Yearly

Maintenance

FOR CORPORATION’S COMPLETION

D

D

M

M

Y

Y

D D M M Y Y

NOTE : THIS SECTION/PORTION IS CUSTOMIZEABLE BY CORPORATION

Company Stamp/ Logo (Optional)

AUTHORIZATION FORM

Type of Application *

Account Holder’s Name (Primary) *

ID Number (without ‘-‘ or ‘/‘) *

Saving, Current or Card Account No (without ‘-‘ or ‘/‘) * Telephone Number

E-Mail

Purpose of Payment *

New IC Old IC

Passport

Business Reg.

New Application

Termination

Bank Abbreviation * (Refer to Guideline for abbreviation list)

Maximum amount to debit per transaction (RM)*

(Subject to maximum limit specified by

the DD Operator)

Effective Date * (DDMMYY)

Expiry Date (DDMMYY)

Weekly Monthly

Declaration: a. I/We hereby acknowledge that the information in this form will be disclosed or released to the Corporation, Corporation’s bank and the Direct

Debit Operator for the purpose of the Direct Debit collection. b. I/We hereby acknowledge that a fee/charge will be charged to me/us in the event my/our Account has insufficient balance to make Direct Debit

payment instruction(s). I/We hereby agree the Bank to debit related fees/charges from my/our Account as a consequence of having insufficient fund for Direct Debit payment(s).

c. I/We hereby confirm that I/we have checked the accuracy and correctness of the details furnished by me/us in this application form and I/we are aware of the content and the scope of the services provided therein.

d. I/We hereby declare that all information provided is to the best of my/our knowledge true and correct. e. I/We hereby agree to be bound by the Terms and Conditions. f. This Direct Debit authorization will remain in force until terminated by I/we with prior written notice sent to Bank/Corporation. g. I/We hereby authorise the Bank to debit my/our Account for the Direct Debit payment(s) including the relevant transaction fees/charges not

payable by the Corporation.

Signature / Company Stamp*

Date (DDMMYY)

__________________________________________ Account Holder’s Signatures as per Bank’s record (For Joint Account - Signature as per Bank’s signing condition)

Date (DDMMYY)

Biller ID *

Payment Reference No. (e.g. Policy No., etc. ) (Must be unique) *

_________________________

_________________________

Prepared By (Name) :

Signature :

D D M M Y Y

IMPORTANT NOTE: ALL FIELDS WITH (*) ARE MANDATORY. PLEASE USE CAPITAL LETTERS, BLACK INK AND ON THE RELEVANT BOXES.

FOR ACCOUNT HOLDER’S COMPLETION

Maximum frequency *

Mode of frequency * Daily

DDA-RS-0007

20/03/2017-Version 2.1

D D M M Y Y

-

SHELL MALAYSIA TRADING SDN. BHD. (006087-M) Customer Service Tel No: 1300 22 8181

SHELL CARD E-APPLICATIONS FORM *All fields are compulsory

Company Information *

Company Name

1. ELECTRONIC PIN APPLICATION (E-PIN) *

Please provide details of your E-PIN administrator who will be receiving your Shell Card PINs via email.

E-PIN Administrator Details * Full name

Mobile Number

Email Address

2. SHELL CARD ONLINE APPLICATION (SCOL) * Please provide details of your Shell Card Online administrator who will receive access to effectively manage your Shell Cards via our one stop online portal. Tick if the same as E-PIN Administrator

SCOL Administrator Details * Full name

Mobile Number

Email Address

Note: You will be automatically enrolled on electronic invoicing (e-Invoice) which can be retrieved via SCOL. Please check the box if you require invoice to be sent via regular mail. I want to receive invoice via regular mail (Fee will be subsequently charged)

Authorization & Consent (Manager & Above) *

DATE: - -

Signature : ______________________________________

Full Name : ______________________________________

* Official Company Stamp Designation : ______________________________________

1

GUIDELINE ON COMPLETING THE DIRECT DEBIT AUTHORIZATION FORM FOR PAYMENT OF SHELL CARD INVOICES

2

LIST OF BANKS PARTICIPATING IN THE DIRECT DEBIT

Bank Abbreviation

Bank Name

CIMB CIMB BANK BERHAD

CITI CITIBANK BERHAD

BIMB BANK ISLAM MALAYSIA BERHAD

BKRM BANK KERJASAMA RAKYAT MALAYSIA B2C

BOFA BANK OF AMERICA (M) BERHAD

DBB DEUTSCHE BANK (MALAYSIA) BERHAD

HLBB HONG LEONG BANK BERHAD

HSBC HSBC BANK BERHAD FPX

JPMC J.P MORGAN CHASE BANK

MBB MALAYAN BANKING BERHAD

OCBC OCBC BANK MALAYSIA BERHAD

PBB PUBLIC BANK BERHAD

RHB RHB BANK BERHAD

SCB STANDARD CHARTERED BANK MALAYSIA BERHAD

BNPP BNP PARIBAS

ICBC INDUSTRIAL AND COMMERCIAL BANK OF CHINA

UOB UNITED OVERSEAS BANK

ABMB ALLIANCE BANK MALAYSIA BERHAD

ABB AFFIN BANK BERHAD

SMBC SUMITOMO MITSUI BANKING CORPORATION

BTMU BANK OF TOKYO (MUFG)

ARM AL-RAJHI BANK

AMBB AMBANK MALAYSIA BERHAD

MCBM MIZUHO CORPORATE BANK MALAYSIA BERHAD

1

FORMAT OF BANK GUARANTEE Date: To: SHELL MALAYSIA TRADING SENDIRIAN BERHAD

Menara Shell, No. 211, Jalan Tun Sambanthan, 50470 Kuala Lumpur, Customer Service: 1300-22-8181 Fax: 1300-82-8283

Dear Sirs, BANK GUARANTEE NO.[insert BG No.] FOR RM[insert guaranteed sum] (this “Guarantee”)

1. IN CONSIDERATION of you, Shell Malaysia Trading Sendirian Berhad, having agreed to supply goods, continue to supply goods, render services, continue to supply services and/or withhold legal proceedings to [insert name of Customer] of [insert address of Customer] (hereinafter referred to as the "Customer") pursuant to the agreement(s) between the Customer and you, we, [insert name of bank] of [insert address of bank] hereby irrevocably and unconditionally undertake to forthwith pay you upon our receipt of your written demand, notwithstanding any contestation or protest by the Customer or by any other third party or by us and without proof or conditions, all or any sums of money together with all incidental charges, expenses and interests which now are or shall at any time be owing to you from the Customer or remaining unpaid on the general balance of the Customer's account with you anywhere and on any account whatsoever.”

2. For the avoidance of doubt, we expressly acknowledge and agree that we shall not enquire into

the validity and legitimacy of any demand made by you in accordance with Paragraph 8 below and all such demands shall be conclusive as to the sums due from the Customer to you.

3. The Guarantee shall be a continuing guarantee for the debts contracted by the Customer with

you in respect of such goods and/or services supplied PROVIDED ALWAYS THAT our liability under this Guarantee shall not exceed in aggregate the sum of Ringgit Malaysia [insert guaranteed sum in words] (RM[insert guaranteed sum in figures]) only (hereinafter referred to as the “Guaranteed Sum”).

4. This Guarantee shall remain valid and continue in full force from [insert effective date] to

[insert expiry date – minimum to be 2 years] (hereinafter referred to as the “Expiry Date”), inclusive of both dates.

5. We hereby agree that our obligations and liabilities hereunder shall not be abrogated, prejudiced,

affected or discharged by you granting explicitly or by conduct or otherwise, whether with or without our consent, directly or indirectly, to the Customer or any other person of any time, forbearance, concession, credit, compounding, waiver, variation, renewal, release, discharge or other advantage or indulgence or other accommodation or by any amendment or variation or omission in relation to payment, time, performance or otherwise or by lack of or defect in the Customer’s legal capacity or liability or by any other arrangement made between the Customer and you.

6. You may at any time or times at your absolute discretion and without giving any notice

whatsoever to me/us refuse credit or supplies of any goods and services to the Customer. 7. We hereby agree that our obligations hereunder constitute direct, primary, irrevocable and

unconditional obligations, shall not require any previous notice to or claim against the Customer and shall not be discharged or otherwise prejudiced or adversely affected by any other bond,

2

security or guarantee now or hereafter held by you for all or any part of the obligations of the Customer under the Contract or arrangement between you and the Customer or by the release or waiver of any such bond, security or guarantee or by any invalidity or unenforceability of the Contract or arrangement between you and the Customer or by any dispute or disagreement whatsoever between the Customer and you under or in relation to the Contract or arrangement between you and the Customer or by the insolvency, bankruptcy, winding-up, reorganization or change in constitution of the Customer whether by retirement, expulsion, death or admission of new partner or amalgamation where the Customer is a partnership.

8. All demands under this Guarantee shall be made in writing and delivered by hand or by post to

our last-known address or to our address stated in Paragraph 1 above upon or before the expiry of thirty (30) days from the Expiry Date, after which this Guarantee shall automatically be cancelled and shall be considered null and void irrespective of whether or not this Guarantee is returned to us for cancellation unless this Guarantee is renewed.

9. This Guarantee is a renewal of the former bank guarantee No. [insert old BG No.] dated

[insert old BG date] issued by us in your favour for RM[insert old BG guaranteed sum]. 10. This Guarantee shall be subject to the laws of Malaysia and it is irrevocably agreed that the courts

of Malaysia are to have exclusive jurisdiction to settle any disputes which may arise out of or in connection with this Guarantee.

11. This Guarantee shall not be assigned without our prior written consent.