ICONIC VACATION CLUB BERHAD (891079-P)

4th Floor Wisma CNI,No.2 Jalan U1/17, Seksyen U1,

Hicom Glenmarie Industrial Park,
40000 Shah Alam,Selangor Darul Ehsan,Malaysia
Tel: +603-5569 0800
Fax: +603-5569 0900
www.sepanggoldcoast.com
www.iconicvacationclub.com

AUTO PAYMENT AUTHORIZATION FORM

*IMPORTANT FOR ALL MEMBERS TO COMPLETE THE REQUIRED INFORMATION PROVIDED
Yes, I / We want to register for the Auto Payment Services

(A) Member's Information

Name of Member
IVC No.
NRIC No.
Telephone No.

tanhuisean

:
:

Residence
Mobile
Office
Fax

(B) Credit Card Information

Card Holder's Name
Name On Card
Card Issuing Bank
Card No.
CVV

gohcheechuan

:
:

gohcheechuan

citibank

:
:

Visa / Master / AMEX

Expiry Date :

7
0

5
-

4
20

I / We agree the abovementioned IVC Membership Fee and/or monthly instalment to be auto-charged to my Credit Card as below:1st Downpayment (inclusive of GST)

RM

charge on

2nd Downpayment (inclusive of GST)

RM

charge on

3rd Downpayment (inclusive of GST)

RM

charge on

Monthly Instalment (inclusive of GST)

RM
commencing from

to

"GST" is Goods and Services Tax which takes effect from 1 April 2015.
I / We hereby agreed and accepted the terms and conditions set below.
I / We the undersigned declared that all the particulars given are true to my / our knowledge and belief.

Signature of Applicant

Date

TERM & CONDITION

1.

Receipt will not be issued for payments made through the auto debit facility, I will refer to my credit card statement for confirmation of payment.

2.

I must inform ICONIC VACATION CLUB BHD. in writing of any changes pertaining to the credit card, including new account numbers termination or cancellation of credit card acounts at least 30 days before the next
payment due date.

3.

ICONIC VACATION CLUB BHD. reserves the right, at its own discretion, to change the Term & Conditions herein without prior notices to me or to the membership owner.

4.

ICONIC VACATION CLUB BHD. may its absolute discretion or anytime without prior notice, terminate this authorization without assigning any reason and thereupon shall be under no obligation to debit my credit card
for any payments.

5.

ICONIC VACATION CLUB BHD. is under no obligation to honour any debit instructions unless there is sufficient available credit limit in my credit card account at the time the payment is due.

6.

ICONIC VACATION CLUB BHD. shall not be held responsible or liable fo any claims, loss, damages, costs and / or expenses arising from the successful and unsuccessful processing of the debit due to exceeding
credit limit, malfunction of the system, electricity failure and / or other factors beyond the control of ICONIC VACATION CLUB BHD.

7.

I hereby agree to indemnity and keep ICONIC VACATION CLUB BHD. indemnity against any claims, losses, damage, costs and / or expenses which ICONIC VACATION CLUB BHD. may suffer or incur as a result
of my authotization to debit my credit card account.

8.

This authorization shall remain binding upon me until ICONIC VACATION CLUB BHD's receipt of my written notification to cancel the authorization. ICONIC VACATION CLUB BHD. is entitled to disallow any debit
from my credit card upon notice of my death or bankrupt.