Letter of Consent for Debiting Account For maximum convenience, your Card Account balance can be directly paid for by deducting from your bank account!
Please indicate the Bank at which you have your account.
Bangkok Bank PCL KASIKORNBANK PCL Krungthai Bank PCL Siam Commercial Bank PCL TMB Bank PCL Direct Debit United Overseas Bank (Thai) PCL Service The Sumitomo Mitsui Banking Corporation The Bank of Tokyo-Mitsubishi UFJ LTD Bank of Ayudhya PCL
You have one less cheque to write, How the Service Works: one less bill to forget 1. We will send you your monthly statement just as before. All you have to do is check your monthly statement and make sure you have su cient funds in your bank account to cover your expenditure. The statement will specify the date your bank account will be debited, which is approximately 10 days for American Express Card from date of statement.
2. The Bank will usually deduct the payment from your bank account before the beginning of its working hours. If you need to make additional deposits to your bank account to cover the full payment, please allow clearing time before the direct debit date;
• For cash deposits: 1 day • For Bangkok cheques: 3 days • For upcountry cheques: please check with the Bank • For any other deposits: please check with the Bank Please ll in your American Express Card Account Number I hereby certify that the Bank’s debiting my account pursuant to this letter is in 3 7 accordance with my request as if I have withdrawn the monies from the account Date: by myself. If there is any damage or error a ecting the Bank and/or Amex Thai, I To: Branch Manager of Bank, agree to fully indemnify the Bank and/or Amex Thai against all actual damages. Branch: I, If documents of evidence and the account number mentioned in the rst owner of the savings account current account paragraph have changed for whatever reason, this letter of consent for debiting the account shall remain in e ect in all respects with respect to the account Account Number (Specify fully): number of which has changed. Account Name: Current Address : Therefore, please be advised accordingly and proceed in accordance with this Letter of Consent as of the date of this letter until otherwise instructed in writing by me to the Bank and Amex Thai, provided that such written instruction shall be Telephone: given to the Bank and Amex Thai at least 30 days in advance. hereby submit this letter of consent to the Bank Sincerely, (hereinafter called “Bank”) as set forth below:
I consent to the Bank’s paying to American Express (Thai) Co., Ltd. (“Amex Thai”) (Signed) Grantor of Consent the amounts for purchases of goods and services by using the American Express Card (“Card”), including annual fees, other fees and expenses (collectively, “Charges”) by debiting my above mentioned account and crediting the same Signature of the Owner of the Account (as in the sample given to the Bank) amounts to the account of Amex Thai at the Bank. Amex Thai will notify the Bank For American Express & Participating Bank use only of the amounts of such payment. I consent to the Bank’s charging fees for Bank Branch carrying out such transaction in accordance with the practices of the Bank. This consent is e ective immediately and continues in e ect until withdrawn by me. (Signed) ( ) Attorney-in-fact In debiting my account to pay to Amex Thai as mentioned above, the Bank shall Certi ed true copy: Certi ed correct account and signature of grantor of consent debit my account only when there are monies remaining in the account and/or the overdraft limit is then su cient for debiting. If it appears later that the (Signed) amounts which Amex Thai has noti ed to the Bank are incorrect and the Bank has debited the amounts as appeared in the statement of account from my account, I ( ) American Express (Thai) Co., Ltd. agree to demand directly such amounts from Amex Thai. I waive any and all rights For American Express use only to demand or sue the Bank for indemni cation by the Bank with respect to the Bank Branch Account Number: monies the Bank has credited to the account of Amex Thai, including the right to claim any damages from the Bank. RCP Express. This form Express. This form Tel. 0 2273 5599 Tel. 0 2273 5555 Tel. 0 2273 5544 Bank to debit your bank account for your to debit Bank questions about this Direct Debit service at questions about this Direct Debit This system helps protect helps system This you have previously applied for the Direct Debit Service on your on Debit Service Direct the for applied have previously you that you never forget to pay your bill. to pay never forget that you your good credit standing by ensuring standing credit your good Please contact our Customer Service if you have any enquiries or Please contact our Customer Service American Express Platinum Card American Express Gold Card & American Express Business Card American Express Card You may nominate the following banks to participate in this Direct banks to participate following nominate the may You Debit system: con rm your participation in the Direct Debit system. Please Please system. Debit Direct the in participation your con rm or cheque by the date speci ed continue to pay your bill by cash you see the Direct Debit message on your monthly statement until on your statement. American Express Charge Card and now wish to apply for the the for apply to wish now and Card Charge Express American this complete please Card, Credit on Service Debit Direct again. application form the amount due on your Credit Card Account. the amount due will authorize your nominated will authorize your 3. We will immediately notify your nominated the Bank, which will We will immediately notify your 3. 2. If 1. ll in the form and return it to American Simply How to Enroll: How to