Ending a Direct Debit Authorization (Mail to Bank) (Document Template)

This letter is used to terminate a direct debit authorization. You have to send it to your bank.

Your first and last names

your contact information

Your account number

Name and address of the bank

TO town, on date

Subject: Cancelation of a direct debit permit

Madam, Sir,

I pay every month on the (...) by deduction the sum of (amount of the levy in figures and letters) on the account of (creditor's name ).

I hereby request you to cancel this direct debit as of (date).

I thank you in advance, and I ask you to accept, Madam, Sir, the expression of my esteemed consideration.

Verified 28 February 2017 - Directorate for Legal and Administrative Information (Prime Minister)

For details, please use the practical information sheets :

Je donne mon avis sur Services Publics +. L'administration concernée me répondra.