UXS Service Request Form - NTUC

NATIONAL TRADES UNION CONGRESSNTUC Customer Service Centre Tel +65 6213 8008NTUC Centre, 1 Marina Boulevardwww.ntuc.org.sgB1 -01 One Marina Boulevard, Singapore 018989UNION MEMBERSHIP – APPLICATION FORM FOR INTERBANK GIROForm “A”PART 1: FOR MEMBER’S COMPLETIONDateTo (Name of Bank)Name of Billing Organisation ("BO")NTUC-UMSMember's NameMember's UnionBranchMember's (NRIC/FIN) No.AUTHORISATION TO BANK(a) I / We hereby instruct you to process the BO's instructions to debit my / our account.(b) You are entitled to reject the BO's debit instruction if my / our account does not have sufficient funds and charge me/us a fee for this. You may also at your discretion allowthe debit even if this results in an overdraft on the account and impose charges accordingly.(c) This authorisation will remain in force until terminated by your written notice sent to my / our address last known to you or upon receipt of my / our written revocationthrough the BO.My / Our Name(s) & NRIC/ FIN No. (Account Holder)My / Our Contact (Tel/Fax) No(s).My / Our Account No.My Signature(s) / Thumbprint(s) * (Account Holder)(As in Bank's records)For all banks other than POSB/DBS, thumbprints should be affixed in thepresence of the bank officerFOR OFFICIAL USE ONLYPART 2: FOR BILLING ORGANISATION'S COMPLETIONBank Branch Biling Account Organization’s Account No.Billing Organisation's Member'sReference No.7 1 7 1 0 0 1 0 0 1 0 6 4 8 1 1 0Bank Branch Account No. To Be DebitedPART 3: FOR BANK'S COMPLETIONTo:NTUC-UMSNTUC Customer Service CentreNTUC CENTRE, No 1, Marina Boulevard,#B1 -01, One Marina Boulevard,Singapore 018989This Application for hereby REJECTED (please tick) for the following reason(s):[ ] Signature / Thumbprint# differs from Bank's records [ ] Wrong account number[ ] Signature / Thumbprint# incomplete / unclear# [ ] Amendments not countersigned by customer[ ] Account operated by signature / thumbprint# [ ] Others: ______________________________________________ ________________________ ______________________Name of Approving Officer Authorised Signature Date# For thumbprint, please go to the branch with your Identity Card / Work Permit* Members should countersign against any amendments made on the form

Seal here with clear tapeHow to use the Business Reply Envelope (BRE)Step 1. Print the NTUC Business Reply Envelope(BRE) on a clean, single-side A4 sheet.Step 2. Enclose your completed GIRO ApplicationForm and/or Colour Passport Photo in the BRE. Foldinwards carefully along the dotted lines as shown.Step 3. Seal the edges with clear tape, taking carenot to stick the tape onto the documents. Do not staple. Postthe sealed BRE and its contents back to us.FoldHerePostage will bepaid by addressee.For posting inSingapore only.BUSINESS REPLY ENVELOPEPERMIT NO. 04966NTUC Customer Service CentreNo. 1 Marina Boulevard#B1-01, One Marina BoulevardSingapore 018989FoldHerePlease Note:> If you have enclosed the GIRO Application Form for NTUC Membership, please ensure that it is completed and signed.> Kindly ensure that you have included all necessary documents in the BRE.> For enquiries/assistance, please call NTUC Customer Service Centre at 6213-8008 during office hours.> Thank you for applying to be an NTUC member!Seal here with clear tape