Direct Debit Mandate Form Template UK

The Direct Debit Mandate Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, featuring customizable and printable samples for your convenience.

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Sample

Direct Debit Mandate Form Template UK

Editable – Printable

PDF – 1 PDF – 2

Direct Debit Mandate Form Template UK

1. Payer Information



2. Payee Information



3. Direct Debit Instruction

4. Amount and Frequency

5. Payment Initiation Date

6. Cancellation Terms

7. Declaration

8. Contact Information

9. Signature and Date


PDF

WORD

Examples

Direct Debit Mandate Form Template UK (1)
Payee Information:
[Name of the Payee]
[Payee’s Bank Name]
[Payee’s Account Number]
[Payee’s Sort Code]
[Payee’s Address]
Payer Information:
[Name of the Payer]
[Payer’s Address]
[Payer’s Phone Number]
[Payer’s Email]
Reference:
[Unique Reference Number for the Transaction]
Declaration:
I hereby authorize [Name of the Payee] to collect payments from my bank account as per the details below, in accordance with the Direct Debit Guarantee.
Bank Account Details:
Account Holder Name: [Name of the Account Holder]
Account Number: [Account Number]
Sort Code: [Sort Code]
Payment Information:
This Direct Debit will be collected on the [Frequency of Payments, e.g., monthly] on or after the [Payment Due Date]. The amount will be [Amount] per transaction.
Cancellation Rights:
You are entitled to cancel this Direct Debit at any time by contacting your bank or building society.
Signed on [Date]:
Sincerely,
[Signature of the Payer]
[Name of the Payer]
Direct Debit Mandate Form Template UK (2)
Payee Information:
[Name of the Payee]
[Payee’s Bank Name]
[Payee’s Account Number]
[Payee’s Sort Code]
[Payee’s Address]
Payer Information:
[Name of the Payer]
[Payer’s Address]
[Payer’s Phone Number]
[Payer’s Email]
Reference:
[Unique Reference Number for the Transaction]
Declaration:
I authorize [Name of the Payee] to collect the amount as stated below from my account, with the details provided, in accordance with the Direct Debit Guarantee.
Bank Account Details:
Account Holder Name: [Name of the Account Holder]
Account Number: [Account Number]
Sort Code: [Sort Code]
Payment Schedule:
Payments will be collected on the [Frequency of Payments, e.g., monthly or quarterly], starting from [Start Date], with a payment amount of [Amount].
Cancellation Rights:
You can cancel this Direct Debit at any time by informing your bank, ensuring all future payments are halted.
Signed on [Date]:
Sincerely,
[Signature of the Payer]
[Name of the Payer]

Printable

PDF – 1 PDF – 2

Direct Debit Mandate Form Template UK