No.//Name of BankName of BranchBranch CodeAccount Number Type of AccountCurrent Account Other (specify ) ..Savings Account Transmission Account DATE STAMP OF BANKBANK ACCOUNT PARTICULARSCERTIFIED AS CORRECTPrint Name:Signature:Date:FOR OFFICE USE ONLYAPPROVED BY HEAD OF OFFICEBank Details Date dd/mm/ccyyAuthorised SignatureInitials and SurnameI/We.....................................herebyrequestandauthoriseyoutopayanyamountswhichanyaccruetome/ustothecreditofmy/ouraccountwiththementionedbank.I/Weunderstandthatthecredittransfersherebyauthorisedwillbeprocessedbycomputerthroughasystemknowasthe"ACBELECTRONICBANKTRANSFERSERVICE",andI/Wealsounderstandthatnoadditionaladviceofpaymentwillbeprovidedbymy/ourbank,butdetailsofeachpaymentwillbeprintedonmy/ourbankstatementoranyaccompanyingvoucher.(Thisdoesnotapplywhereitisnotcustomaryforbankstofurnishbankstatements).I/weunderstandthatapaymentadvicewillbesuppliedbytheDepartmentinthenormalway,andthatitwillindicatethedateonwhichfundswillbeavailableinmy/ouraccount.Thisauthoritymaybecancelledbyme/usbygivingthirtydaysnoticebyprepaidregisteredpost.
No.//Name of BankName of BranchBranch CodeAccount Number Type of AccountCurrent Account Other (specify ) ..Savings Account Transmission Account DATE STAMP OF BANKBANK ACCOUNT PARTICULARSCERTIFIED AS CORRECTPrint Name:Signature:Date:FOR OFFICE USE ONLYAPPROVED BY HEAD OF OFFICEBank Details Date dd/mm/ccyyAuthorised SignatureInitials and SurnameI/We.....................................herebyrequestandauthoriseyoutopayanyamountswhichanyaccruetome/ustothecreditofmy/ouraccountwiththementionedbank.I/Weunderstandthatthecredittransfersherebyauthorisedwillbeprocessedbycomputerthroughasystemknowasthe"ACBELECTRONICBANKTRANSFERSERVICE",andI/Wealsounderstandthatnoadditionaladviceofpaymentwillbeprovidedbymy/ourbank,butdetailsofeachpaymentwillbeprintedonmy/ourbankstatementoranyaccompanyingvoucher.(Thisdoesnotapplywhereitisnotcustomaryforbankstofurnishbankstatements).I/weunderstandthatapaymentadvicewillbesuppliedbytheDepartmentinthenormalway,andthatitwillindicatethedateonwhichfundswillbeavailableinmy/ouraccount.Thisauthoritymaybecancelledbyme/usbygivingthirtydaysnoticebyprepaidregisteredpost.