Fillable Direct Debit Requests on Transaction Accounts (Commonwealth Bank of Australia)

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Direct Debit Requests on Transaction Accounts (Commonwealth Bank of Australia)

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Direct Debit Requests on Transaction Accounts
(Stop Payments, Cancel Arrangements and Customer Claims)
You can use this form to:
• Stop payment(s) until further notice from your transaction account to your Direct Debit User i.e. merchant (Section 3)
• Permanently cancel an existing Direct Debit Request (Section 4)
• Seek a refund from your Direct Debit User i.e. merchant for payment(s) initiated without your authority (Section 5)
Important Note: This notice is not suitable if a Credit Card number or Debit MasterCard number has been provided in
the set up of the direct debit payment. If a Credit Card or Debit MasterCard number has been provided, you will need to
contact the merchant directly to stop or cancel payments. Please refer to details in the Conditions of Use handout.
Section 1 – Personal details
Commonwealth Bank of Australia
ABN 48 123 123 124
Australian credit licence 234945
Please enter the full account title as appears on your statement (if held in joint names, details of all parties to be included)
Section 2 – Direct Debit User details
APCA User ID (6 digit Direct Debit User ID code – can be extracted from Client Data Enquiry)
Name of Direct Debit User (must be provided) Date of last payment
$
Amount
*Note: The Commonwealth Bank will notify the Direct Debit User of your cancellation instructions via their
sponsor Financial Institution. You should allow at least 10 days for the request to be received and processed by
the Direct Debit User.
Section 3 – Stop payments
Section 4 – Cancel my Direct Debit Request
Section 5 – Customer claim on disputed transactions
Effective today, please stop payment of all future direct debits to the Direct Debit User specified in Section 2 until further
notice. I accept that if multiple direct debits are set up with this Direct Debit User, all direct debits to them will be stopped.
Stop all payments to the Direct Debit User until further notice
Please arrange to permanently cancel my Direct Debit Request* and effective today, stop any payment of all future direct debits
to the Direct Debit User specified in Section 2. I accept that if multiple direct debits are set up with this Direct Debit User, all
direct debits to them will be stopped (note a new cancellation request is required for each payment authority being cancelled).
Permanently cancel my Direct Debit Request
I have not given this Direct Debit User any authority to draw funds from my account; or
Payment(s) against an existing or former authority were unauthorised for the following reasons:
Please provide details of your billing number, contract or policy number that you supplied to the Direct Debit User. If unknown,
include the transaction description from your statement.
I believe that money has been incorrectly withdrawn from my account by this Direct Debit User and request that you seek
restitution on my behalf because:
Address (PO Box is not acceptable)
State Postcode
BSB Account number
000-470 240718 Page 1 of 2
DD/MM/YYYY
Section 5 – Customer claim on disputed transactions (continued)
If you have previously contacted the Direct Debit User to cancel your authority, please let us know the date
Transaction details for disputed Direct Debits
Please list all transactions being claimed individually. Attach a separate page if there are insufficient lines:
Note: I understand that effective today, a stop will apply on all future direct debits to the Direct Debit User
specified in Section 2. I accept that if multiple direct debits are set up with this Direct Debit User, all direct debits
to them will be stopped.
Note: The Direct Debit User has the right to dispute your claim. They are required to respond to us within
5 business days (or within 1 month for transactions which occurred more than 12 months ago) to either refund
the amount you have claimed, or provide evidence to support their dispute of your claim. If the Direct Debit User
disputes your claim and you disagree with their decision, you can lodge a further claim with us and the dispute
will, in most cases, be resolved within 1 month.
Date debited Amount Customer statement description
$
$
$
$
$
$
$
Any other details of claim
Section 6 – Authorisation (must be completed in all cases)
✗
Signature of customer 1 Date
✗
Signature of customer 2 Date
I/We authorise and request the Commonwealth Bank to take action specified in the completed sections of this form
Direction(s) to proceed provided by phone
(If disputed transaction(s) involved, apply stop to prohibit DDR payments but notify customer that a signed notice is required
to finalise. Please ask customer to provide ASAP by going to nearest branch to complete).
Bank use only
Customer’s Stop Payment direction under sections 3, 4 & 5 to be processed immediately before faxing form to Melbourne
Processing Services)
#
enter Debit User ID from Section 2 or look up Client Data Enquiry if first payment debited
DDA Stop (CommSEE file change) *Only applicable to accounts not on the new banking platform.
Customer identified
If multiple account holders, Method of Operation confirmed
DD Stop without User ID Tran code Sub code
3 1 5 9
Detail
Add
DD Stop User ID known Tran code Sub code
3 1 5 12
Debit User ID
#
Full Name of customer supplying details
Step 1. Select Add/Remove Account Stop, Step 2. Select Add Stop, Step 3. Stop Reason Direct Entry, Step 4. Enter comment.
A. Passbook Stop (CommSEE maintenance)
For DDA & Passbooks
Form faxed to PS immediately on (03) 8327 0283
Imaging arranged for DDR notice
Date Stop Input
CommSEE Stop Input by
Branch
BSB
Telephone number
Facsimile number Mobile number
Step 1. Select Add/Remove Direct Entry Stop, Step 2. Select Add Stop, Step 3. Enter APCA ID and details, Step 4. Submit.
B. Accounts on the new banking platform
000-470 240718 Page 2 of 2
DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY
( )
( )
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Direct Debit Requests on Transaction Accounts (Commonwealth Bank of Australia)

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Completed 4 March 2022

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