Pre Authorized Debit Form

Pre Authorized Debit Form Template for Belgium

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Key Requirements PROMPT example:

"I need a Pre-Authorized Debit Form in Belgian jurisdiction for my subscription-based software company, allowing monthly recurring payments from customers with a maximum limit of €500 per transaction and the option for customers to choose between French and Dutch languages."

Document background

The Pre-Authorized Debit Form is a crucial financial document used in the Belgian market to establish automated payment arrangements between parties. It enables businesses and service providers to collect recurring or one-off payments directly from customers' bank accounts, subject to prior authorization. The document must comply with Belgian banking laws, SEPA regulations, and EU directives (particularly PSD2 and GDPR). This form is essential for businesses that process regular payments and provides a secure, standardized method for setting up direct debits within the Belgian banking system. It includes mandatory elements such as the SEPA mandate reference, account holder details, creditor information, and specific authorization parameters. The form serves as both a legal record of the account holder's consent and an operational tool for initiating automated payments.

Suggested Sections

1. Account Holder Information: Details of the account holder including full name, address, and contact information as required by GDPR and banking regulations

2. Bank Account Details: IBAN and BIC/SWIFT code of the account to be debited

3. Creditor Information: Details of the company/entity receiving the payments, including their creditor identifier

4. Mandate Reference: Unique mandate reference number (to be completed by the creditor)

5. Type of Payment: Specification of whether this is a one-off or recurring payment authorization

6. Payment Details: Amount or calculation method, frequency, and duration of the authorized debits

7. Authorization Declaration: Legal declaration confirming the account holder's authorization for direct debits

8. Data Protection Notice: GDPR-compliant statement about how personal data will be processed

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

Optional Sections

1. Secondary Account Holder: Section for joint account holders' details and authorization, used when the account requires multiple signatories

2. Specific Debit Conditions: Additional conditions such as maximum amount limits or specific debit dates, used when there are special arrangements

3. Digital Consent: Alternative to physical signature for electronic forms, used when implementing digital authorization

4. Cancellation Rights: Detailed explanation of cancellation procedures, used when required by specific creditor policies

5. Language Selection: Option to choose between French, Dutch, or German versions, used in multilingual regions of Belgium

Suggested Schedules

1. Terms and Conditions: Standard terms and conditions for the direct debit mandate

2. Privacy Policy: Detailed privacy policy explaining data processing practices

3. Revocation Form: Standard form for future cancellation of the mandate

4. Payment Schedule: If applicable, detailed schedule of planned debit dates and amounts

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok��˰� | 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

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Banking and Financial Services

Insurance

Utilities

Telecommunications

Property Management

Professional Services

Retail and E-commerce

Education

Healthcare

Subscription Services

Non-profit Organizations

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Finance

Legal

Compliance

Customer Service

Operations

Treasury

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Accounts Receivable

Banking Operations

Credit Control

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Finance Manager

Accounts Receivable Specialist

Billing Coordinator

Compliance Officer

Legal Counsel

Customer Service Manager

Banking Operations Manager

Treasury Analyst

Credit Controller

Financial Controller

Payment Services Manager

Business Operations Manager

Accounts Manager

Sales Administration Manager

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