To: The Manager
HSBC Bank Malaysia Berhad (Company No. 127776-V)
DIRECT DEBIT AUTHORISATION
Until further notice in writing, I/We hereby authorise the Bank to process payments from time to time and
to debit to my/our account/s but not exceeding the limit specified hereunder. I/We are fully aware that this
prior authorisation is further governed by the Terms & Conditions pertaining to the service as specified
Name of Company to be paid MAXIS COMMUNICATION BERHAD (158400-V)
HSBC Account Holder's Name
HSBC Account Number (to be debited)
__ __ __ __ __ __ __ __ __ __ __ __
HSBC Account Holder's I/C Number (New)
__ __ __ __ __ __ __ __ __ __ __ __
(Old) __ __ __ __ __ __ __ __
Company Registration No. (if applicable ) __ __ __ __ __ __ __ __
MAXIS Account Number
(please attach photocopy of telephone bill) __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Cell Phone Number 1. __ __ __ - __ __ __ __ __ __ __
(Kindly provide separate attachment if more than 2 )
2. __ __ __ - __ __ __ __ __ __ __
Maximum Amount Payable for Each Payment RM
Debit Authorisation Start Date/Month
Authorised Signature (s) and Company Stamp (if applicable) Date
Correspondence Address: For Bank Used:
___________________________________________ Rejected Reason:
___________________________________________ ___ Signature Differ
___________________________________________ ___ Invalid HSBC Account Number
___________________________________________ ___ Invalid TMB Account Number
___________________________________________ ___ Others: _____________________
Direct Debit Service - Authorisation
Terms & Conditions
To : HSBC Bank Malaysia Berhad (Company No. 127776-V)
In consideration of your agreeing to accept my/our prior authorization for you to debit my/our account/s in connection
with the use of your Direct Debit service, I/We hereby agree to be bound by the following terms and conditions :-
1. I/We hereby authorise you to debit my/our account/s with a sum (in RM) not exceeding the maximum
amount payable for each payment specified in the Direct Debit Authorisation Form for any one payment and
understand that changes to any information therein will require the completion of a new Direct Debit
Authorisation Form (hereafter referred to as the ‘DDA Form’).
2. I/We shall ensure that there are sufficient funds in my/our account(s) to facilitate the automatic processing of
all payments, failing which the Bank is entitled to reject such payments.
3. I/We understand that my/our first payment through the Direct Debit service shall only commence one week
after the date of submission of the DDA Form or on the specified effective date determined by Maxis
Commuunication Berhad whichever shall be the later.
4. Subject to the provisions of Clause 5 herein-below, I/we understand that I/we may verify the contents of
my/our bills with Maxis Communication Berhad and that any irregularity shall be settled between Maxis
Communication Berhad and me/us.
5. I/We shall accept full responsibility for all transactions arising from the use of this Service provided you shall
not hold me/us liable for any transaction entered into after you receive notification from me/us in writing
handed either to ‘Payment Services Center’ or to the Manager of my/our branch of account and provided
further that my/our liability in respect of transactions entered into prior to such notification is limited to the
maximum amount payable specified in the DDA Form
6. You shall not be responsible or liable for any claims, loss, damage, costs and expenses arising from the
unsuccessful processing of the debits due to insufficient funds, malfunction of systems, telephone line failure
and any other factors beyond the control of the Bank. Under such circumstances, I/we shall resolve the
payment of my/our bills directly with Maxis Communication Berhad
7. I/We consent to the release of any information including my/our name(s), Identification Number(s) and
HSBC Account Number to Maxis Communication Berhad in connection with this Direct Debit Service.
8. I/We agree to pay you your normal charges for the provision of Direct Debit service including for any
payment not effected for lack of funds and further understand that you shall be entitled to vary such charges
from time to time as you shall in your absolute discretion deem appropriate.
9. You acknowledge that you reserve the right to change the terms and conditions contained herein.
10. I/We agree that this authorisation shall remain binding upon me/us until you receive a notification in writing
to cancel the authorisation by way of the Direct Debit Cancellation From.
11. This authorisation shall remain effective for the protection of the Bank in respect of payment made in good
faith notwithstanding my/our death, bankruptcy, dissolution or winding-up (as the case may be) until notice
in writing of the same is received by the Bank.
12. The Bank may in its absolute discretion conclusively determine the order of priority of payment by it of any
moneys pursuant to this authorisation and any other payment instruction/order/service (whether in writing or
otherwise) or cheque drawn on my/our account which I/we have heretofore or may hereafter give to the