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AUTHORISATION BANK USE 1. Please make this automatic payment as detailed by debiting my/our account. Name of Account ACCOUNT DETAILS On behalf of Name if other than payer Bank/Branch Account Number Suffix Details to appear on my/our Bank statement. Particulars Company Code max 12 Characters Reference max 12 Characters Enter the Last 10 digits of your account number FREQUENCY AND AMOUNT First Payment Date Frequency Weekly Last Payment Date Fortnightly Fixed Amount or Until Further Notice tick...
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