Investor name/Name of entity Your account number (existing investors)
Weekly Fortnightly Monthly Quarterly Annually One-Off
Information to appear in my bank statement
(To be completed by Investor)
Payer particulars Payer code
I/we have read and retained a copy of the attached product
disclosure statement and agree to be bound by the terms and
conditions of the Governing Document.
Please complete investment
payment details on page 2
FISHER FUNDS MANAGED FUNDS
DIRECT DEBIT AUTHORITY FORM
If you would like help in completing this form, please email email@example.com or phone us on
0508 FISHER (0508 347 437).
You can complete this form on-screen by typing directly into each eld. Once you have completed your details, please print,
sign and post the form to Fisher Funds, Private Bag 93502, Takapuna, Auckland 0740 or email to firstname.lastname@example.org.
FF630 - 08/19
ACCEPT DIRECT DEBITS
(Not to operate as an
assignment or agreement)
Name of account to be debited
Bank Branch Account number Sufx
From the acceptor to my bank:
I authorise you to debit my account with the amounts of direct debit instructions received from TEA Custodians o/a Fisher Funds Management
Limited (the ‘Initiator’) with the authorisation code specied on this authority and in accordance with this authority until further notice from me.
I agree that this authority is subject to:
» my bank’s terms and conditions that relate to my account, and
» the terms and conditions listed below.
Authorised signature/s: Date
Recorded by Checked by
Original - Retain at branch
Copy - Forward to initiator if requested
For Bank Use Only
debit in a series.
2) Changes to the amounts or dates of a series of direct debits require 10 days’ prior notice to me.
requested by me.
4) All notices must be in writing, but can be delivered electronically, if I have agreed that with the Initiator.
Specic conditions relating to notices and disputes
5) I can also ask you to reverse a direct debit up to 120 days after the direct debit if:
» I didn’t receive proper notice of the amount and date of the direct debit, or
» I received notice but the amount or date of the direct debit is different from the amount
or date on the notice.
6) If you dishonour a direct debit but the Initiator retries it within 5 business days of the
original direct debit, I understand that the Initiator doesn’t need to notify me again about
that direct debit.