Instruction to your
bank to pay by Direct Debit
Liberata PbA Support Team
PO Box 3166
Service user number
6 9 8 15 2
Please fill in the whole form including official use box using a ball
point pen and send it to:
Name(s) of account holder(s)
Bank/building society account number
Branch sort code
Name and full postal address of your bank
To: The Manager Bank
Reference - For HM Courts & Tribunals Service Official Use Only
Banks and building societies may not accept Direct Debit Instructions for some types of account
FOR HM Courts & Tribunals Service OFFICIAL USE ONLY
This is not part of the instruction to your bank or building society.
Instruction to your bank or building society
Please pay HM Courts & Tribunals Service Direct Debits from the account
detailed in this Instruction subject to the safeguards assured by the Direct
Debit Guarantee. I understand that this Instruction may remain with HM
Courts & Tribunals Service and, if so, details will be passed electronically
to my bank/building society.
This guarantee should be detached and retained by the payer.
• This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits
• If there are any changes to the amount, date or frequency of your Direct Debit HM Courts & Tribunals Service will notify you
ten working days in advance of your account being debited or as otherwise agreed. If you request HM Courts & Tribunals
Service to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
• If an error is made in the payment of your Direct Debit, by HM Courts & Tribunals Service or your bank or building society,
you are entitled to a full and immediate refund of the amount paid from your bank or building society
- If you receive a refund you are not entitled to, you must pay it back when HM Courts & Tribunals Service asks you to
• You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be
required. Please also notify us.