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Direct Debit Request Service Agreement

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Direct Debit or Credit Card Request

August 2022

Zurich Australia Limited (Zurich, OnePath)

ABN 92 000 010 195 AFSL 232510

Customer Care
Phone 133 667

Please note you can change the details of your direct debit or credit card over the phone on 133 667.

Policy number

Name of policy owner or company name (you)

Address of policy owner

Suburb/Town State Postcode

Phone

Mobile Email

ACN/ARBN number

Payment details

Preferred billing date

Note: Preferred billing date is an optional field. Only complete this if a preferred billing day is required.

Instructions

Complete Section 1 to provide your Direct Debit Authority, or complete Section 2 to provide your Credit Card Authority. (Complete one Section only). Section 3 is optional to change your payment frequency.

If the account holder or card holder is different to the policy owner(s), please complete Section 4.

Note: There may be tax implications due to the premiums being paid from a personal account. Speak to your financial or tax adviser on how this may affect you.

Section 1: Direct Debit Authority

Direct debit is not available from all account types. If in doubt, please check with your financial institution.

By signing this Direct Debit Authority I/we acknowledge having read and understood the Direct Debit Request Service Agreement and the Privacy Policy on page 2 of this form, and are bound by the terms and conditions contained in this authorisation.

I/We request and authorise OnePath (user number 219313) to arrange for any amount OnePath may debit or charge me to be debited through the Bulk Electronic Clearing System from an account held at the financial institution identified below subject to the terms and conditions of the Direct Debit Request Service Agreement.

Name of financial institution

Details of account to be debited

Name of account

BSB number Account number

Signature (if direct debit is from a joint account, provide all signatures)

Signature of account holder

Date (dd/mm/yyyy)

Signature of account holder

Date (dd/mm/yyyy)

Section 2: Credit Card Authority

I/We understand my/our financial institution may charge a processing fee to my/our credit card for each payment that is made under this authorisation. I/We acknowledge it is my/our responsibility to notify OnePath of any material change in credit card details, including a new expiry date. By signing this Credit Card Authority, I acknowledge having read and understood the Privacy Policy on page 2 of this form.

I authorise OnePath to charge my Visa Mastercard

Card holder’s name

Card number Expiry date

Card holder’s signature

Date (dd/mm/yyyy)

Section 3 (Optional): Change of Payment Frequency

Note: This Section is optional and will need to be completed only if Payment Frequency change is required.

monthly half yearly yearly

Please note: Paying monthly or half-yearly will incur a payment frequency loading to your premium. If selected, the following payment frequency loading will apply to your OneCare policy:

  • monthly 6% loading (5% for OnePath, life risk advised policies excluding OneCare)
  • half-yearly 3% loading
  • yearly 0% loading

Section 4: Policy owner(s) consent required if different to the account holder or card holder.

I/We consent to the change of payment method and payment frequency.

Signature(s) of policy owner(s)

Date (dd/mm/yyyy)

Signature(s) of policy owner(s)

Date (dd/mm/yyyy)

Direct Debit Request Service Agreement

Our commitment to you

We will:

  • arrange for funds to be debited from your account as authorised in the Direct Debit Request
  • give you at least 14 days’ notice in writing before changing the terms of the debiting arrangements, unless you request the change
  • keep information about your Direct Debit Request private and confidential unless otherwise required by the Bulk Electronic Clearing System (BECS) rules.

If the date on which we usually debit your account falls on a weekend or public holiday, your account will be debited on the next working day.

Your commitment to us

It is your responsibility to:

  • ensure your nominated account can accept direct debits and that all account holders on the nominated account agree to the debiting arrangements
  • ensure that the account details that you have provided are correct by checking them against a recent account statement
  • advise us if the nominated account is transferred or closed, or the account details have changed
  • ensure there are sufficient funds available in the nominated account to meet each direct debit
  • check with the financial institution if you have any queries about how to complete the Direct Debit Request.

If there are insufficient funds in the nominated account, the financial institution may charge a fee and/or interest. We will not charge a fee. You may arrange for the debit payment to be made by another method or arrange for sufficient clear funds to be in your account by an agreed time so that we can process the debit payment.

Your rights

You may defer, alter or cancel the debiting arrangements you hold with us by providing notice to us or through your nominated financial institution. We must receive notice at least 14 days before the next debit is due.

If you consider that your account has been debited incorrectly, you should contact us directly. We will investigate your query.

If we find that your account has been incorrectly debited we will arrange for your financial institution to adjust your account (including interest and charges) accordingly. We will also notify you in writing of the amount by which your account has been adjusted.

If we find that your account has not been incorrectly debited, we will provide you with reasons and any evidence for this finding in writing.

If we cannot resolve the matter, you can refer it to your financial institution, which may lodge a claim on your behalf.

Privacy Policy

I consent to the collection, use, storage and disclosure of my personal information as described in the Privacy Policy and the Privacy Statement contained in the PDS (including discussing any information obtained from me and any doctors or accountants with the financial adviser associated with this application). OnePath’s Privacy Policy is available at onepath.com.au/about-us/privacy-policy

If I have provided personal information about any identified person, I declare that I have their permission to do so and I have informed them of the Privacy Policy and the Privacy Statement.

RHEN-018675-2022 574138_OPLM0029_0822

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What the Direct Debit Request Service Agreement Is

A Direct Debit Request Service Agreement is a written authorization that allows a payee or biller to initiate ACH or bank debits from a payer's account on a recurring or one-time basis. It documents account details, payment schedule, maximum amounts, revocation terms, and legal consent required under electronic transaction laws while establishing operational and compliance expectations between the parties.

Why a Clear Direct Debit Agreement Matters

A properly completed Direct Debit Request Service Agreement minimizes payment disputes, clarifies authorization scope, and supports compliance with federal electronic-signature and banking rules, improving reconciliation and reducing chargebacks for both billers and customers.

Why a Clear Direct Debit Agreement Matters

Who Typically Completes This Agreement

The Direct Debit Request Service Agreement is used by organizations that collect recurring or scheduled payments electronically.

  • Commercial billers and subscription services that collect recurring ACH payments from customers.
  • Financial institutions and payment processors that originate ACH debits on behalf of clients.
  • Property managers, utilities, and service providers that require regular customer debits.

Use this agreement when you need documented payer consent, consistent payment timing, and an auditable record to support electronic debits.

Core Elements to Include in the Agreement

A professional Direct Debit Request Service Agreement should be structured and unambiguous to protect both payer and payee, and to align with banking/ACH requirements.

Authorization Details

Describe payer consent scope, one-time or recurring status, and the exact authorization language required for ACH originators and banks.

Bank Account Data

Collect payer routing and account numbers, account type (checking/savings), and instructions for attaching voided checks or micro-deposit proof.

Payment Schedule

Specify frequency, exact debit dates or trigger events, and any holiday or weekend processing rules that affect settlement.

Amount and Limits

State the regular amount, maximum single-debit cap, and whether amounts may vary with notice to the payer.

Cancellation Terms

Explain how the payer may revoke authorization, required notice period, and the effect on pending debits.

Privacy & Compliance

Include data handling terms, references to applicable privacy rules, and any required consumer disclosures.

Step-by-Step: Completing the Agreement

Follow these steps to collect valid authorization and reduce processing errors.

  • 01
    Gather documents: Collect voided check or bank verification.
  • 02
    Enter details: Type routing/account numbers and payer name.
  • 03
    Set schedule: Confirm dates, frequency, and amounts.
  • 04
    Sign and submit: Obtain signatures and deliver to originator.

How to Configure the Online Workflow

Configure validation and authentication to reduce returns and ensure auditable consent.

Field Settings Field | Configuration
Authentication Email + optional SMS OTP | Stronger verification
Field Validation Routing checksum | Prevent invalid routing entries
Conditional Logic Revocation notice fields | Display on cancel
Storage Encrypted storage | AES-256 at rest

Where to Send or File the Completed Agreement

After signatures, route the agreement to the appropriate parties and retain an auditable copy.

  • Submit to Biller: Deliver signed authorization to billing operations.
  • Send to Originator: Provide to your ACH originator or bank.
  • Bank Processing: Originator transmits to ACH network for settlement.
  • Retain Copy: Keep signed copy for compliance and audits.

Digital Signing and Technical Requirements

Use a platform that supports secure e-signing, auditable trails, and the document formats you work with.

  • Integrations: CRM and ERP integrations supported
  • Formats: PDF, DOCX, and HTML
  • Authentication: Email, SMS OTP, or KBA

Timing and Processing Expectations

Understand operational cutoffs and notice periods to avoid failed debits and disputes.

Submission Cutoff:

Submit authorizations before the billing cycle cutoff.

Bank Settlement Time:

ACH settlement typically 1–3 business days.

Change Notice:

Provide at least 3 business days' notice for schedule changes.

Revocation Timing:

Payer revocation may require advance notice to stop debits.

Record Retention:

Keep signed authorizations per retention guidelines.

Common Mistakes to Avoid

  • Entering an incorrect routing or account number, which commonly causes returned transactions and reconciliation issues.
  • Using vague authorization language that does not clearly permit recurring debits or variable amounts.
  • Failing to obtain a dated signature or electronic consent that meets ESIGN/UETA consent requirements.
  • Not retaining a signed copy or audit trail, which complicates dispute resolution and compliance verification.

Penalties and Risks of Errors

Bank Fees: Possible return or NSF fees.
Unauthorized Debit Liability: Regulation E protections apply.
Chargebacks: Disputes can reverse debits.
Unenforceable Authorization: Poor wording may invalidate consent.
Operational Delays: Incorrect data increases processing time.
Regulatory Exposure: Noncompliance may trigger audits.

eSignature Pricing and Feature Comparison

Vendor pricing and core capabilities for signing and storing Direct Debit Request Service Agreements; signNow appears first for direct feature comparison.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial Yes, 7-day trial No No No No
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Security and Compliance Essentials

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest
Certifications: SOC 2 Type II; ISO 27001
Healthcare: HIPAA support available with BAA
Regulated Records: 21 CFR Part 11 compliance options
Privacy: GDPR and CCPA controls
Audit Trail: Tamper-evident action log

Real-World Examples of Use

These examples show how organizations used a Direct Debit Request Service Agreement to streamline collections and maintain compliance.

Optica Ventures — COO

Optica Ventures moved recurring collections online to eliminate paper checks and phone calls, speeding remittance and reconciliation.

  • Reduced manual processing time significantly.
  • The interface was simple for our team and customers, allowing us to process recurring authorizations with consistent audit trails and faster settlement while lowering administrative overhead.

Fertility Centers — Founder

A healthcare provider adopted online direct debit authorizations to collect patient payments while preserving privacy and auditability.

  • Ensured HIPAA-conscious handling.
  • The platform delivered necessary security controls, responsive support, and reliable records retention, enabling compliant patient billing and fewer payment disputes.

Practical Tips for Accurate Agreement Completion

Follow these best practices to reduce errors and disputes when collecting debit authorizations.

Verify account details twice
Confirm routing and account numbers directly from a voided check or bank verification to avoid returned transactions and reconcile payments faster.
Use clear authorization language
State whether authorization is one-time or recurring, specify amounts or maximums, and include revocation instructions for enforceability and reduced disputes.
Retain auditable records
Keep signed copies and a complete audit trail including timestamps, IP addresses, and authentication evidence to support dispute resolution and regulatory compliance.
Match authentication to risk
Use stronger verification (SMS OTP or KBA) for high-dollar or recurring agreements and simpler methods for low-risk, infrequent debits.

FAQs and Troubleshooting

Answers to frequent questions about using and enforcing Direct Debit Request Service Agreements, including e-signature acceptability and revocation.


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