To The Manager by zau9tzT

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									                               BANK WAIVER LETTER                               APPENDIX 4

This form will be sent to the Bank where you hold your Direct Payment account. Please
complete and return this form as soon as possible.

To : The Manager                                                    Date :

Bank           ……………………………………………………….

Address        ……………………………………………………….

               ……………………………………………………….

Post Code      ……………………………………………………….


Dear Sir/Madam,

Please find below, details of the account I established when I became a member of the Direct
Payment scheme with the London Borough of Merton. Although held in my name, this is not a
personal account and was set up to receive funds in order for me to purchase Community
Care Services direct and support me in living a fully independent life.
Monies paid into this account by the London Borough of Merton are not my personal income
and may not be regarded as such. In the event that the legal agreement supporting this
arrangement is terminated, suspended or in the event of death, any unspent funds in the
account must be returned to:

The London Borough of Merton , Direct Payment Finance Officer ,5th Floor Civic Centre
London Road ,Morden ,SM4 5DX

Account holders name:                ……………………………………………………….

Sort Code:                           ……………………………………………………….

Account Number:                      ……………………………………………………….

Address of Account holder:           ……………………………………………………….

                                     ……………………………………………………….

                                     ……………………………………………………….

                                     Postcode…………………………………………….

Tel. No.                             ……………………………………………………….

Name of Service user:                ……………………………………………………….

Yours faithfully

Signed :                                             Print Name :




DP Appendix 4 – bank waiver letter
Sept 2007

								
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