2. Deputy responsible person details Deputy responsible person details A person within the organisation (Please place an in the appropriate box) ‘X’ nominated to supervise the administrators. The deputy Mr Mrs Miss Ms responsible person will have access to reports documenting the activities Other (please specify) of the administrators and Variable Direct Debit (VDD) account data. There is no limit on the number of deputy responsible persons an organisation can have. *Delivery method of security credentials (Please an in the appropriate box) ‘X’ Postal Electronic VDD details Variable Direct Debit (VDD) details Include VDD key numbers where known. If you are applying for a new If you this section blank, all portal enabled VDD key numbers for VDD key number, enter the account your organisation will be allocated to this deputy responsible person. name. This should correspond to the of account holder(s)’ ‘Name(s) If you only wish to allocate specific VDD key numbers or account that appears on the VDD mandate. names to this deputy responsible person, please enter them all here. A default key number will be allocated to the deputy responsible Enter the default VDD key number/account name person. The lowest key number will be set as the default, unless you indicate otherwise in the space provided. Other VDD key number/account names * Signature This form must be signed and dated on behalf of the _________________________________________________________________________ organisation by the responsible person. *Print name *Date
Deputy responsible person details A person within the organisation nominated to supervise the administrators. The deputy responsible person will have access to reports documenting the activities of the administrators and Variable Direct Debit (VDD) account data. There is no limit on the number of deputy responsible persons an organisation can have. 2. Deputy responsible person details (Please place an ‘X’ in the appropriate box) Mr Mrs Miss Ms Other (please specify) *Delivery method of security credentials (Please an ‘X’ in the appropriate box) Postal Electronic VDD details Include VDD key numbers where known. If you are applying for a new VDD key number, enter the account name. This should correspond to the ‘Name(s) of account holder(s)’ that appears on the VDD mandate. A default key number will be allocated to the deputy responsible person. The lowest key number will be set as the default, unless you indicate otherwise in the space provided. Variable Direct Debit (VDD) details If you this section blank, all portal enabled VDD key numbers for your organisation will be allocated to this deputy responsible person. If you only wish to allocate specific VDD key numbers or account names to this deputy responsible person, please enter them all here. Enter the default VDD key number/account name Other VDD key number/account names This form must be signed and dated on behalf of the organisation by the responsible person. * Signature _________________________________________________________________________ *Print name *Date
AFS5a_11_17_HMLR.docx