CREDIT CARD AUTHORISATION FORM

STUDENT DETAILS Students name : Student ID : Current Class : TRANSACTION DETAILS Payment for : Full time Part time YL/YA course IELTS Others Next Class :

Transaction Amount : RM CREDIT CARD HOLDER DETAILS Cardholders Name : Card Account No : Card Expiry Date : Contact Details : E-mail : DECLARATION SECTION I, RM Date : FOR OFFICE USE ONLY Name of staff : Date & Time : Approved / Declined hereby agree to authorize The British Council to charge the amount of Cardholders Signature : (H) (MM/YY) Card Type : Approval code : (O) (HP) Mastercard Visa

EXPRESS PAYMENT Students name : Student ID : Date & Time : Name of Staff :

Acknowledgement Slip

www.britishcouncil.org.my
The British Council is the United Kingdoms international organization for cultural relations and educational opportunities. British Council Malaysia is a branch (995232-A) of the British Council, registered as a charity in England and Wales (209131) and Scotland (SC037733).

TERMS & CONDITIONS

Class registration or payment is only confirmed upon cheque clearance and credit card transaction approval by the bank. Payment will only be deemed complete upon issuance of an official British Council receipt. Request for change of class/class time must be made at the Front Desk and is subject to availability. This acknowledgement slip is only valid with a British Council stamp. The British Council shall not be held liable for any loss, delay or error of the Express Payment process which is not caused by British Council. This form will be retained by the British Council for 5 years from the date of submission.