Ingénieur - Pre-authorized withdrawals

Formulaire - Prélèvements pré-autorisés NID 2099 EN

Monthly pre-authorized withdrawals  

 

Required fields*

BANK ACCOUNT INFORMATION

Numéro civique et rue

specimen.jpg

(example : 12345)
(example : 123)
(example : 1234567)
If more than one signature is required on withdrawals issued against the account, bot account holders must accept the present authorization

AUTHORIZATION

Non-Checking account

Comme l’approbation de mon/notre institution financière est requise pour les paiements préautorisés à partir des comptes sans privilège de chèques, j’ai/nous avons pris les dispositions nécessaires pour permettre les prélèvements surmon/notre compte. J’ai/nous avons joint à la présente un bordereau de retrait portant le timbre d’approbation de mon/notre institution financière et attestant que les montants exigibles peuvent être prélevés sur mon/notre compte d’épargne véritable.

You may obtain a sample cancellation form by contacting your financial institution or through www.cdnpay.ca If you have any questions about withdrawals from your bank account, contact us at 1 800 361-5303, information@sogemec.qc.ca or write to us at Sogemec Assurances inc., 2, Complexe Desjardins, East Tower, 20th Floor, P.O. Box 217, Desjardins Station, Montreal, Quebec H5B 1G9.

 

You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any PAD withdrawal that is not authorized or is inconsistent with this PAS agreement. To obtain a form for a Reimbursement Claim, or for more information on your recourse rights, you may contact your financial institution or visit www.cdnpay.ca.

 

You may obtain a sample cancellation form by contacting your financial institution or through www.cdnpay.ca If you have any questions about withdrawals from your bank account, contact us at 1 800 361-5303, information@sogemec.qc.ca or write to us at Sogemec Assurances inc., 2, Complexe Desjardins, East Tower, 20th Floor, P.O. Box 217, Desjardins Station, Montreal, Quebec H5B 1G9.

 

You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any PAD withdrawal that is not authorized or is inconsistent with this PAS agreement. To obtain a form for a Reimbursement Claim, or for more information on your recourse rights, you may contact your financial institution or visit www.cdnpay.ca.