The Payment Authorization Form is a critical document used in the Netherlands to establish legal authorization for processing payments from a bank account. It is designed to comply with Dutch financial regulations, EU payment services directives (PSD2), and SEPA requirements. This form is essential for businesses and organizations that need to collect payments from customers or clients, whether as one-time transactions or recurring payments. The document includes necessary personal data processing provisions to comply with GDPR, clear payment terms as required by Dutch law, and mandatory disclosures under the Financial Supervision Act. It's particularly important for direct debit arrangements and can be used in both B2B and B2C contexts, providing legal security for all parties involved in the payment process.
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1. Account Holder Information: Essential details of the account holder including full name, address, and contact information as required by SEPA and PSD2
2. Bank Account Details: IBAN, BIC/SWIFT code, and bank name information for the account to be debited
3. Payment Details: Specification of payment type (one-time/recurring), amount/variable amount, and frequency if applicable
4. Merchant Information: Details of the company/entity receiving the payment, including their identification and creditor ID
5. Authorization Declaration: Clear statement of authorization for the specified payments and acknowledgment of terms
6. Data Protection Notice: GDPR-compliant statement about how personal data will be processed
7. Signature Block: Space for date, place, and signature of the account holder
1. Secondary Account Holder: Additional section for joint accounts requiring second account holder's information and authorization
2. Payment Schedule Details: Detailed breakdown of payment dates and amounts, used when payment schedule is complex or varies
3. Cancellation Rights: Additional information about the right to cancel the authorization and the process, particularly important for consumer contracts
4. Digital Authentication Method: For electronic forms, section detailing the digital authentication process in compliance with PSD2 requirements
5. Special Instructions: Field for any specific payment processing instructions or conditions
1. Terms and Conditions: Detailed terms governing the payment authorization, including rights and obligations
2. Privacy Notice: Detailed information about personal data processing, retention, and rights under GDPR
3. Payment Schedule: Detailed schedule of payments if multiple or recurring payments are involved
4. Bank Mandate Information: SEPA mandate information and reference numbers if applicable
Relevant legal definitions
Account Holder
Authorization Date
Bank Account
BIC/SWIFT Code
Creditor
Creditor ID
Cut-off Time
Debit Date
Direct Debit
Due Date
Electronic Signature
IBAN
Mandate
Mandate Reference
Maximum Amount
Payment Date
Payment Instruction
Payment Service Provider
Payment Type
Processing Date
Recurring Payment
Refund Rights
SEPA
Settlement Date
Single Payment
Transaction
Variable Amount
Authorization Date
Bank Account
BIC/SWIFT Code
Creditor
Creditor ID
Cut-off Time
Debit Date
Direct Debit
Due Date
Electronic Signature
IBAN
Mandate
Mandate Reference
Maximum Amount
Payment Date
Payment Instruction
Payment Service Provider
Payment Type
Processing Date
Recurring Payment
Refund Rights
SEPA
Settlement Date
Single Payment
Transaction
Variable Amount
Clauses
Relevant Industries
Financial Services
Banking
Retail
E-commerce
Subscription Services
Utilities
Insurance
Telecommunications
Professional Services
Property Management
Education
Healthcare
Relevant Teams
Finance
Legal
Compliance
Operations
Customer Service
Administration
Treasury
Risk Management
Accounts Receivable
Payment Operations
Relevant Roles
Finance Manager
Accounts Receivable Specialist
Compliance Officer
Legal Counsel
Payment Operations Manager
Customer Service Manager
Credit Controller
Financial Controller
Treasury Manager
Billing Coordinator
Risk Manager
Operations Director
Company Secretary
Administrative Manager
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