Thursday, June 6, 2013

Credit Card Authorisation Slip -

Credit Card Authorisation Slip - Gov.ukCREDIT / DEBIT CARD – PAYMENT AUTHORISATION SLIP If you are applying for Passports and/or other Consular Services by post, you can pay by debit or credit card using this form. The cards we accept are Mastercard and Visa credit and debit cards. Visa Electron cards may also be used, except for customers in Portugal. 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. Actual fees at the time of issuance may fluctuate due to exchange rate movements. We will calculate the correct fee on your behalf. 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 your passport or other service(s) is returned to you. Applicant’s Details Name: Date of Birth: Daytime telephone number: Mobile telephone number: Services requested: □ Adult 32 page Passport □ Adult 48 page Passport □ Child Passport □ Other Consular Services – Please specify: Please note: A charge for the return of your new passports and supporting documents will be added to the passport fee. Please visit the passport pages on our Website for the latest information on fees and delivery charges. Payment type: □ VISA □ Mastercard □ VISA Debit Card Number: Expiry Date: / Cardholder’s Name: Cardholder’s Passport/ID Number: Cardholder’s Address: Cardholder’s Tel.No: Cardholder’s Signature: Date: If you do not want your receipt to be returned to you, please tick this box. □...

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