This document is an application form for a recurring credit card payment scheme to pay monthly service and conservancy charges or temporary occupation license fees to Tanjong Pagar Town Council. It requests the applicant's personal details, property information, credit card details, and signature to authorize the Town Council to charge the monthly fees to the provided credit card. It also contains a notice that all information must be fully completed for the payment to be processed and details the purposes for which the Town Council may collect, use and disclose the applicant's personal information.

1. APPLICATION FORM FOR
RECURRING CREDIT CARD PAYMENT SCHEME
IMPORTANT NOTICE
*All information on this form must be fully completed otherwise the payment cannot be processed
Attention: The Finance Department (RCCS)
Tanjong Pagar Town Council
Finance@tptc.org.sg
Address : Block 166 Bukit Merah Central
#03-3527
Singapore 150166
Fax: 6375 3198
I authorise Tanjong Pagar Town Council to charge to my credit card (details below) for the service and conservancy (S&CC) /
temporary occupation licence (TOL) payment on a monthly basis:
Name of Resident/ (TOL) Applicant : (Mr/Mrs/Mdm/Miss) __________________________________________________________
Contact Number : (H) ____________________ (O) ___________________ (H/P) ____________________
Town Council Ref Number : _____________________________________________________________________
Property Address : _____________________________________________________________________
_____________________________________________________________________
Postal Code ( )
Credit Card Details
Type of Card : Mastercard Visa Name of Bank: ____________________
Cardholder’s Name : __________________________________________________________________________
Card number :
Card Expiry Date (MM/YYYY) : ___________________________
Cardholder’s Signature : ___________________________ Date : _________________
__________________________________________________________________________________________________________________
By signing and submitting this form, I agree that Tanjong Pagar Town Council (the "Town Council") may collect, use and disclose any and all
information contained in this Form or otherwise collected from me and/or my authorised representatives, for the following purposes and other
purposes as set out in the Personal Data Protection Policy of the Town Council accessible at http://www.tptc.org.sg/:
(i) to facilitate the collection of service & conservancy charges ("S&CC") / temporary occupation licence charges (“TOL”), the refund of any
excess charges, and/or the transfer of credit balance to designated account(s); and
(ii) for the setting up and/or termination of recurring S&CC / TOL payment arrangements with financial institutions and banks (such as Interbank
GIRO deduction or credit card monthly payments).
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