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 sucient 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certify that the Bank’s debiting my account pursuant to this letter is in 3 7 accordance with my request as if I have withdrawn the monies from the account Date: by myself.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 aecting 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 eect 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 eective immediately and continues in eect until withdrawn by me. (Signed) ( ) Attorney-in-fact In debiting my account to pay to Amex Thai as mentioned above, the Bank shall Certied true copy: Certied 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 sucient for debiting. If it appears later that the (Signed) amounts which Amex Thai has notied 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 indemnication 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 This system helps protect your good credit standing by ensuring that you never forget to pay your bill. How to Enroll: 1. Simply ll in the form and return it to American Express. This form will authorize your nominated Bank to debit your bank account for the amount due on your Credit Card Account. 2. If you have previously applied for the Direct Debit Service on your American Express Charge Card and now wish to apply for the Direct Debit Service on Credit Card, please complete this application form again. 3. We will immediately notify your nominated the Bank, which will conrm your participation in the Direct Debit system. Please continue to pay your bill by cash or cheque by the date specied on your monthly statement until you see the Direct Debit message on your statement. You may nominate the following banks to participate in this Direct Debit system: Please contact our Customer Service if you have any enquiries or questions about this Direct Debit service at American Express Platinum Card Tel. 0 2273 5599 American Express Gold Card & Tel. 0 2273 5555 American Express Business Card American Express Card Tel. 0 2273 5544.