[Please print on company letterhead]

To: Manager / Team Leader,

Payroll Department, DOZ B1F2,
Mashreqbank psc,
Dubai Outsource Zone, Dubai (Bank).

Date: DD/MM/YYYY_

Dear Sir,
Re:- Debit Authority Letter for Salary Payment Services - WPS
We,
, [Please insert employers name] (Customer)
hereby request that the Bank debit the Customers account, details of which are given below for the Total File Amount and transfer
the Total File Amount, representing the wages of the Customers employees, to the employees respective accounts maintained
with the financial entities as per the Customers instructions (Request) through the WPS system.
The account details are as follows:
Customer Account No
SIF File Name
Value Date (Not before)

Total File Amount

No of employees

Customer MOL ID

In case of any communication / clarification on this Request, please contact the following persons as per their details.
Name
Telephone #

Mobile #

Mobile #

E-mail Add

I/We, hereby confirm that we have, read the Mashreq Salary Payment Services Banking Services Terms and Conditions (Terms
and Conditions) and/or signed the Mashreq Salary Payment Services Banking Services Agreement (Agreement). By our
signature on this Debit Authority, we, on behalf of the Customer, hereby confirm our acceptance of the provisions in the Terms
and Conditions and/or Agreement and agree to abide by it.
I / We, the undersigned further confirm that we have been duly authorised by the Customer to issue this Debit Authority and to
confirm our acceptance of the Terms and Conditions and/or Agreement. I/We request the Bank to proceed with the Request.
Regards,
For and on behalf of
Customers name and stamp:
Sign:
Name:
Designation:
(Authorised signatures should be as per account operation rights)
Attachments
1. SIF file in non-rewriteable CD
2. Print-out of the SIF File with company stamp and signature.

Sign:
Name:
Designation: