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AUTHORITY TO ACCEPT DIRECT DEBITS

(Not to operate as an assignment or agreement)

AUTHORISATION CODE

To: The Manager, (Please Print Full Postal Address Clearly for Window Envolope)

Date

Bank Branch

Address (P O box)

Town/City

I/We authorise you until further notice in writing to debit my/our account with all amounts which

BOUTIQUE BODY CORPORATES LIMITED

(hereinafter referred to as the Initiator)

The registered Initiator of the above Authorisation Code may initiate by Direct Debit.

I/We acknowledge and accept that the bank accepts this authority only upon the conditions listed on the reverse of this form.

Information to appear to appear in my/our bank statement

PAYER PARTICULARS

PAYER CODE

PAYER REFERENCE

NAME OF ACCOUNT

AUTHORISED SIGNATURE(S)

Approved

For Bank Use Only

BANK STAMP

Date Recorded Checked
Received: By: By:

CONDITION OF THIS AUTHORITY

1. The Initiator:

(a) The Initiator has agreed to give written advance notice of the net amount of each Direct Debit and the Due date of
      debiting at least 10 calendar days before (but not more than 2 calendar months) the date the Direct Debit will be
      initiated. The advance notice will be provided either:

(i) in writing; or
(ii) by electronic mail where the Customer has provided prior written consent to the Initiator

      The advance notice will include the following message:

      "Unless advice to the contrary is received from you by (*date), the amount of $__________ will be directly
      debited to your Bank account on (initiating date)."

*This date will be at least two (2) days prior to the due date to allow for the amendment of Direct Debits.

(b) May, upon the relationship which gave rise to this Authority being terminated, give notice to the Bank that no
      further Direct Debits are to be initiated under the Authority. Upon receipt of such motice the Bank may terminate
      this Authority as to future payments by notice in writing to me/us.

2. The Customer may:

(a) At any time, terminate this Authority as to future payments by giving written notice of termination to the Bank
      and to the Initiator.

(b) Stop payment of any Direct Debit to be initiated under this Authority by the Initiator giving written notice to
      the Bank prior to the Direct being paid by the Bank.

3. The Customer acknowledge that:

(a) This authority will remain in full force and effect in respect of all Direct Debits made from my/our account in
      good faith notwithstanding my/our death, bankruptcy or other revocation of this authority until actual notice of
      such event is received by the Bank.

(b) In any event this Authority is subject to any arrangement now oe hereafter existing between me/us and Bank
      in relation to my/our account.

(c) Any dispute as to the correctness or validity of an amount debited to my/our account shall not be the concern
      of the Bank except in so far as the Direct Debit has not been paid in accordance with this authority. Any other
      disputes lie between me/us and the Initiator.

(d) The Bank accepts no responsibility or liability for the accuracy of information about payments on Bank
      Statements.

(e) The Bank is not responsible for, or under any liability in respect of:
            - any variations between notices given by the Initiator and the amounts of Deirct Debits.
            - the Initiaor's failure to give written advance notice correctly nor for the non-receipt or late receipt of
            notice by me/us for any reason whatsoever. In any such situation the dispute lies between me/us and the
            Initiator.

4. The Bank may:

(a) In its absolute discretion conclusively determine the order of priority of payment by it of any monies pursuant to
      this or any other Authority, cheque or draft properly executed by me/us and give to or drawn on the Bank.

(b) At any time terminate this authority as to future payment by notice in writing to me/us.

(c) Charge its current fees for this service in force from time-to-time.

*Please attach the saved form to an email and send it to us.

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