For Customer use only

To NatWest ..................................................................................................Branch


Please make the following payments by means of the NatWest Autopay Service. The names of the beneficiaries and the respective payment amounts and autopay reference numbers are detailed below.
Name of account to be debited
.........................................................................
Authorised Signatures
....................................................................................
For completion by Customer
Final total to be debited
NAR DR £1,379.46

Account Number
Name of Beneficiary
John Smith
Total
Amount of payment
£1,379.46
£1,379.46

For Bank Use Only

Signature confirmed
Date to be keyed checked
For Facsimile Instructions
Indemnity held? Yes/No
Name of customer contact


Initial
.........
.........

.........
.................................



Account checked for funds

Call back made by


Initial
.........

.........
Keyed by: ..........................................................................
Waste and sequence number of final credit entry ............................................


Retain with Day’s Work

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