Instructions to Your Bank Or Building Society to Pay by Direct Debit

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Instructions to Your Bank Or Building Society to Pay by Direct Debit

Instructions to your Bank or Building Society Originator's Identification Number to pay by Direct Debit 88 30 08 Please fill in the whole form and send it to your Halifax branch 1. Name and full postal address of your bank or building society branch To: The Manager bank or building society Address Postcode 2. Name(s) of account holder(s) 5. Halifax reference number (from which funds will be paid) 6. Instruction to your bank or building society Please pay Halifax direct debits from the account detailed 3. Branch sort code on this instruction subject to the safeguards assured by (from the top right hand corner of your cheque) The Direct Debit Guarantee. I understand that this instruction may be retained by Halifax and if so, details will be passed electronically to my bank/building society. 4. Bank/building society account number Signature(s) Banks and building societies may not accept direct debit Date instructions for some types of account. Halifax is a division of Bank of Scotland plc. Registered in Scotland No. SC327000. Registered Office: The Mound, Edinburgh EH1 1YZ. Customer Name Address This question only applies to mortgage customers whose household insurance premiums are added to their mortgage account. 7. Would you like your monthly repayment to include one twelfth of your property insurance premium? Yes No Tear-off slip to be retained by Halifax This guarantee should be detached and retained by the payer The Direct Debit Guarantee • This guarantee is offered by all banks and building societies that take part in the Direct Debit Scheme. The efficiency and security of the scheme is monitored and protected by your own bank or building society. • If the amounts to be paid or the payment dates change, Halifax will notify you 10 working days in advance of your account being debited or as otherwise agreed. • If an error is made by Halifax, a division of Bank of Scotland plc, or your bank or building society, you are guaranteed a full and immediate refund from your branch of the amount paid. • You can cancel a direct debit at any time by writing to your bank or building society. Please also send a copy of the letter to us. 1/142300-4 (08/09) .

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