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    02 Takaful CREDIT and DEBITCARD AUTOPAY Form V1.4 2018

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    UstazFaizalAriffinOriginal
    This document authorizes Etiqa Family Takaful Berhad to charge initial and subsequent contributions to the cardholder's credit or debit card. If the card cannot be successfully charged on the deduction date, Etiqa is authorized to retry charging the card on subsequent dates. The cardholder agrees to the terms and conditions, including taking full responsibility for transactions and not holding Etiqa liable for issues outside its control. Etiqa is only responsible for arranging the card charges through the card center and the cardholder must resolve any disputes with the card company directly.

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    © All Rights Reserved
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    02 Takaful CREDIT and DEBITCARD AUTOPAY Form V1.4 2018

    Uploaded by

    UstazFaizalAriffinOriginal
    77 views2 pages
    This document authorizes Etiqa Family Takaful Berhad to charge initial and subsequent contributions to the cardholder's credit or debit card. If the card cannot be successfully charged on the deduction date, Etiqa is authorized to retry charging the card on subsequent dates. The cardholder agrees to the terms and conditions, including taking full responsibility for transactions and not holding Etiqa liable for issues outside its control. Etiqa is only responsible for arranging the card charges through the card center and the cardholder must resolve any disputes with the card company directly.

    Original Description:

    Debit kad Takaful etiqa

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    This document authorizes Etiqa Family Takaful Berhad to charge initial and subsequent contributions to the cardholder's credit or debit card. If the card cannot be successfully charged on the deduction date, Etiqa is authorized to retry charging the card on subsequent dates. The cardholder agrees to the terms and conditions, including taking full responsibility for transactions and not holding Etiqa liable for issues outside its control. Etiqa is only responsible for arranging the card charges through the card center and the cardholder must resolve any disputes with the card company directly.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    77 views2 pages

    02 Takaful CREDIT and DEBITCARD AUTOPAY Form V1.4 2018

    Uploaded by

    UstazFaizalAriffinOriginal
    This document authorizes Etiqa Family Takaful Berhad to charge initial and subsequent contributions to the cardholder's credit or debit card. If the card cannot be successfully charged on the deduction date, Etiqa is authorized to retry charging the card on subsequent dates. The cardholder agrees to the terms and conditions, including taking full responsibility for transactions and not holding Etiqa liable for issues outside its control. Etiqa is only responsible for arranging the card charges through the card center and the cardholder must resolve any disputes with the card company directly.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    CREDIT/DEBIT CARD AUTHORISATION (AUTOPAY)

    (VISA / MASTERCARD / AMEX)


    Payment Instruction
    I hereby authorise Etiqa Family Takaful Berhad to charge my initial and subsequent contributions payable from my Visa /
    MasterCard / Amex Card account.

    In the event that my Visa / MasterCard / Amex Card account cannot be successfully debited and processed on a
    particular deduction date, I authorise Etiqa Family Takaful Berhad to re-attempt to charge the Contribution due from my Visa
    / MasterCard / Amex Card account on the subsequent deduction date(s).

    I also agree to abide to the Terms & Conditions as specified overleaf and understand that no receipt will be issued for
    contributions paid through my Visa / MasterCard / Amex Card account.
    Please charge my Visa / MasterCard / Amex Card as I have indicated below:
    Proposal/Certificate No. -
    Certificate Owner's
    Name
    Payment Frequency Monthly Quarterly Half Yearly Yearly One-Time Payment

    Contribution Amount RM

    Type of Card Credit Card Debit Card

    Visa/MasterCard No. - - -
    or
    AmexCard No. - - -

    Card Expiry Date / (MM/YY) Issuing Bank :

    Cardholder's Name

    Cardholder IC No. - - ( New )

    (Old) Email :

    Cardholder Tel No - (H/P)

    - (Office/House)

    Cardholder's Address
    Postcode State
    Relationship to Certificate Owner
    Own Spouse Children Parent Brother / Sister

    X Cardholder's signature
    (As per the signature on the Credit / Debit Card) Date Signed : / /
    Note : Please fill up this form individually for each
    certificate and select which ever is applicable.
    AGENT'S INFORMATION AND CONFIRMATION
    I hereby certify that I have sighted and verified the relevant documents of the Card Holder’s information and the relationship of Card
    Holder with the Certificate Owner. I hereby confirm that all the particulars and/or information furnished by the Card Holder to Etiqa
    Family Takaful Berhad are true and correct and I have not withheld and/or misstated any particulars and/or information of the Card
    Holder(s) which might jeopardize the interest of Etiqa Family Takaful Berhad.
    Agent Name Agent Code

    Agent Tel No Agent Email

    FOR ETIQA USE ONLY


    Alt No : Data Entry By/ Date: Verified By/ Date:

    FOR BANK USE ONLY (VALIDATION PURPOSE)


    Particulars of Card holder checked & confirmed by : Date :

    Page 1of 2
    EFTB_LIFE_CRM_PC2c_CC_BI_Aug2018
    TERMS AND CONDITIONS FOR CREDIT/DEBIT CARD AUTHORISATION (AUTOPAY) VISA / MASTERCARD / AMEX

    In consideration of your agreement to accept my authorisation to you to debit my Visa / MasterCard / Amex
    Card account to pay for my takaful contribution(s), I expressly agree to the following Terms and Conditions:

    1) I authorise Etiqa Family Takaful Berhad to debit my Visa / MasterCard / Amex Card account for payment of my
    takaful contribution(s) under the given Certificate / Proposal Number.

    2) The first debit will be made anytime from the date of submission of the Credit/Debit Card Authorisation (AutoPay)
    Visa / MasterCard / Amex Payment Instruction Form.

    3) I shall accept full responsibility for all transactions arising from the use of my Visa / MasterCard / Amex Card for
    payment of my contribution(s).

    4) Etiqa Family Takaful Berhad shall not be held responsible or liable for any claims, loss, damage, cost and
    expenses arising from the successful processing of the debit due to exceeding credit limit, malfunction of the
    system, electrical failure and any other factors beyond the control of Etiqa Family Takaful Berhad.

    5) Etiqa Family Takaful Berhad is only responsible for making arrangement to debit my Visa / MasterCard / Amex
    Card account through the Card Centre as authorised by me. Therefore, for any problems or disputes arising
    from the processing / debiting of my Visa / MasterCard / Amex Card account will be at my own responsiblity to
    resolve it with my Card company.

    6) I will ensure that Etiqa Family Takaful Berhad is notified in writing of any changes, loss or replacement of my
    Visa / MasterCard / Amex Card or cancellation of this authorisation at least one month before the next
    contribution(s) due. Such changes or cancellation will become effective only after Etiqa Family Takaful Berhad has
    duly acknowledged receipt of such request.

    7) Etiqa Family Takaful Berhad may at its absolute discretion at any time terminate the Visa / MasterCard / Amex Card
    debiting arrangement if the certificate / proposal inactive.

    8) Etiqa Family Takaful Berhad reserves the right to change the Terms and Conditions set out herein at any time or from
    time to time when circumstances warrant without giving prior notice to me.

    9) The contribution payment(s) that is/are payable will be considered as paid only upon successful processing
    of the debiting by the Card Centre.

    10) The takaful coverage shall only commenced from the date of approval of the application subject to the full contribution
    being paid according to terms and conditions specified in certificate contract.

    11) I/We agree and consent that Etiqa Family Takaful Berhad and/or its service providers may collect, use and process
    my personal information (whether obtained in this form or otherwise obtained) and disclose such information in
    accordance with Etiqa Family Takaful Berhad’s Privacy Notice as found at http://www.etiqa.com.my/en/privacy-notice

    12) In the event of any conflict or discrepancy between these Terms and Conditions in English and Malay
    language, the English version shall prevail.

    Page 2 of 2
    EFTB_LIFE_CRM_PC2c_CC_BI_Aug2018

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