REGISTRATION FORM Program: UBER DRIVERS (18% discount for Petrol and Diesel)

UBER Account Details (Please provide the email address and phone number you used to register with UBER for VERIFICATION)

UBER Registered Email Address _________________________________________

UBER Registered Phone Number _________________________________________

Personal Particulars

Full Name

NRIC

Block/House No. Street Name

Unit Number Postal Code

Payment Mode (Please choose either Credit Card OR InterBank GIRO)

Credit Card (Citibank or OCBC credit / debit card ONLY)

Issuing Bank Citibank OCBC

Name on Card

Card Number

Expiry MM/YYYY

InterBank GIRO (Please fill in attached GIRO form)

Service Fees

o Refundable security deposit (for $800 monthly fuel limit): SGD $200 per Vehicle

o Penalty per Deduction Failure: SGD $40

o Administrative charge for cancellation/termination : SGD $10

Note: Issuance of fleetcard will be done only upon successful deduction of security deposit

Undertaking

I agree to subscribe to the above mentioned scheme as governed by the Terms and Conditions

(http://www.sesami.net/abecha/esso/docs/Abecha-EssoTC.pdf) of Abecha Pte Ltd’s Bulk Fuel Discount FleetCard Porgramme

_________________________

Signature / Date

PDPA Declaration

I hereby consent to the collection of my above personal data by SESAMi/Abecha. In addition,

I agree to be contacted via phone for redemption of this promotion. I also consent to the further use of my above

personal data by SESAMi/Abecha to update me on the latest promotions / products.

I agree to be contacted via phone for redemption of this promotion only. I do not consent to the further use of my above

personal data by SESAMi/Abecha.

Please fill in this form and mail the original form to us for bank processing if you have chosen

InterBank GIRO as your payment mode

APPLICATION FORM FOR INTERBANK GIRO

PART 1: TO BE COMPLETED BY BANK ACCOUNT HOLDER

Date:

Name of Billing Organization:

Abecha Pte Ltd 1 Changi Business Park Crescent #02-17 (Podium C) Plaza 8 @ CBP Singapore 486025

Applicant ‘s name :

NRIC ( for Individual ) / UEN ( for Corporate )

Name of Bank

A) I/We hereby instruct you to process Abecha Pte Ltd’s Instructions to debit my/our account. B) You are entitled to reject Abecha Pte Ltd’s debit instructions if my/our account does not have sufficient funds and charge me/us

a fee for this. You may also at your discretion allow the debit even if this results in an overdraft on the account and impose charges accordingly.

C) This authorization will remain in force until terminated by your written notice sent to my/our address last known to you or upon receipt of my/our written revocation to Abecha Pte Ltd

Bank account holder ‘s name ( as per Bank ‘s record )

Bank account number

Signature(s)/ Thumbprint(s)/ Company stamp Contact No. ( Tel / Hp )

PART 2: TO BE COMPLETED BY ABECHA PTE LTD

Bank Branch Abecha Account No. 7171 003 0039014244

Bank Branch Account No. to be debited

Agreement No.

PART 3: TO BE COMPLETED BY BANK

To Abecha Pte Ltd This Application is REJECTED (tick where applicable) for the following reason(s):

Signature/Thumbprint# differs from Financial Institution records. Wrong account number Signature/Thumbprint# incomplete/unclear# Amendments not countersigned by customer Account operated by Signature/Thumbprint# Others ____________________________________

____________________________________

____________________________ ___________________________ __________________ Name of Approving Officer Authorized Signature Date *For thumbprint/s, please go to the branch with your identification #Delete where applicable

Please email the completed form to custcare_bc@abecha.com

For enquiries, please feel free to call our hotline at 6333 1188.

Bank Branch