Direct Debit Application

Customer Details

Full Name *

Phone Number *

Email Address *

Would you like to receive your rates invoices by email? *

Address * For receiving confirmation Letter

Property Details

Property Number

Please select which frequency you would like to make payments in

On which day? If you have chosen weekly or fortnightly please select one

Monday
Tuesday
Wednesday
Thursday
Friday

Preferred start date *

Day Month Year

Bank Details

Name of your bank *

Name of your bank account *

Bank Account Number

Bank *

Branch

Account Number *

Suffix *

Authorisation Code
0	3	2	0	6	3	2

Approved
2063	05/2021

Please note that by ticking the boxes below you declare as follows:

I/we agree to use direct debits as a payment method to pay my/our rates in accordance with the terms and conditions stated in this application *

I agree

I / we have sole signing authority on the bank account specified in this application (Where the account is a joint account requiring more than one to sign that I/we (the signatories) also provide a signed a written DD authority form.) *

I agree

The bank account we specified in ii) above is able to receive direct debits in accordance with the terms and conditions related to my bank account *

I agree

Terms and conditions

Specific conditions relating to notices and disputes

You may ask your bank to reverse a direct debit up to 120 calendar days' after the debit if:

You don't receive a written notice of the amount and date of each direct debit from the initiator or
You receive a written notice, but the amount or the date of debiting is different from the amount or the date specified on the notice.

The initiator is required to give you a written notice of the amount and date of each direct debit no less than 10 calendar days before the date of the debit.

For weekly or fortnightly direct debits, the initiator is required to give you a written notice of the amount and date if each direct debit is no less than 2 business days before the date of the debit.

For the direct debits with notice no later than the date of the debit, the initiator may only send a direct debit if you have asked the initiator to send it and agreed the amount of the direct debit. The initiator is required to give you a written notice of the amount and date of each direct debit no less than the date of the debit.

For instalment or scheduled direct debits, the initiator is required to give a written notice of the amount and date of each direct debit in a series of direct debits no less than 10 calendar days before the date of the first direct debit in the series. The notice is to include the dates of the debits, and the amounts of each direct debit. If the initiator proposes to change an amount or date of a direct debit specified in the notice, the initiator is required to give you notice no less than 30 calendar days before the change.

If the bank dishonours a direct debit but the initiator sends the direct debit again once within 5 business days of the dishonour, the initiator is not required to give you a second notice of the amount and date of the direct debit.

We will send you details of this authority within the next 5 business days. If you wish to cancel this direct debit authority please contact us on phone 03 307 7700 OR email rates@adc.govt.nz