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The Direct Debit Authorization Form is a fundamental financial document used across various sectors in Canada to establish automated payment arrangements. This form is essential when businesses or organizations need to set up recurring or one-time direct withdrawals from a customer's or client's bank account. The document must comply with Payments Canada Rule H1, PIPEDA, and other relevant federal and provincial regulations. It includes critical information such as the account holder's details, banking information, payment specifications, and clear authorization statements. The form is commonly used for recurring payments such as utility bills, insurance premiums, loan payments, or subscription services, and can be configured for both fixed and variable amount debits. It provides security for both the payor and payee while ensuring transparent terms and clear cancellation rights.

1. Account Holder Information: Details of the account holder(s) including full legal name, address, contact information, and any relevant identification numbers

2. Bank Account Details: Financial institution information, transit number, institution number, and account number

3. Payment Details: Specification of payment amount (fixed or variable), frequency, and start date

4. Authorization Statement: Legal statement confirming the account holder's authorization for direct debits, including acknowledgment of terms and conditions

5. Cancellation Rights: Statement of the account holder's right to cancel the authorization and required notice period

6. Recourse Statement: Information about the account holder's rights and recourse mechanisms for disputed transactions

7. Signature Block: Space for date and signature(s) of authorized account holder(s)