OCBC PayMaster Registration Form

Please complete this form, print and fax to 03-2711 9177.

YES! I wish to enrol for the OCBC PayMaster service

Name as in NRIC

New NRIC No  -   -  Old NRIC No

Tel No.(1)  -  Tel No. (2)  -

OCBC Credit Card No.  -   -   -  Exp. Date

Multimedia / Telecommunications

ASTRO Account No.1   Account No.2     CELCOM Account No.1   Account No.2     DIGI Account No.1   Account No.2     MAXIS Account No.1   Account No.2     TELEKOM Account No.1   Account No.2

Municipal Council (Assessment)

* MBPJ = Majlis Bandaraya Petaling Jaya * MPSJ = Majlis Perbandaran Subang Jaya * MBSA = Majlis Bandaraya Shah Alam * MPK = Majlis Perbandaran Klang * MPPP = Majlis Perbandaran Pulau Pinang

MBPJ Account No     MPSJ Account No     MBSA Account No     MPK Account No     MPPP Account No

DECLARATION AND AGREEMENT I hereby authorise OCBC Bank to perform auto-billing on my OCBC Credit Card for the bills payment selected above. I agree to abide and be bound by the terms & conditions governing OCBC PayMaster Services including any amendments, supplements and additions thereto made from time to time by the Bank and I acknowledge having read and understood the terms and conditions which are available at the Bank's website at www.ocbc.com.my.

_____________________________________ Signature (per signature on OCBC Credit Card) _________________________ Date

Important Note: If you are currently enrolled with any of the merchant(s) for auto-billing of the above mentioned bill(s), kindly ensure you have cancelled the existing auto-billing arrangement before submission of this form.

FOR BANK USE ONLY

_________________________ Date received _________________________ Verified by _________________________ Entered by _________________________ Date