I/ We __________________________________ (name) authorise and request you to debit my/our Account no.: ______________________ and credit the account of
With the sum of € _____________________ (amount in words) This amount is to be paid _______________ (annually, quarterly, or monthly) For a period of ______________ years, that is a total of ______ payments. The first payment is to be made on _______________________ It shall be understood that the Bank shall not be under any liability for damage or loss caused by any omission to make these payments. Signature(s): ________________________________________ Date: _____________________
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