ACH Payment Form Template for Belgium

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Key Requirements PROMPT example:

ACH Payment Form

"I need an ACH Payment Form under Belgian law for setting up recurring monthly payments from our international suppliers, with specific provisions for handling multiple currencies and including bilingual text in both French and Dutch."

Document background

The ACH Payment Form, adapted for the Belgian market as a SEPA Direct Debit mandate, serves as the primary document for establishing automated payment arrangements between parties within the Single Euro Payments Area. This document is essential when setting up recurring payments or automated transfers and must comply with both Belgian national law and broader EU regulations, including PSD2 and GDPR. The form captures crucial information such as bank account details, payment schedules, and authorization permissions, while incorporating necessary data protection notices and mandatory regulatory disclosures. It's particularly relevant for businesses operating in Belgium that need to establish regular payment relationships with customers, suppliers, or service providers, and requires careful attention to both linguistic requirements (given Belgium's multilingual nature) and specific national banking protocols.

Suggested Sections

1. Form Title and Instructions: Clear identification of the document as a SEPA Direct Debit Authorization Form with brief instructions for completion

2. Payer Information: Fields for name, address, and contact details of the person/entity making the payment

3. Bank Account Details: IBAN, BIC/SWIFT code, and bank name of the payer's account

4. Payee Information: Creditor's name, creditor identifier, and business details

5. Payment Authorization: Clear statement authorizing recurring or one-time SEPA direct debits

6. Payment Details: Specification of payment amount, frequency, and start date

7. Data Protection Notice: GDPR-compliant statement about personal data processing

8. Signature Block: Space for date, signature, and name of authorized signatory

Optional Sections

1. Mandate Reference: Optional unique identifier for the mandate, used when part of a larger contract or recurring payment system

2. Alternative Contact: Secondary contact information section, used for business accounts or when a separate billing contact is needed

3. Payment Purpose: Additional field to specify the reason for payment, used in business contexts or when required for accounting purposes

4. Electronic Signature Provisions: Added when the form will be processed electronically, including specific eIDAS compliance statements

5. Language Selection: Dual-language version of the form (Dutch/French), used when operating in multiple Belgian regions

Suggested Schedules

1. Terms and Conditions: Standard SEPA Direct Debit terms and conditions, including rights and obligations

2. Privacy Notice: Detailed GDPR-compliant privacy notice explaining data processing practices

3. Cancellation Form: Standard form for canceling the SEPA mandate

4. Fee Schedule: If applicable, breakdown of any associated banking or processing fees

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Authorization
Payment Terms
Data Protection
Mandate Details
Cancellation Rights
Processing Terms
Account Information
Electronic Consent
Modification Rights
Privacy Notice
Dispute Resolution
Refund Rights
Notification Requirements
Governing Law
Language Declaration

Relevant Industries

Banking and Financial Services

Insurance

Retail

Utilities

Telecommunications

Professional Services

Healthcare

Education

Real Estate

Non-profit Organizations

Government Services

Subscription Services

E-commerce

Relevant Teams

Finance

Accounting

Legal

Compliance

Treasury

Administration

Risk Management

Operations

Customer Service

Data Protection

Relevant Roles

Finance Manager

Accounts Payable Specialist

Accounts Receivable Specialist

Treasury Manager

Financial Controller

Compliance Officer

Legal Counsel

Payment Operations Manager

Banking Relations Manager

Credit Controller

Administrative Officer

Company Secretary

Financial Operations Director

Risk Manager

Data Protection Officer

Find the exact document you need

Authorisation Form

A Belgian-law compliant document that formally grants specific powers or permissions from an authorizing party to an authorized representative.

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Let's create your ACH Payment Form

Authors

Alex Denne

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