HAP Standing Order Form

• Published date: 01 July 2020
• Issuer: Department of Housing, Local Government and Heritage

To the

Manager

Branch

Address

I /We hereby authorise and request you to debit my/ our account

(Details of the account from which payments will be made)

Account

Name:

BIC (optional

1s1

IBAN

Details of the account to which payments will be made

Account

Name: HAP SHARED SERVICES CENTRE LIMERICK CITY & COUNTY COUNCIL

BIC

IBAN

*Reference

(Your HAP Recipient/Customer ID + HAP) to identify your payment

Start Date

Frequency Weekly

Weekly

Amount

Signature

Signature

Please allow 5 working days prior to the first payment due date.

H

A

P

A

I

B

K

I

E

2

D

I

E

3

7

A

I

B

K

9

3

5

4

7

6

0

7

9

3

6

0

3

4

€

.

Date

Date