Customer services phone 06 374 4080 or 06 376 0110.
Tararua District Council, PO Box 115, 26 Gordon Street, Dannevirke 4942.
Direct debit authority form
Customer name Daytime phone number
I/We wish to pay for:
Rates Water Other: (please specify)
Property/Water/Other ID number:
Payment cycles (tick one)
I/We wish to make payments:
Weekly on: (tick which day of the week)
Tuesday Wednesday Thursday
Fortnightly on: (tick which day of the week)
Monthly – 20th or next business day
Quarterly on due date
Annually on 31st August
Details of the Bank Account you nominate to be debited
Name of account
Bank name
Address (PO Box)
Town/City
Account number
Authorisation
I/We authorise you, until further notice in writing, to debit my/our account with all amounts which TARARUA DISTRICT COUNCIL, PO Box
115, Dannevirke, New Zealand (hereinafter referred to as the ‘Initiator’), the registered Initiator of the Authorisation Code 0330117, 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.
The following information will appear in my/our Bank Statement:
Payer particulars Payer code Payer reference
T D C
Signed Signed
Authorised by holder(s) of the above nominated bank account.
For bank use only:
Original –
Retain at branch
Copy –
Forward to Initiator if requested
Approved 3011
Date received: Received by: Checked by: Bank Stamp
05 13
CUSTOMER DETAILS
DIRECT DEBIT AUTHORITY
AUTHORITY TO
ACCEPT DIRECT DEBITS
(Not to operate as an
assignment or an agreement)
AUHTORISATION CODE
0 3 3 0 1 1 7
Date
DD / MM / YYYY
Date of rst payment
DD / MM / YYYY
click to sign
signature
click to edit
click to sign
signature
click to edit
CONDITIONS OF THIS AUTHORITY TO ACCEPT DIRECT DEBITS
1. The Initiator:
(a)
Undertakes to give notice to the Acceptor of the commencement date, frequency and amount at least 10 calendar days before the rst Direct
Debit is drawn (but no more than 2 calendar months). This notice will be provided either:
(i)
in writing; or
(ii) by electronic mail where the Customer has provided prior written consent to the Initiator
Where the Direct Debit system is used for the collection of payments which are regular as to frequency, but variable as to amounts. The
initiator undertakes to provide the Acceptor with a schedule detailing each payment amount and each payment date.
In the event of any subsequent change to the frequency or amount of the Direct Debits, the initiator has agreed to give advance notice of AT
LEAST 30 DAYS BEFORE changes come into effect. This notice must be provided either:
(i)
in writing; or
(ii) by electronic mail where the Customer has provided prior written consent to the Initiator
OR
(a)
Has agreed to give written advance notice to the Acceptor of the net amount of each Direct Debit and the due date of the debiting AT LEAST
10 CALENDAR DAYS BEFORE (but not more than 2 calendar months) the date when the Direct Debit will be initiated. This advance notice
must be provided either:
(i)
in writing; or
(ii) by electronic mail where the Customer has provided prior written consent to the Initiator
The advance notice will include the following message:-
“Unless advice to the contrary is received from you by (date*), the amount of $………, will be direct debited to your Bank account on (initiating
date).”
* This date will be at least two (2) days prior to the initiating 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.
(c)
Where a variation to the amount agreed between the Initiator and the Customer from time to time to be direct debited has been made without
notice being given in terms of 1(a) above, request the Bank to reverse or alter any such Direct Debit initiated by the Initiator by debiting the
amount of the reversal or alteration of the Direct Debit back to the Initiator through the Initiator’s Bank, PROVIDED such request is made not
more than 120 days from the date when the Direct Debit was debited to my/our account.
3. The Customer acknowledges that:-
(a)
This authority will remain in full force and effect in respect of all Direct Debits passed to my/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 me/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 lies 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:
- the accuracy of information about Direct Debits on Bank statements
- 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.
(f)
Notice given by the Initiator in terms of clause 1(a) to the debtor responsible for the payment shall be effective. Any communication necessary
because the debtor responsible for payment is a person other than me/us is a matter between me/us and the debtor concerned.
4. The Bank may:-
(a)
In it’s absolute discretion conclusively determine the order of priority 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.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome