Dp Gen Form – Fill Out and Use This PDF

About payment into an account

Before we can start making payments into an account we need the account details. Please read these notes before completing the form.

About the account you would like your benefit, pension or allowance paid into

You will find the account details on your cheque book, passbook or

statementsYou. Paymustents canusebe madetheintoPrintmost bankButtonor buildi gatsocietythe end of this form accounts but not some mortgage and business accounts. Please check with

the office that pays you. Not all accounts are accessible at the Post Office¨.

If this is important to you, please remember to ask your bank or building society whether you can useInvalidyour account t the Post Office¨Claim!.

If you are not sure about the details, sk the bank or building society.

If not enough money is paid into the account

We will make another payment to you or add the money we owe you onto your next payment. We will contact you to tell you what we are going to do.

Sometimes we may pay too much money into your account

If this is because of the way the system works for payments direct into an account, we have the right to recover any money you are not entitled to. For example, you may give us information which means you are entitled to less money but we may not be able to change the amount already sent out. We will contact you first if we propose to recover money under this rule.

You should tell us immediately if you change your account.

Please fill in this form and sign and date it. Then return it to us as soon as possible.

Please make sure that you have completed ALL the details on this form.

About you

Your surname

Other names

Address

		Postcode
Letters Numbers		Letter

National Insurance (NI) number

Name of the benefit, pension or allowance to be paid into the account

About payment into an account continued

About the account you want to use

What name or names is the account in?

Please write the name or names as they appear on the cheque book, passbook or statement.

Full name of bank or building society

For a Post Office¨ card account insert the words Post Office.

Sort code

Please tell us all six numbers, for example: 12-34-56.

Account number

This is 7 to 10 numbers long.

And the roll or reference number if it is a building society account. The number is on the passbook.

The roll or reference can contain letters and numbers and can be up to 18 characters long.

Your declaration

I have read the notes on the front page.

I agree to my payment being paid directly into the account I have chosen. I understand that the Department has the right to recover overpayments caused by the way the system works for direct payment as described in the notes.

I confirm that if I have chosen an account of the person acting on my behalf or an account in my name and the person acting on my behalf, I will authorise them to use the money in the way I tell them.

For office use	Issued by
	Payment frequency