Direct Debit Form.indd

Diners Club Direct Debit Request
Your Diners Club Account Numberr
3
6
Diners Club Direct AUTOMATIC Account Payment
Date
Please advise the date you wish your Diners Club Card Account to be paid by direct debit each month, provided it is between your statement ‘Issue Date’ and your
applicable card ‘Default Date’. This may be a period of 14, 21 or 28 days depending on your account type. Please refer to your account statement for the appropriate
period.You cannot select the 29th, 30th or 31st day of the month.
If a date is not nominated the direct debit will be drawn ten (10) days after the issue date
Request and Authority to Debit
Account Holder 1 (of nominated bank Account)
Surname*
Account Holder 2 (of nominated bank Account)
Surname*
Given name/s
Given name/s
Address
Address
Postcode
Postcode
(Jointly and severally,You) request and authorise Diners Club Pty Limited (User ID Number 008582) (“Diners Club”) to arrange for any amount that Diners Club may debit
or charge You to be debited through the Bulk Electronic Clearing System from the account identified below. This authority is given subject to the terms and conditions of the
Direct Debit Request Service Agreement. *If you are a company, please include your company name and ABN instead of Surname and Given Names.
Your Financial Institution
Financial Institution name
Address
Postcode
Your Financial Institution Account
Name of account
BSB number
-
Account number
(Your account)
Acknowledgment
By signing this Direct Debit Request you acknowledge having read and understood the terms and conditions governing the debit arrangements between
you and Diners Club as set out in this Request and in your Direct Debit Service Agreement.

Signature
/
Date
/

Signature
/
/
Date
(If Your nominated bank Account is held by more than one person, all account holders must complete and sign this form. If signing for a company, please also print your full name
and capacity eg. Director. By signing for a company, you warrant that you have authority to enter into this agreement for and on behalf of the company).
Please fax your completed form to 1300 360 390 or mail to:
Customer Service, Diners Club International, GPO BOX 40, Sydney, NSW 2001.
For further assistance please call 1300 360 060.
© 2012 Diners Club Pty Limited ABN 35 004 343 051 (“Diner Club”). Diners Club is the registered trademark of Diners Club International Limited used and registered throughout the world.
Terms and conditions
This is your Direct Debit Service Agreement with Diners Club Pty Limited
ABN 35 004 343 051 (User ID Number 008582). It explains what your
obligations are when undertaking a Direct Debit Request arrangement with
us. It also details what our obligations are to you as your Direct Debit Request
provider. Please keep a copy of this agreement for your future reference.
It forms part of the terms and conditions of your Direct Debit Request and
should be read in conjunction with your Direct Debit Request authorisation.
4.2 You should check your account statement to verify that the amounts
debited from your account are correct.
5. Other important information you should know
5.1 All enquiries and requests for payment changes should be directed to
us. All disputes or cancellations should be directed to us or your financial
institution.
Definitions
5.2 We will initiate debits to your nominated financial institution account in
accordance with the instructions on the Direct Debit Request form, which
will be held by us.
account means the account held at your financial institution from which we
are authorised to arrange for funds to be debited.
5.3 Deductions made under the authority of this direct debit request will
appear as payments on your Account Statement.
agreement means this Direct Debit Request Service Agreement between
you and us.
5.4 Direct Debit will automatically debit the amount you specify from your
nominated account on the date you have advised on this form or if a date
is not nominated, the direct debit will be drawn ten (10) days after the
issue date
business day means a day other than a Saturday or a Sunday or a public
holiday listed throughout Australia.
debit day means the day that payment by you to us is due.
debit payment means a particular transaction where a debit is made.
direct debit request means the Direct Debit Request between us and you.
us or we means Diners Club Pty Limited ABN 35 004 343 051 (User ID
Number 008582).
you means the customer who has signed or authorised by other means the
Direct Debit Request.
your financial institution means the financial institution nominated by you
on the Direct Debit Request at which the account is maintained.
1. Debiting your account
1.1 By signing a Direct Debit Request or by providing us with a valid
instruction, you have authorised us to arrange for funds to be debited
from your account. You should refer to the Direct Debit Request and this
agreement for the terms of the arrangement between us and you.
6. Disputes
6.1 If you believe that there has been an error in debiting your account,
you should notify us directly on 1300 360 060 and confirm that notice in
writing (Ref: 9 Notice) with us as soon as possible so that we can resolve
your query more quickly. Alternatively you can take it up directly with your
financial institution.
6.2 If we conclude as a result of our investigations that your account has
been incorrectly debited we will respond to your query by arranging for
your financial institution to adjust your account (including interest and
charges) accordingly. We will also notify you in writing of the amount by
which your account has been adjusted.
6.3 If we conclude as a result of our investigations that your account has
not been incorrectly debited, we will respond to your query by providing
you with reasons and any evidence for this finding in writing.
7. Accounts
1.2 We will only arrange for funds to be debited from your account as
authorised in the Direct Debit Request, the terms of this Direct Debit
Request Service Agreement and the relevant terms and conditions
applicable to your Diners Club account.
7.1 You should check:
1.3 If the debit day falls on a day that is not a business day, we may direct
your financial institution to debit your account on the next business day. If
you are unsure about which day your account has or will be debited you
should ask your financial institution.
b) your account details which you have provided to us are correct by
checking them against a recent account statement; and
2. Amendments made by us
2.1 We may vary any details of this agreement or a Direct Debit Request
at any time by giving you at least fourteen (14) days written notice.
a) with your financial institution whether direct debiting is available from
your account as direct debiting is not available on all accounts offered by
financial institutions;
c) with your financial institution before completing the Direct Debit Request
if you have any queries about how to complete the Direct Debit Request.
8. Confidentiality
Diners Club Pty Limited
8.1 We will keep any information (including your account details) in your
Direct Debit Request confidential. We will make reasonable efforts to keep
any such information that we have about you secure and to ensure that
any of our employees or agents who have access to information about
you do not make any unauthorised use, modification, reproduction or
disclosure of that information.
GPO BOX 40
8.2 We will only disclose information that we have about you:
Sydney NSW 2001; or
a) to the extent specifically required by law; or
arranging it through your own financial institution, which is required to act
promptly on your instructions.
b) for the purposes of this agreement (including disclosing information in
connection with any query or claim).
3. Amendments by you
3.1 You may change*, stop or defer a debit payment, or terminate this
agreement by providing us with at least 7 days notification by writing to:
If you change, stop or defer a debit payment or terminate this agreement
you must make suitable alternate arrangements for payment of your home
loan.
* Note: in relation to the above reference to `change`, your financial
institution may `change` your debit payment only to the extent of advising
us, Diners Club Pty Limited ABN 35 004 343 051 (User ID Number
008582) of your new account account details.
4. Your obligations
4.1 It’s your responsibility to ensure that:
a) there are sufficient clear funds available in your account 2-3 days prior
to the Debit Day to allow a debit payment to be made in accordance with
the Direct Debit Request;
b) you notify us if the nominated account is transferred or closed;
c) you pay the repayment due by an alternative method if the direct debit
arrangements are cancelled either by you or us;
d) your payments are up-to-date, whether a notice is received from us or
not;
e) If there are insufficient clear funds in your account to meet a debit
payment;
i) you may be charged a fee and/or interest by your financial institution;
ii) you may also incur fees or charges imposed or incurred by us; and
iii) you must arrange for the debit payment to be made by another
method or arrange for sufficient clear funds to be in your account by an
agreed time so that we can process the debit payment.
9. Notice
9.1 If you wish to notify us in writing about anything relating to this
agreement, you should write to: Diners Club Pty Limited, GPO BOX 40,
Sydney NSW 2001
9.2 We will notify you by sending a notice in the ordinary post to the
address you have given us in the Direct Debit Request.
9.3 Any notice will be deemed to have been received on the third business
day after posting