Form TH10: Boat registration – Direct Debit application form Thames
TH10 Version 6, October 2017 page 1 of 2
Boat registration – Direct Debit
application form Thames
Please complete the whole form in capital letters
and post it to the address below emailed forms
can not be accepted:
Environment Agency, Boat Registration, PO Box 544,
Rotherham, S60 1BY
For advice on completing this form please contact
03708 506 506 or email
You only need to send us the first page.
Please read the Direct Debit Guarantee and explanatory notes
on page two. This should be kept for information.
1 Boat registration number and name
Boat registration number, if available Office use only
Boat name
2 Boat owner details
Boat owner name
Title (Mr, Mrs, Miss and so on)
First name Last name
Contact numbers, including the area code
Phone Fax Mobile
3 Payment plan
Please indicate your preferred payment plan, by ticking the relevant box below. If you do not make a selection, or your selection is
unclear, we will take one payment from your bank account. Please be aware that it can take time to process your application. If this
happens, or you send your application in late, we may not have time to set up 10 payments. In this situation we will split the full cost
over the remaining months to the end of October. For example, if we receive your request at the end of April it is likely your payment will
be split over six months (MayOctober).
One payment
Six payments (JanuaryJune)
10 payments (JanuaryOctober)
Calls to 03 numbers cost no more than a national rate call to an 01 or 02 number
and must count towards any inclusive minutes in the same way as 01 and 02 calls.
These rules apply to calls from any type of line including mobile, BT, other fixed
line or payphone.
Instruction to your bank or building society to pay by Direct Debit
Please fill in the whole form using a ball point pen and send to:
Environment Agency Boat Registration, PO Box 544, Rotherham, S60 1BY
Name and full postal address of your bank or building society
To The Manager: Bank or building society
Name of account holder
Bank sort code
Bank or building society account number
Service user number
Instruction to your bank or building society.
Please pay Environment Agency Direct Debits from the account detailed in
this Instruction subject to the safeguards assured by the Direct Debit
I understand that this instruction may remain with Environment Agency and,
if so, details will be passed electronically to my bank/building society.
Banks and building societies may not accept Direct Debit instructions for
some types of account.
Form TH10: Boat registration – Direct Debit application form Thames
TH10 Version 6, October 2017 page 2 of 2
Direct Debit Guarantee
This guarantee should be detached and retained by the payer.
The Direct Debit Guarantee
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 Environment Agency will notify you 10 working
days in advance of your account being debited or as otherwise agreed. If you request Environment Agency to collect a
payment, confirmation of the amount and date will be given to you at the time of your request.
If an error is made in the payment of your Direct Debit, by Environment Agency 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 Environment Agency 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.
Direct debit explanatory notes
If you wish to spread the full cost of your registration over six or ten months, complete and return the direct debit mandate together with
your registration application. Once your direct debit is set up, this will continue in future years unless you inform us of a change in
circumstances. We will send notification of payment amounts and dates at the time of your next renewal.
When agreeing to pay by Direct Debit, you are responsible to pay the full registration charge unless you qualify for a refund.
If you cancel your Direct Debit before the final instalment is paid, we will invoice you for the outstanding balance.
If you default on your direct debit payments, we may refuse to grant you a direct debit facility in the future.
If you are paying for your registration by direct debit and sell your boat, you have two options:
pay the remaining outstanding balance, we can then transfer the registration to the new owner
return all the registration documents to us for a refund, if you qualify. Please note, in some cases you may still owe us part of the
registration fee.
Please refer to our website for the latest refund and transfer guidance:
LIT 7451