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Payment Consent Form - UOB

Date post: 09-Feb-2022
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Postage will be paid by addressee. For posting in Singapore only. United Overseas Bank Limited Robinson Road P.O. Box 1688 Singapore 903338 UOB Bill Pay Service Form BPS-DC BUSINESS REPLY SERVICE PERMIT NO. 08567 (085676)
Singapore 903338
YES! I would like to pay my bills with my UOB Card.
Name: NRIC/Passport No.:
Signature of Cardmember Date
PLEASE SIGN Simply complete the form below and mail or fax to us at 6353 3013.
Policy No.(s): Name of Policy Owner: NRIC/Passport No.:
Town Council 1 Please indicate your choice of Town Council by ticking ONE of the check boxes below.
Aljunied-Hougang-Punggol East Bishan-Toa Payoh Chua Chu Kang Holland-Bukit Panjang Marine Parade
Jalan Besar Pasir Ris-Punggol Tampines Tanjong Pagar West Coast
Town Council 2 Please indicate your choice of Town Council by ticking ONE of the check boxes below.
Aljunied-Hougang-Punggol East Bishan-Toa Payoh Chua Chu Kang Holland-Bukit Panjang Marine Parade
Jalan Besar Pasir Ris-Punggol Tampines Tanjong Pagar West Coast
Reference No.:
Reference No.:
Policy No.(s):
Motor Insurance:
United Personal Accident Insurance:
My Singtel Account No.(s): Name of 3rd Party Account Holder:
3rd Party’s NRIC / Passport No:
3rd Party’s Singtel Account No.(s):
StarHub Account No.(s):
M1 Bill Account No. 1:
M1 Bill Account No. 2:
M1 Bill Account No. 3:
This facility is not applicable for UOB PRVI American Express® Card, Preferred Platinum American Express® Card and PRVI Miles Platinum American Express® Card.
UNI$ will not be awarded for UOB PRVI Miles Visa and PRVI Miles MasterCard.
UOB Card No.
Office No.:
If you wish to pay for another person’s Singtel account, please fill up the following: (not applicable for Singtel-UOB Platinum Cardmember)
All StarHub customers: Please fill in your UOB Card details in the StarHub Payment Slip (found on your StarHub bill). Sign and mail it together with this application form.
Disclaimer United Overseas Bank Limited (“UOB”) assumes no liability or responsibility for the acts or defaults of the merchant or defects in the goods or services offered in this promotion. UOB is not an agent of the merchant. Any dispute about the quality or service standard must be resolved directly with the merchant. The merchant may impose conditions for the redemption of the goods or services. UOB will not be responsible for any injury, loss or damage suffered as a result of the redemption or usage of the goods and services. While the information provided herein is believed to be reliable as at the date of printing, United Overseas Bank Limited makes no representation or warranty whether expressed or implied, and accepts no responsibility or liability for its completeness or accuracy. UOB and the participating merchants reserve the right to vary/amend the privileges and/or terms and conditions without prior notice.
Terms and conditions. 1. You warrant that the information you have provided is true and correct and authorise United Overseas Bank Limited (“UOB”) to disclose such account details to the relevant merchants as may be necessary to facilitate your participation in this service. 2. You confirm and agree that if this application has been sent by fax and/or email, you are authorised to rely and act upon on the faxed and/or emailed copy without the original. 3. Your UOB Card account must be in good standing and remain valid for the monthly bills to be debited successfully. 4. The following are ineligible: UOB JCB Cards, UOB Purchasing Cards, UOB Corporate Cards, UOB Private Label Cards, all UOB Visa Electron Cards. 5. Please allow at least six weeks for processing of your application. 6. Please continue to pay to the relevant merchants until you see the amount reflected on your monthly UOB Card statement. 7. All applications are subject to approval from the relevant merchants. UOB will not notify customers separately of their application status. 8. Your account name with the relevant merchants must be the same as the name shown on your UOB statement, unless otherwise specified. 9. Should you cancel or replace your card, please make alternative payment arrangements with your relevant merchants. 10. If your existing account is paid by GIRO, the GIRO payment arrangement will be terminated. 11. Please contact the relevant merchants to make alternative payment arrangements should you wish to terminate this payment arrangement. 12. If any payment charged to your UOB Card is unsuccessful for any reason whatsoever, you will be responsible for arranging payment to that merchant by other means. 13. UOB shall not be liable for any loss, expenses, delays, mistakes, neglect or omission in the transmission of payment under this facility or for any unsuccessful payment. 14. UOB reserves the right to amend these terms and conditions and reject or decline any application in its sole discretion without giving any reasons. For details, please refer to uob.com.sg.
United Overseas Bank Limited Co. Reg. No. 193500026Z
By signing here, I certify that I have read and agreed to the Terms and Conditions stated below. By indicating the Account No.(s), Customer No.(s), Reference No.(s), Policy No.(s) and all other information as required by the respective billing organisation(s) stated below, I hereby authorise and give my consent to the respective billing organisation(s) to charge the bills/fees /charges/ premium/subscription to my UOB Card.
I consent to United Overseas Bank Group("UOB") collecting, using and disclosing my personal data for the purpose of informing me about its card products and card-related services, via voice calls or text messages or email. This is in addition to any other consent which I may have provided to UOB in respect of the collection, use and/or disclosure of my personal data and shall be without prejudice to and does not derogate from UOB's rights to collect, use and/or disclose my personal data under the law.
Note: The approval of the following authorisation will supercede existing payment instructions with the respective merchants for the respective Account No.(s) indicated below. Please allow at least 6 weeks for processing of your application.
Card Expiry Date
Relationship (If it differs from Cardmember):
Terms and conditions for Prudential only: 1. Cardmembers can apply for Bill Pay Service and charge the policy premium(s) belonging to them and/or their Family Members to their UOB Card. “Family Members” shall mean spouse, children, parents, parents-in-law, brothers and sisters. 2. This facility shall apply to only regular premium proposals/policies which are expressed in Singapore Dollars. It is not applicable to payment of premium for Prushield policies, single premium policies, recurring single premium policies, US Dollar policies, top-up premiums and policies purchased under CPF Investment Scheme and Supplementary Retirement Scheme. 3. Upon approval of the application, the premium amount will be charged to the Cardmember’s Card on the premium due date and the UOB Card statement will reflect the proposal/policy number(s) and the amount deducted. No renewal premium notices or official receipts will be issued. The relevant entries reflected in the UOB statement will be recognised as evidence of your payments. 4. All authorisations referred to above shall remain in force until terminated by you in accordance with this clause. To terminate any authorisation, please call your Financial Consultant or the PruCustomer Line at 1800-333-0-333. The appropriate forms will then be sent to you for completion. Alternatively, you can write to: Prudential Assurance Company Singapore (Pte) Limited, Robinson Road PO Box 492 Singapore 900942. Any termination of such authorisation shall only take effect upon receipt by Prudential of your completed form or written request (as the case may be). 5. Cardmembers who are not the owners of the policy(s) will have no rights, under the Contract (Rights of Third Parties) Act, Cap 53B to enforce any of the terms and conditions of such policy.
This facility is only available for the following insurance plans. UNI$ will not be awarded for sign-ups with UOI.
Note: This facility will not be extended to customers who have existing standing payment arrangements with UOB (such as Property Mortgaged Insurance) or UOI.
Delivery Address:
Postal Code:
Email Address (Your username will be the same as your email address):
Residential Type Monthly delivery fee
HDB [ ] S$3
The Straits Times & The Sunday Times [ ] S$29.90 [ ] S$34.90
The Business Times [ ] S$29.90 [ ] S$34.90
Lianhe Zaobao [ ] S$26.90 [ ] Chinese 3-in-1 Bundle PDF Version (Lianhe Zaobao + Lianhe Wanbao + Shinmin Daily News) S$29.90
Lianhe Wanbao [ ] S$26.90
Berita Harian & Berita Minggu [ ] S$18.90 [ ] S$19.90
Tamil Murasu [ ] S$17.90 [ ] S$22.90 PDF Version
The prices and charges (subscription costs of the newspapers, delivery costs, and costs of any supplemental services) shall be subject to revision from time to time in SPH’s sole discretion, with at least one month notice given by SPH prior to such revision. The prevailing subscription rate at the time of submission of this form will apply. For more details, please visit www.sphsubscription.com.sg. SPH full Terms and Conditions apply. *Monthly subscription rates exclude delivery fees. Delivery fees will only be charged once per household on a monthly basis.
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