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1. Account Holder Information: Details of the account holder including full legal name, contact information, and address as required by BSP regulations
2. Bank Account Details: Complete banking information including bank name, branch, account number, and account type
3. Payment Authorization Details: Specific details about the authorized payment including amount (fixed or variable), frequency, and duration
4. Authorization Declaration: Clear statement of the account holder's authorization for the payment arrangement
5. Terms and Conditions: Essential terms including processing timeframes, fees, and modification/cancellation procedures
6. Data Privacy Notice: Statement on how personal and financial information will be collected, used, and protected as per Data Privacy Act
7. Signature and Date: Space for account holder's signature and date of authorization
1. Secondary Account Holder: Additional section for joint accounts requiring multiple authorizations
2. Special Instructions: Section for any specific payment processing instructions or conditions
3. Emergency Contact: Optional contact person for payment-related communications
4. Digital Authorization: Alternative to wet signature for electronic submission, including OTP verification details
5. Cancellation Terms: Detailed process for canceling the payment authorization, if different from standard terms
1. Schedule A - Payment Schedule: Detailed breakdown of payment dates, amounts, and frequencies if involving multiple or recurring payments
2. Schedule B - Fee Schedule: Comprehensive list of all applicable fees and charges
3. Appendix 1 - Required Documentation: List of supporting documents required for verification (e.g., valid ID, proof of billing)
4. Appendix 2 - Terms Dictionary: Definitions of technical terms and banking jargon used in the form
Authorization Period
Banking Day
Authorized Amount
Payment Instruction
Recurring Payment
One-Time Payment
Payment Date
Processing Date
Bank Account
Reference Number
Electronic Fund Transfer
Payment Recipient
Valid ID
Authorized Representative
Cancellation Notice
Force Majeure
Processing Fee
Service Provider
Payment Platform
Digital Signature
Electronic Authorization
Payment Schedule
Transaction Record
Personal Information
Confidential Information
Business Day
Notice Period
Payment Frequency
Default Events
Bank Charges
Authorization Code
Security Credentials
Payment Confirmation
Settlement Date
Payment Details
Data Privacy
Consent
Term and Duration
Modification Rights
Termination Rights
Processing Terms
Fee Structure
Liability
Force Majeure
Representations and Warranties
Security Measures
Dispute Resolution
Governing Law
Notices
Confidentiality
Record Keeping
Electronic Authorization
Indemnification
Banking and Financial Services
Retail
Insurance
Utilities
Telecommunications
Real Estate
Education
Healthcare
Professional Services
E-commerce
Government Services
Finance
Accounts Payable
Treasury
Compliance
Banking Operations
Customer Service
Legal
Risk Management
Administration
Business Operations
Finance Manager
Accounts Payable Specialist
Treasury Manager
Compliance Officer
Banking Operations Manager
Financial Controller
Customer Service Representative
Account Manager
Credit Controller
Payment Processing Officer
Legal Counsel
Risk Management Officer
Administrative Officer
Business Operations Manager
Financial Analyst
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