IRAS Master Giro Application Form

Payment Consent SP Services

Application for One Bill on Citibank Checking

and Savings Account

(For payment and refund of tax for individual taxpayer. You can only use your
own bank account when you sign up using the Master GIRO application form)

Change of Bank Account

Bank

55 Newton Road, Revenue House,

Singapore 307987. Tel : 1800-356 8300

Name of SP Services Customer:

Part 1 : For Applicants Completion

Date

SP Services Bill Account No.:

I hereby agree to pay the monthly SP Services bills charged to my Citibank Checking and
Savings Account for the above-stated customer.

Yes! Id like to participate in Citibank Checking and Savings One Bill

Payment Service and have my bills paid through my Citibank Checking
and Savings Account.

Part 2: For IRASs Completion

New Application

Branch

Bank

IRAS Income Tax Bank A/C No.

Branch

0 1

One Bill

Account No. to be Debited / Credited

To. Citibank Singapore Limited

Name in Citibank Checking and Savings Account:

Name and Address of Tax payer

NRIC/Passport No.:

Taxpayers Tax Reference Number

Please continue to pay bills to SP Services Ltd until your GIRO application is approved. Your
Giro application is only effective when this message "Total Charges will be deducted from you
account with Citibank on date" appears in your bill.

Citibank Savings and Checking Account No.:

Part 3: For Bank's Completion

Taxpayer's Tax Reference Number (NRIC/FIN)

Mobile No.:

To: IRAS
Signature as in bank records

Date

To: Name of Bank

This Application is hereby REJECTED (please tick ) for the following reason(s):

Citibank Singapore Limited

For SP Services/Citibank's Completion:
Bank

Branch

7 2

Citibank Checking and Saving

Account No. To be Debited
2 1

0 1

Signature/Thumbprint# incomplete/unclear#

011

SP Services Account No.

Signature/Thumbprint# differs from Banks records

Branch

SP Services Bank Account No.

Pls tick the

tax type.

Pls tick
the type of
payment plan.
One Time

For Property Tax.

Pls indicate the Tax
Reference No. of the
property.

Account operated by signature/thumbprint#

Signature as in bank records

Wrong account number

To ensure that there are no delays in processing your application, please complete all fields.

Others:
#

N. A.

Please delete where inapplicable.

SP Services application rejected due to:

I have read the Terms & Conditions and agree to them.

Property
Tax*
GST

N. A.

Signature

N. A.

* Please attach separate list of

PTX references if you are
applying for multiple
properties. The list should be
signed by authorized signatory
as in Banks records.

Name of Approving Officer

Authorised Signature

(a) I/We hereby instruct you to process IRASs instruction to debit and credit my/our account.

Application rejected for the following reasons:

Signature/Thumbprint differs
Signature/Thumbprint incomplete/unclear
Account operated by signature/thumbprint
Wrong account number
Amendments not countersigned by customer

Date
Bank Account Holders Name

Bank Account No. (own account only)

Name of Approving Officer

Name of Service Staff

Branch

Contact (Tel/Fax) Number(s) of Taxpayer

Date

GEID

Signature(s)/ Thumbprint(s)*

(As in Banks records)

* For thumbprint(s), please go to the Banks /Financial companys respective branch with your identification
document(s)

Enjoy the convenience of consolidating payments for all your bills

via GIRO using 1 single account.
Participating organisations include:
SingTel, MobileOne, StarHub, Singapore Power and Inland Revenue
Authority of Singapore.

(b) You are entitled to reject IRASs 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.
(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 revocation through IRAS.

Bank Completion

Authorised Signature

Date

Amendments not countersigned by customer

Monthly

Income Tax

Approving Officer

I have read and agree to be bound by the Citibank Checking and Savings One Bill
Payment Service Terms & Conditions printed below.

Verified by IRAS

For more information, please call us at our 24-Hour CitiPhone

Banking at 6225 5225 or visit www.citibank.com.sg

One bill for

convenience.
Consolidate your monthly utility, tax
and telecommunication bills via GIRO.

Payment Consent - SingTel

Payment Consent StarHub Ltd

Payment Consent - M1

New Application

New Application

New Application

Change of Bank Account

Change of Bank Account

Change of Bank Account

Part 1: Particulars of Applicant

Name of Singtel Customer:

Name of Billing Organisation: StarHub Ltd

To: Citibank Singapore Limited

Branch: 011

1.

Name of M1 Customer:

Address of Singtel Customer:

M1 Bill Account No. (1):

StarHub Customer Address

2.

M1 Bill Account No. (2):

Singtel Bill Account No. (1):

StarHub Customer Name

Citibank Savings and Checking One Bill Payment Service

Terms & Conditions

3.

M1 Handphone or Fixed Line IDD No. (1):

Singtel Bill Account No. (2):
StarHub Customer NRIC/FIN/BRN

(b) You are entitled to reject StarHub 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.

I hereby agree to pay the monthly M1 bills charged to my Citibank Checking and Savings
Account for the above-stated customer.

4.

I hereby agree to M1 collecting, using and disclosing my personal data for the purpose of
processing this recurring payment arrangement, payments and refunds.

5.

(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 revocation through StarHub Ltd.
(d) I agree to StarHub Ltd collecting, using and disclosing my personal data for the purposes of processing
this recurring payment arrangement, payments and refunds.

6.
Signature as in bank records

Part 2: Particulars of Bank Account Holder

My/Our Name(s) as in Citibank Checking and Savings Account

Signature as in bank records

Date

Bank Completion
Citibank Checking and Savings Account Number

Application rejected for the following reasons:

Signature/Thumbprint differs

Application rejected for the following reasons:

Signature(s) as in bank records

Date

Bank

Branch

Wrong account number

Account operated by signature/thumbprint

Amendments not countersigned by customer

Wrong account number

Part 3: To be completed by Billing Organisation

Account operated by signature/thumbprint

Signature/Thumbprint incomplete/unclear

Please Remember
To Sign Here

StarHub Bank Account No.

Amendments not countersigned by customer

9.

Citibank Checking and Savings

Account No. To be Debited

8.

Signature/Thumbprint incomplete/unclear

Signature/Thumbprint differs

Branch

7.

Bank Completion

My/Our Contact Number(s)

Bank

Date

Name of Approving Officer

Name of Approving Officer

10.

StarHub Payment Code

11.
Part 4: To be completed by Bank

Authorised Signature

To: StarHub Ltd, DBS Bank, Giro Processing Unit 750E Chai Chee Road TechnoPark@Chai Chee Singapore 469005
This application is 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:

Authorised Signature

Date

Date

12.
Name of Approving Officer

Authorised Signature
# Please delete where appropriate

Date

For Citibank full disclaimers, terms and conditions apply to individual products and banking services. For more details, please
visit www.citibank.com.sg. 2015 Citibank. Citi, Citibank and Citi and Arc Design are registered service marks of Citigroup Inc.
Citibank Singapore Limited Co. Reg. No. 200309485K. Printed on 05/2015.

Attn: Acquisition Sales

CASA One-Bill

This can be found on the right-hand corner of the bill.

(a) I/We hereby instruct you to process StarHub Ltd's instruction to debit my/our account.

M1 Handphone or Fixed Line IDD No. (2):

Global Consumer Banking

Robinson Road P.O. Box 356
Singapore 900706

StarHub Payment Code

I consent to your, and Singapore Telecommunications Limiteds (Singtel) and/or its related
corporations (collectively, Singtel Group), collection, use or disclosure of my personal data
and the personal data of the holders of the Singtel Bill Account Number(s) mentioned above
(Singtel Account Holder(s)) for the purposes as described in Singtels and/or Singtel Group's
and your terms conditions and/or relevant personal data protection policies (by whatever
name), including Singtels and/or Singtel Group's disclosure of such personal data to you where
Singtel and/or Singtel Group instructs you to debit my Citibank Checking and Savings Account
with such amounts due and owing in respect of the Singtel Bill Account Number(s) mentioned
above. I warrant that I have obtained consent from the Singtel Account Holder(s) to provide
the consent above on his/her/their behalf.

By applying for the Citibank Checking and Savings One Bill Service (the
Service), I agree to be bound by these terms and conditions, which may be
added to and/or varied from time to time by Citibank after giving reasonable
notice to me.
I agree to continue to be bound by Citibank Singapore Global Consumer Banking
Terms and Conditions, which can be found at www.citibank.com.sg.
I acknowledge that only completed applications will be processed. I agree to
countersign amendments (if any) made on this application form. I warrant
that the information I have provided in my application for the Service is true
and correct.
I hereby agree to Citibank and the Billing Organisation(s) listed in this application
form collecting, using and disclosing my Personal Data (as defined in the Personal
Data Protection Act of Singapore) to each other and such parties as Citibank
and/or the Billing Organisations(s) considers necessary for the purposes of
processing the recurring payment arrangement, payments and refunds in
connection with the Service.
I acknowledge that Citibank may take at least six (6) weeks to process my
application for the Service. As such, I will continue to pay the bills to the Billing
Organisation(s) for this period and until I see the relevant deductions reflected
in my Citibank Checking and/or Savings statement of account.
My application for and use of the Service is subject to the approval of Citibank,
the Billing Organisation(s) and/or its banks. Citibank, the Billing Organisation(s)
and/or its banks reserve the right to suspend, resume or terminate the GIRO
arrangement at any time at their sole discretion.
I will maintain sufficient available funds in my Citibank Checking and/or Savings
Account for deduction on all payment due dates. Citibank shall be entitled to
reject the Billing Organisations debit instruction if my Citibank Checking and/or
Savings Account does not have sufficient available funds. Citibank shall be
entitled to charge a fee for the failed payment deduction and deduct the fee
from my Citibank Checking and/or Savings Account.
If any payment charged to my Citibank Checking and/or Savings Account is
unsuccessful for any reason whatsoever including as a result of the Service
being suspended or terminated, I will be responsible for arranging payment
to the Billing Organisation by other means. In the event my Citibank Checking
and/or Savings Account is closed (for any reason whatsoever) or I wish to
cancel my use of the Service, I will make alternative payment arrangements
with the Billing Organisation(s).
This authorisation will remain in force until terminated by written notice from
Citibank sent to my address on Citibanks records, or upon Citibank having
received and processed my written instructions to cancel the Service. I agree
that Citibank shall have a reasonable period of time to effect and process my
written instruction to cancel the Service.
Citibank and the Billing Organisation(s) shall not be liable for any loss, expenses,
delays, mistakes, neglect or omission in the transmission of payment under the
Service or for any unsuccessful payment.
I acknowledge that Citibank is not the manufacturer or supplier (or the agent
thereof) of any of the products and/or services purchased from the Billing
Organisation(s). Citibank shall not be in any way liable for any claim, injury,
expense, loss or damage brought or incurred by any part whosoever, or for
any other matter arising from or in connection with the use of any product or
supply of any service purchased. Any complaints or disputes in relation to any
product or service purchased or the amount(s) payable and dates on which
any amount is payable are to be directed to the Billing Organisation(s).
Citibank means Citibank Singapore Limited.