or suspend the DDS in whole rin part a the Banks dooms fit and without asgning ary reason whatioover, ‘ond the dank shal not beheld able for any low or damage ubich may be sulfered by melut or ony other third party regitered under the DDS oy arta of ch ‘ction by the Bank, 182 To vay, add delete or amend thi Terms and Condtlons with notic. Such amendments shall become effective on the date of such notice, and myvour continue wing the DDS shal conse an acceptance ofthe said amendments 16. Notwithstanding the above conditions ofthe DDS, Live shal be bound by the Bank’ conditions governing the operations of mylour account stated above which sll 'be construed in accordance with the laws of Melysa. ‘In consideration of the Banke agreeing to provide the DDS, live hereby undertake to indemnify and hold the Bank hermes and indemnified agains al actions, proceedings, dams, damage, east expenses, demands ond less which the Bane may incur ar sustain by reason of the Banik caryng aut the above request and ‘uthorzation by meus or by any peron purportedly in mylour name, whatsoever arsing fom the DDS andlor ering fem errs ar emisions on mylout Part andlor the Corporation, 18. The Personal Data Protection Act 2010 (hereinafter referred to asthe "PDPAL, hich regulates the procesing of pertnal data in commercial transactions, apis to ‘thi chore