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CREDIT BUREAU CHECKS: DEBIT AUTHORIZATION FORM

I/We consent to the Bank conducting credit checks on me/us from at least 2 credit bureaus as a

condition for processing my/our facility application, in line with regulatory requirements.

I/We hereby authorize the Bank to debit my/our account number ……………………………… for the

sum of =N= ………………… Retail Search (=N=3,500) Corporate/Business Search (=N=3,500) upon

receipt of negative credit report, from 2 credit bureaus in respect of my/our facility application.

Authorized by

…………………………… …………………………………..
Name/Signature/Date Name/Signature/Date

For Bank Use Only

The sum of =N= ……………. for credit bureau checks has been debited to customer’s

account/collected in cash from customer, and credited to the Credit Bureau Charges SRA

0002249417.

Branch:

Teller Name/Signature/Date:

Teller Stamp:

ASO Name/Signature/Date:

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