13569 SDC Direct Debit form V6

DIRECT DEBIT
AUTHORITY
T
0800 732 732
PO Box 903
F
0800 732 329
15 Forth Street
[email protected]
Invercargill 9840
I/We wish to make Payments
Weekly
Fortnightly
Quarterly
Monthly
(Last working day)
Annually
(Installment due date)
(First Installment due date)
First payment date _______________________ (for weekly/fortnightly, subsequent payments will occur on the same day of the week as the first payment date chosen)
PROPERTY DETAILS
Billing Number
Property Address (Please list below all properties this direct debit form is to apply to)
Property Owners Name(s)
Contact Phone Number
Email
_________________________________________________________________________________________________________________
______________________________________________________
Mobile
_______________________________________________
_________________________________________________________________________________________________________________
In future I would like to receive my rates assessment and invoices via email
Yes
No
BANK INSTRUCTIONS
NAME:
(Of Bank Account)
AUTHORITY TO ACCEPT
DIRECT DEBITS
BANK ACCOUNT FROM WHICH PAYMENTS TO BE MADE:
(Not to operate as an
assignment or agreement)
Bank
Branch
Account Number
Suffix
(Please attach an encoded deposit slip to ensure your number is loaded correctly)
AUTHORISATION CODE
0 2 0 7 0 7 9
To: The Bank Manager,
BANK:
BRANCH:
TOWN/CITY:
I/We authorise you until further notice in writing, to debit my/our account with you all amounts which
Southland District Council
(hereinafter referred to as the Initiator)
the registered Initiator of the above Authorisation Code, may initiate by Direct Debit.
I/We acknowledge and accept that the Bank accepts this authority only upon the conditions listed on this form.
INFORMATION TO APPEAR ON MY/OUR BANK STATEMENT (Completed by SDC):
PAYER PARTICULARS
PAYER CODE
S D C
R A T E S
D I R E C T
D E B I T
YOUR SIGNATURE(S)
Approved
06
DATE:
For Bank Use Only
Original - Retain at Branch
Date Received:
Recorded by:
0707
16
PAYER REFERENCE
Checked by:
BANK
STAMP
/
/
CONDITIONS OF THIS AUTHORITY TO ACCEPT DIRECT DEBITS
1.
The Initiator:
(a) Undertakes to give notice to the Acceptor of the commencement date, frequency and amount at least 10 calendar days before the first Direct Debit is
drawn (but no more than 2 calendar months). This notice will be provided in writing (including by electronic means and SMS where the Customer
has provided prior written consent (by electronic means including SMS) to communicate electronically).
Where the Direct Debit System is used for the collection of payments which are regular as to frequency, but variable as to amounts, the Initiator
undertakes to provide the Acceptor with a schedule detailing the amount and each payment date.
In the event of any subsequent change to the frequency or amount of the Direct Debits, the Initiator has agreed to give advance notice of at least
30 days before the changes comes into effect. This notice must be provided in writing (including by electronic means and SMS where the
Customer has provided prior written consent (including by electronic means including SMS) to communicate electronically).
(b)
May, upon the relationship which gave rise to this Authority being terminated, give notice to the Bank that no further Direct Debits are to be initiated
under the Authority. Upon receipt of such notice the Bank may terminate this Authority as to future payments by notice in writing to me/us.
2.
The Customer may:(a)
At any time, terminate this Authority as to future payments by giving notice of termination to the Bank and to the Initiator by means agreed by the
customer, Bank and Initiator .
(b)
Stop payment of any Direct Debit to be initiated under this authority by the Initiator by giving written notice to the Bank prior to the Direct Debit being
paid by the Bank.
(c)
Where a variation to the amount agreed between the Initiator and the customer from time to time to be Direct Debited has been made without notice
being given in terms of clause 1(a) above, request the Bank to reverse or alter any such Direct Debit initiated by the Initiator by debiting the amount of
the reversal or alteration of a Direct Debit back to the Initiator through the Initiator’s Bank PROVIDED such request is made not more than 120 days
from the date when the Direct Debit was debited to my/our account.
3.
The Customer acknowledges that:(a)
This authority will remain in full force and effect in respect of all Direct Debits passed to my/our account in good faith notwithstanding my/our death,
bankruptcy or other revocation of this authority until actual notice of such event is received by the Bank.
(b)
In any event this authority is subject to any arrangement now or hereafter existing between me/us and the Bank in relation to my/our account.
(c)
Any dispute as to the correctness or validity of an amount debited to my/our account shall not be the concern of the Bank except in so far as the
Direct Debit has not been paid in accordance with this authority. Any other dispute lies between me/us and the Initiator.
(d)
Where the Bank has used reasonable care and skill in acting in accordance with this authority, the Bank accepts no responsibility or liability in respect
of:the accuracy of information about Direct Debits on Bank statements; and
any variations between notices given by the Initiator and the amounts of Direct Debits.
(e)
The Bank is not responsible for, or under any liability in respect of the Initiator's failure to give notice in accordance with 1(a) nor for the non-receipt or
late receipt of notice by me/us for any reason whatsoever. In any such situation the dispute lies between me/us and the Initiator.
(f)
Notice given by the Initiator in terms of clause 1(a) to the debtor responsible for the payment shall be effective. Any communication necessary
because the debtor responsible for payment is a person other than me/us is a matter between me/us and the debtor concerned.
4.
The Bank may:(a)
In its absolute discretion conclusively determine the order of priority of payment by it of any monies pursuant to this or any other authority, cheque or
draft properly signed by me/us and given to or drawn on the Bank.
(b)
At any time terminate this authority as to future payments by notice in writing to me/us.
(c)
Charge its current fees for this service in force from time-to-time.