Recurring Credit Card Application

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PLEASE REMEMBER TO SIGN HERE

Signature(s)^(As in credit card account records)

Request Date (dd/mm/yyyy)

Please glue and seal here

#Not applicable for recurring credit card termination

Recurring Credit Card Termination

Please tick the box to indicate your intention^:

StarHub Customer NRIC / FIN Number / BRN / UEN^

StarHub Customer Name / Company Name^

PART 2: TO BE COMPLETED BY CARDHOLDER

^Mandatory Fields

SH_FIN_RCC_FORM_DEC_2016

(strictly for form submission only)

APPLICATION / TERMINATIONFOR RECURRING CREDIT CARD

PAYMENT ARRANGEMENT

For Business customer

(a) Please indicate at least one StarHub Payment Code.(b) Deduction for Bill Payment will be base on the StarHub Payment Code provided.(c) StarHub Payment Code (4 to 8 numeric digits) can be found on the top right corner of the Bill.(d) You agree to StarHub collecting, using and/or disclosing your personal data for the purposes of processing and administering this recurring payment arrangement.

StarHub Payment Code(s)^ (i)

(ii)

(iii)

Name of Cardholder^ (as printed on card)

Credit Card Number^ (for VISA/MASTERCARD)

- - -Credit Card Type^ (please tick one option)

VISA MASTERCARD AMEX

Credit Card Expiry Date^/

( M M / Y Y Y Y )

Payment Authorisation (please tick one option)^#

FIRST PARTY (paying for myself)

THIRD PARTY (paying for StarHub customer in part 1)

Credit Card Number^ (for AMEX)

- -

PART 1: TO BE COMPLETED BY APPLICANT

Please note (e) and (f) are not applicable to the termination of this recurring payment arrangement(e) I hereby instruct StarHub to debit my credit card (as stated in part 2) in payment for all Charges~ billed to the StarHub account(s) as stated in part 1.(f) This recurring credit card payment application/authorisation will continue to be in effect until the StarHub customer for account(s) stated under part 1 notify StarHub in writing

to terminate it, or StarHub receive a notification from the credit card company. StarHub reserve the right to terminate these recurring arrangements at any point in time attheir discretion.

(g) Amendments made on the form must be countersigned by the credit card account holder.(h) I agree to StarHub collecting, using and/or disclosing my personal data for the purposes of processing and administering this recurring payment arrangement.“Charges~” means all amounts due and owing to StarHub, including but not limited to amounts in StarHub bills, penalty fees, purchase charges and any other ad-hoc charges as may be imposed by StarHub.

Please provide your Company Name and BusinessRegistration Number(BRN)/Unique Entity Number (UEN)

during service registration with StarHub.

Please complete and return the form to us by mail,fax: 6721 5051 or email at rccform@starhub.com

NOTES ON RECURRING CREDIT CARD PAYMENT ARRANGEMENTPostage willbe paid byaddressee.

For posting inSingapore only.

BUSINESS REPLY SERVICEPERMIT NO. 09330

STARHUB LTD (RECURRING CREDIT CARD)

SINGAPORE POST CENTREP.O. BOX 291

SINGAPORE 914010

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For ApplicationThe information given in the application will supercede all relevant information we have in oursystems.

For approved new applications, this authorisation will take effect from customer's next billing cycle.

A system generated letter of notification will be sent upon approval.

The StarHub account holder will see the following liner in their bill “Total outstanding balance willbe deducted from your Credit Card <account no.> on <due date>.” once the recurring paymentarrangement is in effect.

For TerminationKindly note that termination is in effect only when the following message “The total outstandingbalance will be deducted from your Credit Card account xxxxx on dd/mm/yy” is not stated inyour bill.

Terms & ConditionsIf you send the application form to StarHub by email, the Customer is responsible for ensuring thesecurity of the application form in transmission and StarHub shall have no liability in respect thereof.

Please do not staple or tape this application form.

StarHub refers to StarHub Ltd and / or the relevant Affiliate providing the particular service, as setout in the StarHub Consumer Terms & Conditions and Business Terms & Conditions.

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All incomplete recurring payment arrangement forms will not be processed.

Please note that the given email address is strictly for application/termination of recurring paymentarrangement form submission only. Any other correspondence to the given email address shall notbe entertained and will not receive any reply.