Instruction To Your Bank or Building Society To Pay by Direct Debit

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Instruction to your Bank or

Building Society to pay


by Direct Debit

Please fill in the whole form using a ball point pen:

The Fitness Centre


The University of Nottingham
University Park
Nottingham
Service user number
NG7 2RD

9 4 8 5 0 7

Name(s) of Account Holder(s) Reference

Ty Tankard D R S V 1 2 4 3

Bank/Building Society account number


Instruction to your Bank or Building Society
5 2 6 5 0 4 4 4 Please pay University of Nottingham Direct Debits from the account
detailed in this Instruction subject to the safeguards assured by the
detailed
Direct in this
Debit Instruction subject to the safeguards assured by the Direct
Guarantee.
Branch Sort Code Debit Guarantee.

4 0 1 7 1 4 and, if so, details


I understand thatmay be passed may
this Instruction electronically to my
remain with University of
Bank/Building
Nottingham and,Society.
if so, details will be passed electronically to my
Bank/Building Society.
Name and full postal address of your Bank or Building Society
To: The Manager Bank/Building Society
HSBC BANK PLC
Address Signature(s)
P O Box 16
47 Eastgate St
Postcode Date
Chester CH1 1XW 25/12/2016

Banks and Building Societies may not accept Direct Debit Instructions from some types of account

This guarantee should be detached and retained by the Payer.

The
Direct Debit
Guarantee
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UHIXQGRIWKHDPRXQWSDLGIURP\RXUEDQNRUEXLOGLQJVRFLHW\

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