No. 10 – Instruction to cancel a direct debit authorisation
Use this sample letter to instruct your bank or financial institution to cancel a direct debit authorisation.
This sample letter is for information only and should not be relied upon as legal advice. The information
applies only in Victoria, and was updated on 16 September 2009.
[Date] [Your street]
[Your suburb and postcode]
[Your phone number]
[Street number and name]
[Suburb and postcode]
Dear [ ],
Subject: Instruction to cancel direct debit authority
Name: [Your Name] Account Reference No. [your number]
I am writing to instruct you that I hereby cancel and withdraw any previous authority I have granted the
bank to make direct debit transactions in relation to my bank account number [xxxx xxxxx].
At present you are authorised to make the following direct debits from my account:
Payee Amount Frequency Next due date
Lifestyle gym $40 monthly day month year
AGL electricity (full amount of account) as issued by AGL not known
Health insurance $ 1600 Annually 30 June 2010
My instructions are now that, in accordance with the Code of Banking Practice, you cancel all of the
above direct debits immediately on receipt of this letter, and any other claims for direct debit payment
from my account.
I shall be advising all of the above payees that I have cancelled my direct debit authority and I will not
accept responsibility for direct debits or any fees or charges as a result of direct debit activity in my
Please give this matter your earliest attention, and advise me in writing when you have carried out this
[your name and signature]