Cash Acknowledgement by Contractor by qbw18279

VIEWS: 14 PAGES: 2

More Info
									                              Purchasing of StarHub Plant Map
                              Attention: Administrator for Sale of StarHub Fixed Plant Map
                              3 Tai Seng Drive Da Vinci Holdings Building #04-00
                              Singapore 535216
                              Tel: 6825 6374 / 9855 8903, Fax: 6821 7000
                      FOR INTERNAL USE ONLY:                                                                       GST NO: M9-0005650-C
                      Date Of Collection:
                      Mode Of Collection:                         Checked by :                                     Serial No :
                      * Please ensure that this Form must be endorsed with the company's stamp.
                          1   Principal
                              Company
                              Particulars             (Name in Full)

                                                      Contact No:                                  Pager/Mobile No:

                                                      Fax No:                                      Designation :

                                                      Company's Name :

                                                      Company's Address :



                          2   Requesting
                              Company
                              Particulars             (Name in Full)

                                                      NRIC :

                                                      Contact No:                                  Pager/Mobile No:

                                                      Fax No:                                      Designation :

                                                      Company's Name :

                                                      Company's Address :



                                                      ROC Registration No :

                          3   Description Of Map:
                              Base on Singapore Street Directory
                              (Eg: Map 319 - A2, site W infront of XYZ, ON Road ABC)




                              (Please attach a clear location plan with the area of interest demarcated)

                          4   Size Of Plot

                                          A1     ($34.24)       X

                              *The above price is inclusive of 7% GST.

                              Remarks (If any)


                          5   Mode Of Collection

                                          Personally
                                          Authorised to collect on behalf (Please fill in Authorisation Form.)
                                          Delivery (Please note additional cost of S $15.29 will be levied)

                              Note: Collection of plan and Submission of NCE is from 9am to 11:30am and 2pm to 5pm.
                                     (excluding Saturday, Sunday and Public Holiday).

                          6   Payment (Company cheques payable to StarHub Ltd)
                              Note: Personel cheques, Cash, Nets & Credit card are not acceptable

                              Cheque No : _______________                                                          Bank : ___________________

                      FOR INTERNAL USE ONLY
                       6 Total Cost
                                    Cost of map (Inclusive of GST)                 =
                                    Delivery Charge                                =
                                    Total


                      Acknowledgement

                      We confirm that the above information is correct and accurate. While StarHub will endeavour to provide updated copies of plant
                      map, we understand that StarHub reserves the right to make any amendments to the maps without prior notice and that the
                      purchase of the map(s) does not in any way affect our obligations under the Telecommunications Act or any other relevant
                      legislation or regulations.
                      We acknowledge that the payments submitted will be forfeited if we cancel our purchase for any reason whatsoever.
                      This purchase does not include StarHub Cable Vision CATV network services.
                      Please note that you are still required to purchase the StarHub CableTV Plant Map separately.




                               Name / Signature                                    Company's Stamp                               Date

Purchase/12112008/Rev 3
       Attention: Administrator for Sale of StarHub Fixed Plant Map
       3 Tai Seng Drive #04-00
       Singapore 535216
       Tel: 9859 0385, Fax 6821 7000

FOR INTERNAL USE ONLY:
                                                                                             Date of collection:
Date of issue :                                                                              Series No:




                                               Authorisation Form for Collection
                                 (Please produce together with the original form for Purchasing of StarHub Fixed Plant Map)

  1    Collector's
       Particulars
                                 (Name in Full)

                                 NRIC :

                                 Contact No:                              Pager/Mobile No:

                                 Fax No:                                  Designation :

                                 Company's Name :

                                 Company's Address :



                                 ROC Registration Number:




We hereby authorise                                                      of IC No.
to collect the map purchased. We fully understand that he/she will be responsible for the map(s)
once it / they are collected from StarHub.

* This form is to be produced together with a photocopy of the collector's Identity Card.




Name/ Signature Of Contractor                               Company's Stamp                                        Date




      Authorisation Form/25082006/Rev 2.5

								
To top