<Creditor Name> (mandatory)
<Creditor Identification> (mandatory)
<Creditor Street Name and Number> (mandatory)
<Creditor Postal Code> <Creditor City> (mandatory)
<Creditor Country> (mandatory)
The debtor must return this B2B mandate to the creditor and must confirm the data on his B2B mandate to his banker by giving him a copy containing valid original signature(s).
V 1.4
SEPA Business-to-Business Direct Debit Mandate
By signing this mandate form, you authorise (A) the Creditor to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from the Creditor.
This mandate is only intended for business-to-business transactions. You are not entitled to a refund from your bank after your account has been debited, but you are entitled to request your bank not to debit your account up until the day on which the payment is due.
All fields are mandatory.
Mandate Identification (To be completed by the Creditor)
Mandate reference: (Maximum 35 characters)l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l_l
In respect of the contract: / ______
Type of Payment: / recurrent or one-off
(can be used more than once) (can only be used once)
Debtor Identification (To be completed by the Debtor)
Name: / ______(maximum 70 characters)
Address: / ______
(maximum 70 characters)
Postcode: / ______/ City: / ______
Country: / ______
(You can find your IBAN Number and BIC as info on the paper statements)
Account number (IBAN): / ______
Your bank BIC: / ______
(BIC, maximum 11 characters, not mandatory in Belgium)
Date: / ____/ ____/ ______/ Place: / ______
Name: / ______/ Name[1]: / ______
Signature(s)
Il debitore deve inviare questo mandato al creditore, oltre a spedirne una copia debitamente firmata alla propria banca.
V 1.3 July 2012
[1] If two signatures are necessary for the indicated account, this mandate also requires these two signatures.