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+ SEPA DIRECT DEBIT MANDATE
-SEPA BUSINESS-TO-BUSINESS DIRECT DEBIT MANDATE
-Reference:
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- Service Provider / Creditor:
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- VAT: - -
+ - VAT: - -
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+ SEPA DIRECT DEBIT MANDATE
+SEPA BUSINESS-TO-BUSINESS DIRECT DEBIT MANDATE
+Reference:
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+ Service Provider / Creditor:
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- Policyholder Service / Debtor:
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- VAT:
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+ VAT: +
+ VAT: +
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- Bank name: / BIC:
- IBAN:
- Payment type: +
- IBAN:
- Payment type: +
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+ Policyholder Service / Debtor:
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+ VAT:
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- 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 .
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+ Bank name: / BIC:
+ IBAN:
+ Payment type:
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+ Payment type:
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- This mandate is only intended for business-to-business transactions. You are not entitled to a refund from your bank after your account has been debited, but you are entitled to request your bank not to debit your account up until the day on which the payment is due.
- Please complete all the fields marked *.
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- 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.
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+ 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 .
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- Location and sign: _______________________, at ______ from ____________ from
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+ This mandate is only intended for business-to-business transactions. You are not entitled to a refund from your bank after your account has been debited, but you are entitled to request your bank not to debit your account up until the day on which the payment is due.
+ Please complete all the fields marked *.
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+ 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.
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- Details regarding the underlying relationship between the Creditor and the Debtor - for information purposes only.
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+ Location and sign: _______________________, at ______ from ____________ from
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+ Details regarding the underlying relationship between the Creditor and the Debtor - for information purposes only.
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- Debtor identification code:
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Write any code number here which you wish to have quoted by your bank.
+For business users: write any code number here which you wish to have quoted by your bank.
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Debtor identification code:
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Write any code number here which you wish to have quoted by your bank.
-For business users: write any code number here which you wish to have quoted by your bank.
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Person on whose behalf payment is made:
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Name of the Debtor Reference Party: If you are making a payment in respect of an arrangement between + 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. +
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+ Identification code of the Debtor Reference Party. +
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+ Person on whose behalf payment is made:
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Name of the Debtor Reference Party: If you are making a payment in respect of an arrangement between - 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. -
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- Identification code of the Debtor Reference Party. -
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Party on whose behalf the creditor collects the payment:
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+ Name of the Creditor Reference Party: Creditor must complete this section if collecting payment on behalf of another party. +
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+ Identification code of the Creditor Reference Party. +
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- Party on whose behalf the creditor collects the payment:
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- Name of the Creditor Reference Party: Creditor must complete this section if collecting payment on behalf of another party. -
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- Identification code of the Creditor Reference Party. -
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+ In respect of the contract:
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- Identification number of the underlying contract. -
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- Description of contract. -
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In respect of the contract:
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+ Identification number of the underlying contract. +
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