Fillable 1 FOR APPLICANTS COMPLETION (Citibank Singapore)

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1 FOR APPLICANTS COMPLETION (Citibank Singapore)

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INTERBANK GIRO APPLICATION
Please remember...
To countersign any amendments
The use of correction fluid/tape is not allowed
And for 3rd party payor (for change of Bank Account for GIRO)
Please complete and submit the Policy Details Change Form (Section 4C) together
with this Interbank GIRO Application Form with your identification documents
1 FOR APPLICANT’S COMPLETION
Manulife (Singapore) Pte. Ltd. Reg. No. 198002116D
Need Help? Please contact your Financial Representative for further assistance.
Alternatively, you may call our Client Services Officers at 6833 8188 or
visit us at 8 Cross Street #01-01A, Manulife Tower, Singapore 048424 during service hours.
3 FOR BANK’S COMPLETION
To : Manulife (Singapore) Pte. Ltd.
The Application is hereby REJECTED (Please ) for the following reason(s) :
Signature Differs
Account Operated by Signature / Thumbprint
Signature Irregular
Wrong Account Number
Thumbprint must be taken & witnessed at bank’s branch
Others: ..............................................................................................................
Version 1018
2 FOR MANULIFE (SINGAPORE) PTE. LTD.’S COMPLETION
Ba nk Branch Manulife (Singapore) Pte. Ltd.’s Bank Account Number
7 1 7 1 0 0 3 0 0 3 9 0 0 9 5 4 2
Completed? You may submit the completed and signed form with all relevant documents to us through:
Mail - 8 Cross Street #15-01, Manulife Tower, Singapore 048424
Billing Organization’s
Reference Number(s)/
Policy Number(s)
NameofBilling Organization .................................................................................................................................................. Date................................................................
NameofBank ....................................................................................................................... BranchCode/ Name...........................................................................................
BankAccount Number............................................................................................................................................................................................................................................
Name(s)of Account Holder(s) ........................................................................................... NRIC / Passport No(s). ......................................................................................
ContactNumber(s) ofAccountHolder(s) ..........................................................................................................................................................................................................
MANULIFE (SINGAPORE) PTE. LTD.
For thumbprint(s), please visit the bank’s branch with your identification documents,
your thumbprint needs to be verified by the Bank’s staff.
Signature(s) / Thumbprint(s) of Account Holder(s) as in Bank’s Records
If you wish to understand the list of purposes for which your personal data may be used or disclosed, you may refer to
the Statement of Personal Data Protection located at our website (www.manulife.com.sg)
Name & Signature of Approving Officer
Date
INTERNAL USE - FOR MANULIFE
Doc ID NB106 PA017
I / We hereby instruct you to process Manulife (Singapore) Pte. Ltd.’s instructions to debit my / our account.
You are entitled to reject Manulife (Singapore) Pte. Ltd.’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 allow the debit even if this results in an overdraft on the account and impose charges accordingly.
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 revocation through Manulife (Singapore) Pte. Ltd.
B. Account Holder Details & Authorisation
A. Policy Owner Details
Full Name of Policy Owner ...................................................................................................... NRIC/ Passport No. ..................................................................
Plan Name(s) ..............................................................................................................................................................................................................................
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1 FOR APPLICANTS COMPLETION (Citibank Singapore)

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Completed 7 February 2021

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