Direct Debit Authority form - TCL - Type C

Automatic payment

Vodafone NZ Ltd

Direct Debit payment form - Fixed - TCL

Forms for paying bills - making regular payments. Vodafone NZ.

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Vodafone
Direct debit authority
For Vodafone use only

Account No. Application No.

Customer No.

Order No.

1. Your Vodafone account details
Account holder name Your Vodafone billing account number
AND phone number on invoice

This is up to a 9 digit number located at the top of your Vodafone invoice and it identifies your account to us.

I/We authorise you until further notice in writing, to debit my/our bank account (details below) with all amounts which Vodafone New Zealand Limited (hereinafter referred to as the Initiator) the registered Initiator of the above Authorisation Code, may initiate by Direct Debit. Payment will be debited on or after the statement's due date, unless Vodafone New Zealand Limited is notified.
I/We acknowledge and accept that the bank accepts this Authority only upon the conditions listed below. I/We have read and agree to the conditions of this Authority as listed overleaf.
2. Bank account details
Details of the bank account you want to pay your Vodafone account from

Name of bank account holder

Bank account number Bank

Branch

Account No

Suffix

0611471

Bank

Branch

Information to appear on my/our bank statement VODA FONE Payer particulars

Payer code

Town/City Payer reference

Authorised signature of bank account holder

Date

Authorised signature of joint bank account holder

Date

Scan and email this form to nzpaymentforms@vodafone.com or post this form to: Customer Payments, Vodafone New Zealand Ltd, Private Bag 92161, Victoria Street West, Auckland 1142 Please be aware, direct debits are activated on the next billing cycle (calendar month), so you will still be required to make a one-off payment for your current billing period. Please continue to pay via your current method until you receive at the bottom of your invoice, confirmation of your deduction via direct debit.

1. Vodafone New Zealand Limited (the "Initiator")
(a) Has agreed to give written advance Notice of the net amount of each direct debit and the due date of debiting at least 10 calendar days before (but not more than 2 calendar months) the date the direct debit will be initiated. This notice will be provided in writing (including by electronic means and SMS where the Customer has provided prior written consent (including by electronic means including SMS) to communicate electronically).
The advance notice will include the following message:
"Unless advice to the contrary is received from you by (*date), the amount of $........ will be directly debited to your Bank account on (initiating date)."
* This date will be at least two days prior to the due 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 the Customer.
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.
3. The Customer acknowledges that:
(a) This authority will remain in full force and effect in respect of all direct debits made from the Customer's account in good faith notwithstanding the Customer's 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 the Customer and the Bank in relation to the Customer's account.
(c) Any dispute as to the correctness or validity of an amount debited to the Customer 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 lie between the Customer 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 in accordance with 1(a) nor for the non-receipt or late receipt of notice by the Customer for any reason whatsoever. In any such situation the dispute lies between the Customer and the Initiator.
4. The Bank may:
(a) In its absolute discretion conclusively determine the order of priority of payment by it of any monies pursuant to this or any other authority, cheque or draft properly executed by the Customer and given to or drawn on the Bank.
(b) At any time terminate this authority as to future payments by notice in writing to the Customer. (c) Charge its current fees for this service in force from time-to-time.

Bank use only

Approved 1147

03

13

Received by Recorded by Checked by Bank stamp


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