Individual Fuel Card Application Form
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1 Individual Fuel Card Application Form INDIVIDUAL FUEL CARD APPLICATION FORM PART 1: AUTHORISED APPLICANT S DETAILS Full Name, Underline Surname (As in IC/Passport): Mr Ms Mrs Mdm Dr NRIC / FIN / ID / Passport Number: Mobile: Home Tel: Residential Address (please provide billing proof if address differs from address in Identity): House / Block: Unit #: - Postal Code: Street Name: Address: Vehicle No. 1: Fuel Credit Limit per Vehicle: $500 $800 $1,000 Vehicle No. 2: Fuel Credit Limit per Vehicle: $500 $800 $1,000 Vehicle No. 3: Fuel Credit Limit per Vehicle: $500 $800 $1,000 Fuel Scheme: A (Full Security Deposit) B (Partial Security Deposit) C (No Security Deposit) Card Type: Petrol Diesel Fuel & Diesel PART 2: BILLING DETAILS Billing Address (if different from registered address): House / Block: Unit #: Postal Code: Street Name: Finance Institution s Details (for GIRO deduction) Name of Designated Bank: Designated Account Number: Branch: Page 1 of 6
2 PART 3: DECLARATION & ENDORSEMENT I/We hereby declare and confirm that all information given above is correct and complete. I/We authorise i.logistics Pte Ltd to verify all information from whatever sources i.logistics Pte Ltd can consider appropriate. I/We agree that my/our ESSO Fleet Card (s) may be used subject to the terms and conditions of the i.logistics Fuel Card Terms & Conditions a copy of which has been furnished to me/us which I/We agree to be bound by. All payment including supplementary cardholders, must be made via GIRO through the same account. i.logistics Pte Ltd shall reserve the absolute rights to approve or reject this application as it deems fit without assigning any reason(s) or whatsoever. Upon approval of this application, I/We hereby request i.logistics Pte Ltd to set the Credit Limit on the fleet card as indicated in the application form. I/We understand that the Credit Limit can only be monitored electronically. I/We understand and undertake that should the Credit Limit be breached for any reason(s) whatsoever, this shall not constitute any grounds for us not to pay in full for products or services purchased. i.logistics Pte Ltd reserves the right to charge interest on late payment at the rate of 2% per month on any Charges (or part thereof) remaining unpaid, calculated from the payment due date (after the Credit Period of 7 calendar days from date of invoice). i.logistics Pte Ltd reserves the right to levy a service charge of S$20 for each and every failed attempt for GIRO deduction. By signing this, I/We had read, understood and fully accepted to be bound by all the Terms and Conditions in the i.logistics Fuel Card Terms & Conditions. I/We also acknowledge that i.logistics Pte Ltd will not return any documents pertaining to this application, should the application be unsuccessful. PART 4: AUTHORISED SIGNATORY Full Name, Underline Surname (As in IC/Passport): NRIC / FIN / ID / Passport Number: Date: D D M M Y Y Signature: Kindly submit the following with this application form: 1) Completed GIRO Deduction Form 2) Security Deposit via Cheque / Bank Transfer 3) NRIC Copy For Security Deposit via Cheque, please issue Cheque to i.logistics Pte Ltd For Security Deposit via Bank Transfer, please transfer to OCBC Page 2 of 6
3 FOR OFFICIAL USE Date Received: D D M M Y Y Documents Received in Order Yes No Checked & Received By: Signature: Total Security Deposit Received: $ Fuel Scheme: A B C No. of Vehicle: Fuel Credit Limit per Vehicle: Total Monthly Credit Limit: Date: Verified By: $ $ Signature: Date: Approved By: Signature: Page 3 of 6
4 i.logistics FUEL CARD TERMS & CONDITIONS i.logistics Pte Ltd ( i.log ) is an authorised agent for ExxonMobil Asia Pacific Pte Ltd for Fuel Card system. The terms and conditions to sign up are as follows: 1 FUEL CARD SYSTEM a) i.log is authorised to process the issue of the Esso Fleet Card ( Fleet Card ). b) Applicants will be required to complete (1) Fuel Card Application Form and (2) Application for Interbank GIRO as prescribed by i.log. c) Upon completion, two original copies of the form must be sent to i.log s office (38 Jalan Peminpin #01-02, Singapore ) for processing. The process time will take approximately three weeks upon receiving completed forms, subjected to bank processing lead time for GIRO applications. d) Besides the Fleet Card, applicants may request for Speedpass Key Tag for an easy way to pump and pay. 2 REBATES AND PREVILEGES a) Each fleet card holder will entitle to the following rebates depending on the Scheme that the applicant has chosen. Refer to below table for the amount of rebates for each Scheme. The amount of rebates provided will be based on the prevailing pump price (inclusive of duty and GST). These rebates are subjected to changes depending on the benefits extended to i.log by ExxonMobil. i.log will inform the fleet card holder when there is a change in the rebates. Scheme A with Full Security Deposit, applicants will enjoy Petrol rebates of 22% and Diesel rebates of 24%. S/N Fuel Credit Limit (Per Card) Full Security Deposit Required (Per Card) 1 $500 $500 2 $800 $800 3 $1,000 $1,000 Scheme B with Partial Security Deposit, applicants will enjoy Petrol rebates of 20% and Diesel rebates of 22%. S/N Fuel Credit Limit (Per Card) Partial Security Deposit Required (Per Card) 1 $500 $200 2 $800 $300 3 $1,000 $400 Page 4 of 6
5 Scheme C without any Deposit, applicants will enjoy Petrol rebates of 17% and Diesel rebates of 19%. b) With the Fleet Card, the customer may visit an ExxonMobil station and fill up Petrol/Diesel. The station will provide a receipt with the full price based on the volume of fuel pumped and the prevailing pump price. ExxonMobil will provide i.log the data at the end of the month and the rebates will be shown in our invoice to the customer. c) No minimum purchase required to enjoy the rebates and it can be used on all types of fuel. d) No Smiles loyalty points will be awarded for the purchases. 3 REFUNDABLE SECURITY DEPOSIT a) Depending on the Scheme chosen, applicants will have to place a refundable security deposit with i.log. Unlike most other business, i.log provides credit limit upfront and bill our customer after they have used the services. Hence, to enjoy the maximum rebates, i.log will require our customer to secure their account. This refundable security deposit must be submitted together with the application form either by cheque or bank transfer. b) Once the GIRO arrangement is validated, the fleet card will be created and mailed to you. c) In the event if GIRO has not been validated by the bank and the fleet card is ready for use, applicants have the option to pay by cheque for the 1 st month provided that the security deposit is placed with i.log prior to issuance of the fleet card. This option is only available for Scheme A and B. d) You can us to request for termination of the Fleet Card. We will verify if you have any outstanding payment before refunding you the security deposit (if any). Any outstanding payment will be deducted from the security deposit and balance deposit will be refunded to you. e) i.log reserves the right to offset any outstanding payment with the security deposit. 4 LIABILITY FOR THE USE OF EXXONMOBILE FUEL CARD SYSTEM a) Each fleet card holder shall be liable for any and all transactions effected through the use of the Fleet card or Speedpass whether or not duly authorised by the card holder. 5 LOSS OF FLEET CARD a) Report any loss of fleet card immediately to i.log so that we can de-activate the fleet card immediately to prevent unauthorised use. Report all loss to i.log at fuel@ilogpteltd.com.sg. We will respond to the within 1 working day. 6 PAYMENT a) Invoices rendered by i.log for fuels purchased will be deducted through GIRO on the third week of the following month. Page 5 of 6
6 b) i.log will notify each customer their invoice by the 1st week of the following month and deduct the amount of fuel used through their GIRO account on the 3rd week. c) Customer shall highlight any discrepancies with the invoice within 3 working days. Otherwise, the invoice will be deemed as final. 7 DEFAULT PAYMENT a) If the fleet card holder fails to pay and/or refuse to make payment to i.log for the fuels sold, the fleet card will be cancelled immediately. The fleet card holder must pay and settle in full all the sums and monies in respect of any of the fuels sold under this agreement within seven (7) calendar days. b) i.logistics Pte Ltd reserves the right to charge interest on late payment at the rate of 2% per month on any Charges (or part thereof) remaining unpaid, calculated from the payment due date (after the Credit Period of 7 calendar days from date of invoice). i.logistics Pte Ltd reserves the right to levy a service charge of S$20 for each and every failed attempt for GIRO deduction. c) The fleet card holder shall remain liable for all charges incurred in respect of any fleet card prior to and after the termination, revocation, suspension or cancellation of the fleet card. d) The fleet card holder shall pay for all costs, fees, and expenses (including, without limitation, legal fees and expenses on a full indemnity basis) incurred by i.log associated with this Agreement arising from the fleet card holder s default of its obligations under this Agreement. e) The fleet card holder agrees to indemnify and hold i.log harmless from any losses, damages, costs, expenses or liabilities arising from any or all claims, actions, proceedings or demands (including, without limitation, legal fees/expenses on a full indemnity basis) of any nature whatsoever and howsoever arising which i.log may incur, sustain or suffer arising out of or relating to or in connection with the termination, cancellation, suspension or revocation of the fleet card. Page 6 of 6
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