Cancel a Direct Debit Authorisation Template Letter

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[Date] [Your street]
[Your suburb and postcode]
[Your phone number]

[Financial Institution]
[Street number and name]
[Suburb and postcode]

Dear [ ],

Account Reference No. [your account number]

I hereby cancel and withdraw any previous authority I have granted to you to make direct debit transactions in relation to the above account

At present you are authorised to make the following direct debits from my account:

Payee Amount Frequency Next due date
Healthy gym $40 monthly day month year
White electricity (full amount of account) as issued by provider not known
Health insurance $ 1600 Annually 30 June 2010

These are examples only, please insert the relevant information for your request for direct debits.

In accordance with banking law and the Australian Payment Clearing Association’s Rules, I require you to cancel all of the above direct debits immediately and any other claims for direct debit payment from my account.

I shall be advising all of the above payees that I have cancelled my direct debit authority and I will not accept responsibility for direct debits or any fees or charges as a result of direct debit activity on my account.

Please confirm in writing within seven days that you have received and acted upon my request.

Yours faithfully,

[your name and signature]