Fillable Form 1: SEPA Core Direct Debit Mandate (CIPD)

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Form 1: SEPA Core Direct Debit Mandate (CIPD)

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The Form 1: SEPA Core Direct Debit Mandate (CIPD) form is 2 pages long and contains:

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  • 868 other fields

Country of origin: UK
File type: PDF

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SWIFT BIC
SEPA Core Direct Debit Mandate
By signing this mandate form,
you authorise (A)
to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions
from
As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank.
A refund must be claimed within 8 weeks starting from the date on which your account was debited. Please complete all the fields marked*.
Mandate reference
To be completed by the creditor
Your name
Name of the debtor(s)
Your address
Creditor’s address
Street name and number
Street name and number
Creditor’s name
Creditor name
Creditor identier
Type of payment
Recurrent payment One-off payment
Postal code
City
Postal code
City
Country
Country
Creditor SWIFT BIC
Your account number
Account number – IBAN
Please sign here
Signature(s)
City or town in which
you are signing
Location
Date
Please return to:
Creditor’s use only
D D M M Y Y Y Y
Note: Your rights regarding the above mandate are explained in a statement that you can obtain from your bank.
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CIPD
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CIPD, 151 THE BROADWAY, WIMBLEDON, LONDON,
SW191JQ, United Kingdom
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Specify payment frequency
□ Annual □ Instalments basis
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Person on whose behalf
payment is made
Name of the Debtor Reference Party: If you are making a payment in respect of an arrangement between the Creditor and another
person (e.g. where you are paying the other person’s bill) please write the other person’s name here. If you are paying on your own
behalf, leave blank.
Party on whose behalf the
Creditor collects the payment
Name of the Creditor Reference Party: Creditor must complete this section if collecting payment on behalf of another party.
Debtor indentication code
For business users: write any code number here which you wish to have quoted by your bank.
Identication code of the Debtor Reference Party
Identication code of the Creditor Reference Party
In respect of the contract
Identication number of the underlying contract
Description of contract
Details regarding the underlying relationship between the Creditor and the Debtor – for information purposes only.
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Form 1: SEPA Core Direct Debit Mandate (CIPD)

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Completed 5 April 2021

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