FORM OF AUTHORITY - PAYMENT OF DAMAGES BY BACS

Client’s Name: Mr Riccardo De Sobral Valente

Client’s Address:
22 Bramshott Place
Fleet
Hampshire
GU51 4QF

Date of Birth: 10/02/1993

Accident Date:
21/09/2023

I, Mr Riccardo De Sobral Valente, hereby authorise Bond Turner to release payment of my

damages via BACS into the account details provided below in relation to the abovementioned
accident.

Account holder’s name: ___________________________________

Account number: ___________________________________

Sort code: ___________________________________

Signed: ___________________________________

Name: ___________________________________

Date: ___________________________________

Ref:
MOJ 1/De Sobral Valente/223325/23
 FORM OF AUTHORITY INSTRUCTIONS

• You must complete the Form of Authority in full.

• You must sign the Form of Authority and provide a copy of your photocard ID
• You must also provide proof of address if the address on your photocard ID is not the same (e.g.
Council tax/ Utility bill)
• You must also provide proof of your sort code and account number.
• The firm will not be held liable for any losses or delays arising out of the provision of inaccurate
details by you or any failure to record account details in an accurate, legible manner. Please
ensure details are recorded accurately, clearly and are easy to read.

PLEASE ADHERE TO THE INSTRUCTION ABOVE AS ANY ERRORS IN THE RETURNED FORM OF
AUTHROITY WILL DELAY THE PROCESSING YOUR BACS PAYMENT.