**Supplier to complete this form**

Part A: Supplier Bank Details Business Name PIN Number VAT Number Physical Address Business Address Phone Number Fax Number Email Address Contact Name The group's standard terms are 45 days from date of statement (end of month), provided all invoices are received within the first week of the respective month. These terms of trade may only be varied by specific contractual arrangements or with the approval of the Chief Finance Officer. Name of Bank Name of Branch Bank Account Name Bank Account Number Bank Code Branch Code Part B: Authorisation The undersigned hereby:I. Expressly authorises Scangroup of Companies to make all future invoice payments to the above named Account. II. Confirm that in the event of any changes to the bank details, such details will be notified to Scangroup of Companies in writing. III. Accepts as final proof of payment, the bank account records and /or Remittance advice indicating payment made to the bank account number referred to above. IV. Indemnifies Scangroup of companies against any loss and / or liability whatsoever arising from this instruction. Approved by (Print Name(s) Clearly Authorised Signatory (s) Authorised Signatory (s)