________
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________
Attention: ________
________

Date: ________

RE: NOTICE OF CANCELLATION OF DIRECT DEBIT AUTHORITY

Dear Sir/Madam,

1. Purpose of this notice

1.1 I, ________, am the holder (or authorised joint holder) of the account identified in clause 2 below. I give you this written notice cancelling the direct debit request and direct debit authority described below, in accordance with the Direct Debit Request Service Agreement applicable to my account and the BECS Procedures administered by Australian Payments Network Limited.

2. Details of the direct debit authority

Biller / Merchant Name: ________
Biller Customer / Reference Number: ________
Account Name: ________
BSB: ________
Account Number: ________
Debit Amount: $________ (________) per ________
Date direct debit authority commenced: ________

3. Cancellation

3.1 I hereby cancel the direct debit request and direct debit authority described in clause 2, with effect from ________ (the Effective Date).

3.2 You are directed to cease all further debits from the account described in clause 2 on and from the Effective Date and to take all steps reasonably necessary to give effect to this cancellation, including notifying the biller's financial institution.

4. Your obligations

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4.2 Otherwise, please confirm in writing that: (a) this instruction has been received; (b) it has been forwarded to the biller's financial institution where applicable; and (c) no further amounts will be debited from my account under this direct debit authority.

5. Reservation of rights

5.1 Nothing in this notice affects any rights I may have in respect of any unauthorised, incorrect or wrongly debited transaction, including my right to claim a refund or to dispute a debit under the applicable Direct Debit Request Service Agreement and the ePayments Code.

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Yours faithfully,

________
Signature: ________
Date: ________