Payment Consent Form Template for England and Wales

A Payment Consent Form is a legal document used in England and Wales that establishes authorization for payment processing between parties. It complies with the Payment Services Regulations 2017 and related financial services legislation, ensuring proper consent for payment transactions and data processing. The document includes essential details about payment arrangements, customer information, and authorization specifics, while adhering to both UK financial regulations and data protection requirements.

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What is a Payment Consent Form?

The Payment Consent Form is a crucial document used in England and Wales to establish clear authorization for payment processing. It is designed to comply with the Payment Services Regulations 2017, GDPR, and other relevant financial services legislation. This document is essential when setting up regular payments, direct debits, or one-time payment authorizations. It typically includes customer details, payment specifications, data processing consent, and clear authorization language. The form serves as both a legal record of consent and a practical tool for payment processing.

What sections should be included in a Payment Consent Form?

1. Customer Information: Full name, contact details, and account information of the customer providing consent

2. Payment Details: Specific details about the payment(s) including amount, frequency, duration, and payment method

3. Authorization Statement: Clear and explicit consent language for payment processing, compliant with PSR 2017

4. Data Processing Notice: GDPR-compliant statement on how personal information will be used and stored

5. Signature Block: Space for customer signature, date, and any witness requirements if applicable

What sections are optional to include in a Payment Consent Form?

1. Variable Payment Terms: Additional terms for recurring payments with variable amounts, including maximum payment limits and notification requirements

2. Cancellation Rights: Details of the process and timeframes for withdrawing payment consent

3. Third Party Authorization: Specific permissions and conditions for delegating payment management to other parties

What schedules should be included in a Payment Consent Form?

1. Payment Schedule: Detailed breakdown of payment dates, amounts, and any variable payment calculations

2. Terms and Conditions: Complete terms governing the payment arrangement including rights and obligations

3. Privacy Notice: Comprehensive information about data processing practices, retention periods, and data subject rights

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok��˰� | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents

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Assent Form

A legal template under English and Welsh law used to obtain formal agreement from individuals who may not have full legal capacity to provide consent.

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Generate a Bespoke Document

Download a Standard Payment Consent Form

Review your own Payment Consent Form

What is a Payment Consent Form?

What sections should be included in a Payment Consent Form?

What sections are optional to include in a Payment Consent Form?

What schedules should be included in a Payment Consent Form?

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