Standard Chartered Vietnam - AutoBill Payment

Vietnam

* Indicates mandatory information to be provided.

Please tick where applicable

Auto Bill Payment Registration Form

ACCOUNT HOLDER INFORMATION


(e.g. 0412345678 or 0812345678)

(e.g. 0412345678 or 0812345678)

(e.g. 0901234567 or 01201234567)

(e.g. 0412345678 or 0812345678)

(e.g. 0412345678 or 0812345678)

(e.g. 0901234567 or 01201234567)

PAYMENT INFORMATION

Service Provider Information *

Choose one service or more

Mobile phone service Provider

(e.g: 0901234567; 01201234567)
( dd / mm / yyyy )
(e.g: 0981234567; 01681234567)
(e.g: 0951234567; 0951234569)

Fixed line service provider

(e.g: 0412345678; 0812345678)
(e.g: 0412345678; 0812345678)

ADSL service provider

(Account number given by Service Provider)

Insurance Company

Policy holder name:
Insurance Product:
Policy number: Policy term: year
Total premium per frequency: VND
Frequency of payment:

Instruction to bank account

(e.g: 88123456789 or 99123456789 or 66123456789)
This service is only applied to VND account

Definitions

  • Payment date: is the day that the bank debits the above customer’s registered account for bill payment

Note

  • In order to ensure non-interruption in service usage which can be made by service provider due to late payment, the Bank will process to debit your registered account three (3) days in advance before the request payment day stated in relevant bill
  • First bill is paid three (3) days in advance before the service provider’s payment day of next month from the registration date herein
  • The bill is paid within thirsty (30) days following the payment date indicated in the bill:
    • For new bancassurance customers: the services shall start no earlier than the third month
    • For existing bancassurance customers: the services will start in the next month following the registration date.
  • The minimum amount per monthly bill is VND 30,000

Declaration

  • I/ We represent that the information provided by us in this form to the Standard Chartered Bank (Vietnam) Limited ("the Bank") is true, accurate and complete for the provision of service.
  • I/ We agree that the instruction in the form shall be processed by the Bank three (3) days in advance before the request payment day every month.
  • I/ We hereby instruct and authorize the Bank to debit any amount from my/our registered account for monthly bill payment and service fees (if any) under the terms and conditions set forth herein.
  • Regarding Prudential premium / fees: I/We understand and agree that the bank shall freeze the balance of my/ our registered account until this account has sufficient fund for the bank to proceed with the payment of fees/premium
  • I/ We acknowledge that I/we shall keep enough balance in my/ our registered account to enable the Bank to process the bill payment three (3) days in advance before the request payment day of every month and understand that the Bank shall not process the bill payment if my/ our account does not have sufficient money for such payment.
  • I/ We understand that I/we hold responsibility to inform the Bank in writing if there is any change regarding to billing payment information at least 10 days before the payment date.
  • I/ We understand that I/We can request via Call center for cancellation of auto bill payment service ("request for cancellation").
  • I/ We hereby acknowledge that our request for cancellation shall become effective starting the month following our request, subject to the confirmation email sent by the bank to my/our email address which is registered with the bank.
  • I/ We further agree that our request for cancellation, as well as the bank’s email confirmation shall be recorded for evidence purpose.
  • I/ We acknowledge that the Bank assumes no responsibility in respect of any dispute between me/us and the relevant service provider.

For any query, please call (84 8) 3911 0000 or (84 4) 3696 0000 or visit www.standardchartered.com/vn