The Automatic Withdrawal Form is a crucial document in Canadian financial transactions that establishes a pre-authorized debit (PAD) agreement between parties. This document is essential when setting up recurring payments or authorized one-time withdrawals from a bank account. It must comply with the Canadian Payments Association Rules and relevant provincial and federal legislation, including PIPEDA for personal information protection. The form is commonly used for various purposes such as bill payments, subscription services, loan repayments, and insurance premiums. It includes detailed information about the payor's banking details, payment terms, cancellation rights, and recourse mechanisms. The document provides security and convenience for both parties while ensuring clear documentation of the authorization for automatic fund transfers.
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1. Payor Information: Complete details of the account holder including full name, address, phone number, and email
2. Financial Institution Details: Banking information including institution number, transit number, and account number
3. Payee Information: Complete details of the organization receiving the payments
4. Payment Details: Specification of payment amount, frequency, and start date
5. Authorization Statement: Clear statement of authorization for automatic withdrawals
6. Cancellation Rights: Statement of the right to cancel and required notice period
7. Recourse Statement: Information about the payor's recourse rights and reimbursement
8. Signature Block: Space for date and authorized signature(s)
1. Variable Payment Authorization: Required when payment amounts may vary; includes maximum amount and notification requirements
2. Joint Account Authorization: Required when the bank account requires multiple authorizations
3. Business PAD Details: Required for business accounts, including specific business PAD agreement terms
4. Electronic Communication Consent: Optional section for receiving electronic notifications and statements
5. Special Instructions: For any custom arrangements or specific processing requirements
1. Void Cheque or Bank Form: Attachment of void cheque or bank form confirming account details
2. Payment Schedule: Detailed schedule of payment dates and amounts if varying over time
3. Terms and Conditions: Detailed terms and conditions of the automatic withdrawal arrangement
4. Multiple Account Schedule: List of multiple accounts if withdrawals are to be made from more than one account
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Banking and Financial Services
Insurance
Utilities
Telecommunications
Property Management
Subscription Services
Education
Healthcare
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Retail
Non-Profit Organizations
Government Services
Relevant Teams
Finance
Accounts Receivable
Treasury
Customer Service
Compliance
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Operations
Risk Management
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Administration
Relevant Roles
Finance Manager
Accounts Receivable Specialist
Billing Coordinator
Treasury Manager
Payment Operations Manager
Customer Service Representative
Compliance Officer
Banking Relations Manager
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Financial Controller
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Operations Manager
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