AUTHORITY TO ACCEPT
DIRECT DEBITS
NAME OF OWNER/OCCUPIER
ON RATE ACCOUNT:
CONTACT
ADDRESS:
VALUATION
NUMBER:
CONTACT
PHONE NUMBER:
BANK ACCOUNT FROM WHICH THE PAYMENTS ARE TO BE MADE:
NAME(S) OF BANK ACCOUNT HOLDER(S)
BANK
NO BRANCH NO ACCOUNT NO SUFFIX
TO THE MANAGER OF MY/OUR BANK
Please print full postal address clearly:
NAME OF BANK:
BRANCH:
TOWN/CITY:
AUTHORISATION CODE
0
2
0
5
2
4
8
Please return this
authority to:
QUEENSTOWN LAKES
DISTRICT COUNCIL
PRIVATE BAG 50072
QUEENSTOWN
IMPORTANT
PLEASE INDICATE THE REQUIRED FREQUENCY
FOR DIRECT DEBITS: QUARTERLY MONTHLY
NB: If neither frequency is highlighted, direct debits will automatically default to ‘quarterly’.
I/We authorise you, until further notice in writing, to
debit my/our account with all amounts which the
Queenstown Lakes District Council, 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 the
reverse of this form.
INSERT YOUR SIGNATURE(S)
- MUST APPEAR HERE
DATE:
______________
FOR BANK USE ONLY
APPROVED ORIGONAL
Retain at Branch
BANK
STAMP
DATE
RECEIVED
RECO
RDED
BY
CHECKED
BY
CONDITIONS OF THIS AUTHORITY
1. The Initiator
(a) Has agreed to give written advance notice of the net amount of each direct debit and the due
date of debiting at least 10 calendar days before
(but not more than 2 calendar months) the
date the direct debit will be initiated. The advance notice will include the following message:-
“Unless advice to the contrary is received from you by (*date), the amount of $...... will be
directly debited to your Bank account on (initiating date).”
*This date will be at least two days prior to the due date to allow for amendment of direct
debits.
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 written notice of
termination to the Bank and to the 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.
3. The Customer
acknowledges that:-
(a) This authority will remain in full force and effect in respect of all direct debits made from me/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
be/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 disputes lie 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:
i. The accuracy of information about Direct Debits on bank statements
ii. 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
written advance notice correctly 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.
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 executed 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.