UNITED OVERSEAS BANK LIMITED

UOB CARDS AND PAYMENTS

ROBINSON ROAD P.O. BOX 1111
SINGAPORE 903338
ATTN: PORTFOLIO MANAGEMENT

BUSINESS REPLY SERVICE

PERMIT NO. 08142

UOB BILL PAY

SERVICE FORM

Postage will be
paid by addressee.
For posting
in Singapore only.

UOB BILL PAY SERVICE FORM

Simply complete the form below and mail or fax to us at 6353 3013.

PLEASE SIGN

YES! I would like to pay my bills with my UOB Card.

Name:

NRIC/Passport No.:

Office No.:

Mobile No.:

By signing here, I certify that I have read and agreed to the Terms and Conditions stated below. By indicating
the Account No.(s), Customer No.(s), Reference No.(s), Policy No.(s) and all other information as required by the
respective billing organisation(s) stated below, I hereby authorise and give my consent to the respective billing
organisation(s) to charge the bills/fees /charges/ premium/subscription to my UOB Card.

UOB Card No.

Card Expiry Date

Signature of Cardmember
M

Date

Note: The approval of the following authorisation will supercede existing payment instructions with the
respective merchants for the respective Account No.(s) indicated below. Please allow at least 6 weeks for
processing of your application.

PAYMENT CONSENT

My Singtel Account No.(s):

If you wish to pay for another persons

Singtel account, please fill up the following:
(not applicable for Singtel-UOB Platinum
Cardmember)

StarHub Account No.(s):

M1 Bill Account No. 1:

M1 Bill Account No. 2:

3rd Partys NRIC / Passport No:

Pacnet Account No.:

Name of 3rd Party Account Holder:

User ID:

3rd Partys Singtel Account No.(s):

All StarHub customers: Please fill in your UOB

Card details in the StarHub Payment Slip
(found on your StarHub bill). Sign and mail it
together with this application form.

M1 Bill Account No. 3:

@ pacific.net.sg

This facility is only available for the following

insurance plans.

Town Council 1
Please indicate your choice of Town Council by ticking ONE of the check boxes below.
Aljunied-Hougang-Punggol East

Bishan-Toa Payoh

Chua Chu Kang

Holland-Bukit Panjang

Marine Parade

Moulmein-Kallang

Pasir Ris-Punggol

Tampines

Tanjong Pagar

West Coast

This facility is only available for the following insurance

plans. UNI$ will not be given for sign-ups with UOI.

Name of Insured:

Name of Insured:

Policy No.(s):

Policy No.(s):

Home Insurance:

United Home Protection Insurance:

Reference No.:

D H O F 1 2

Golfers Insurance:

Town Council 2
Please indicate your choice of Town Council by ticking ONE of the check boxes below.
Aljunied-Hougang-Punggol East

Bishan-Toa Payoh

Chua Chu Kang

Holland-Bukit Panjang

Marine Parade

Moulmein-Kallang

Pasir Ris-Punggol

Tampines

Tanjong Pagar

West Coast

D H O M 1 1

Personal Accident Infectious Disease (PAID)

Insurance Plan:

United Personal Accident Insurance:

D H O P 1 1
Travel Insurance (Annual Policy Only):

Reference No.:

This facility is not applicable for UOB PRVI American Express Card, Preferred Platinum
American Express Card and PRVI Miles Platinum American Express Card.

Policy No.(s):

Motor Insurance:

Name of Policy Owner:

NRIC/Passport No.:

Relationship (If it differs

from Cardmember):

Terms and conditions for Prudential only:

1. Cardmembers can apply for Bill Pay Service and charge the policy premium(s) belonging to them and/or their Family Members to their UOB Credit
Card. Family Members shall mean spouse, children, parents, parents-in-law, brothers and sisters. 2. This facility shall apply to only regular premium
proposals/policies which are expressed in Singapore Dollars. It is not applicable to payment of premium for Prushield policies, single premium policies,
recurring single premium policies, US Dollar policies, top-up premiums and policies purchased under CPF Investment Scheme and Supplementary
Retirement Scheme. 3. Upon approval of the application, the premium amount will be charged to the Cardmembers Credit Card on the premium
due date and the UOB Credit Card statement will reflect the proposal/policy number(s) and the amount deducted. No renewal premium notices or
official receipts will be issued. The relevant entries reflected in the UOB Credit Card statement will be recognised as evidence of your payments. 4. All
authorisations referred to above shall remain in force until terminated by you in accordance with this clause. To terminate any authorisation, please call
your Financial Consultant or the PruCustomer Line at 1800-333-0-333. The appropriate forms will then be sent to you for completion. Alternatively,
you can write to: Prudential Assurance Company Singapore (Pte) Limited, Robinson Road PO Box 492 Singapore 900942. Any termination of such
authorisation shall only take effect upon receipt by Prudential of your completed form or written request (as the case may be). 5. Cardmembers who
are not the owners of the policy(s) will have no rights, under the Contract (Rights of Third Parties) Act, Cap 53B to enforce any of the terms and
conditions of such policy.

Note: This facility will not be extended to customers who have existing
standing payment arrangements with UOB (such as Property Mortgaged
Insurance) or UOI.

This facility is not applicable for UOB PRVI American Express Card, Preferred Platinum American Express Card and PRVI Miles Platinum American Express Card.

Newspaper

Monthly subscription rates

All-in-One^

Print only

The Straits Times

] S$28.65

] S$24.65

Lianhe Zaobao

] S$26.65

] S$22.65

The Business Times

] S$28.65

] S$24.65

Berita Harian

NA

] S$14.45

Tamil Murasa

NA

] S$15.50

The New Paper

NA

] S$20.10

Please indicate your residence

type:

Delivery Address:

Postal Code:

Email Address:
Monthly delivery fee

HDB

] S$3

Private Apartment

] S$4

Landed Property

] S$5

User Name (alpha numeric characters):

* Monthly subscription rates exclude delivery fees. Delivery fees will be charged only once per household on a monthly basis.
^ All-in-One Package comprises of Print, Online, iPad, and Smartphones edition where available.
The approval of this authorisation will supersede existing payment instructions with Singapore Press Holdings for the above publications.
For more details, please visit www.sphsubscription.com.sg. SPH full Terms & Conditions apply.

Disclaimer
United Overseas Bank Limited (UOB) assumes no liability or responsibility for the acts or defaults of the merchant or defects in the goods or services offered in this promotion. UOB is not an agent of the merchant. Any dispute about the quality or service standard must be resolved directly with the merchant. The
merchant may impose conditions for the redemption of the goods or services. UOB will not be responsible for any injury, loss or damage suffered as a result of the redemption or usage of the goods and services. While the information provided herein is believed to be reliable as at the date of printing, United Overseas
Bank Limited makes no representation or warranty whether expressed or implied, and accepts no responsibility or liability for its completeness or accuracy. UOB and the participating merchants reserve the right to vary/amend the privileges and/or terms and conditions without prior notice.
Terms and conditions. 1. You warrant that the information you have provided is true and correct and authorise United Overseas Bank Limited (UOB) to disclose such account details to the relevant merchants as may be necessary to facilitate your participation in this service. 2. Your UOB Credit Card
account must be in good standing and remain valid for the monthly bills to be debited successfully. 3. The following are ineligible: UOB JCB Cards, UOB Purchasing Cards, UOB Corporate Cards, UOB Private Label Cards, all UOB Visa Electron Cards and all UOB Visa Debit Cards. 4. Please allow at
least six weeks for processing of your application. 5. Please continue to pay to the relevant merchants until you see the amount reflected on your monthly UOB Credit Card statement. 6. All applications are subject to approval from the relevant merchants. UOB will not notify customers separately of
their application status. 7. Your account name with the relevant merchants must be the same as the name shown on your UOB Credit Card statement, unless otherwise specified. 8. Should you cancel or replace your card, please make alternative payment arrangements with your relevant merchants.
9. If your existing account is paid by GIRO, the GIRO payment arrangement will be terminated. 10. Please contact the relevant merchants to make alternative payment arrangements should you wish to terminate this payment arrangement. 11. If any payment charged to your UOB Credit Card is unsuccessful for any
reason whatsoever, you will be responsible for arranging payment to that merchant by other means. 12. UOB shall not be liable for any loss, expenses, delays, mistakes, neglect or omission in the transmission of payment under this facility or for any unsuccessful payment. 13. UOB reserves the right to amend these
terms and conditions and reject or decline any application in its sole discretion without giving any reasons. For details, please refer to uob.com.sg.
United Overseas Bank Limited Co. Reg. No. 193500026Z