Pre-Authorized Debit (PAD) Application Form

PAD Application form

Pre-authorized Debit (PAD) Application (the "authorization")
  • Date: 10/22/2020

  • Estate information

  • Banking information

  • Accepted file types: jpg, png, pdf, jpeg.
    (Please ensure to upload a specimen "VOID" cheque to this application)
  • Date Format: MM slash DD slash YYYY
    Cancelling the Authorization does not affect the obligations of the Debtor(s) pursuant to the terms outlined in the proposal/bankruptcy documents.

    (i) the PAD was not drawn in accordance with this Authorization;
    (ii) this Authorization was revoked in accordance with section 7 above.

    I/we acknowledge and agree that in order to be reimbursed a declaration to the effect that either (i) or (ii) took place, must be completed and presented to the branch of the Processing Member holding the account up to and including 30 business days after the date on which the PAD in dispute was posted to the Account. In the event that that such declaration is not provided within the time period described, the dispute shall be resolved solely between us and SCB outside of the payments system.

    I/we have certain recourse rights if any debit does not comply with the terms of the Authorization. For example, we have the right to receive reimbursement for any debit which is not authorized or is not consistent with this Authorization. To obtain more information on our recourse rights, we may contact the Processing Member or visit

  • If you are unable to complete the electronic signature you are required to print and sign the form and submit it by fax or email. Upon submission, the results of this form will be emailed to you. Simply print your email, sign and fax back to us.
  • This field is for validation purposes and should be left unchanged.