Direct Payment Form Template for Netherlands

The Direct Payment Form serves as a crucial financial instrument in the Netherlands, enabling authorized automatic withdrawals from bank accounts for various payment purposes. This document is essential for businesses and organizations that need to establish direct debit arrangements with their customers or clients, whether for single transactions or recurring payments. The form must comply with Dutch financial regulations, including the Financial Supervision Act (Wet op het financieel toezicht), EU Payment Services Directive 2 (PSD2), and GDPR requirements. It's commonly used in subscription services, utility payments, insurance premiums, and other regular payment scenarios where automated transactions are preferred. The document includes vital information such as account holder details, payment specifications, SEPA compliance statements, and clear authorization provisions, making it a fundamental tool for modern banking and payment operations in the Dutch market.

1. Account Holder Details: Full name, address, and contact information of the account holder authorizing the payment

2. Payment Details: Specification of payment amount, currency, and whether it's a one-time or recurring payment

3. Bank Account Information: IBAN, BIC/SWIFT code, and bank details of the account holder

4. Beneficiary Information: Details of the party receiving the payment, including their bank account information and creditor ID

5. Authorization Declaration: Clear statement of authorization for direct debit, including reference to SEPA regulations where applicable

6. Data Protection Notice: Brief statement about how personal data will be processed, in compliance with GDPR

7. Signature Block: Space for date, place, and signature of the account holder