Credit/debit card - payment authorisation slip



British Embassy, Hanoi

CREDIT / DEBIT CARD – PAYMENT AUTHORISATION SLIP

The cards we accept are Visa and Mastercard credit and debit cards. We are unable to accept Maestro cards, American Express, JCB or Diners’ Club cards.

Please print this form, enter your personal information and credit/debit card details as instructed and enclose it with your application. A separate credit card authorisation slip should accompany each application. If the cardholder name is different to the applicant’s name, please attach a photocopy of the cardholder’s passport or other photo ID with signature.

Your signature on this form indicates acceptance of these terms and authorises us to charge the actual fee to your card. You will receive a receipt showing the actual fee when you receive the service.

|Applicant’s Details |

|Name: | |

|Date of Birth: | |

|Daytime telephone number: | |

|Mobile telephone number: | |

Services requested:

□ Making or certifying a copy

□ Legalising a signature or seal

□ Administering an oath/declaration/affirmation (including for marriage)

□ Marking of exhibits

□ Other Consular Services – Please specify:

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Payment type: □ VISA □ Mastercard □ VISA Debit □ Mastercard Debit

Card Number:

Expiry Date: /

Cardholder’s Name:

Cardholder’s

Passport/ID Number:

Cardholder’s Address:

Cardholder’s Tel.No:

Cardholder’s Signature: Date:

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