Creditor name and address:

Date:

Your name and address:



Dear Sir/Madam
Account/Agreement No: xxxxxxxxxxxxxx
Cancellation of Continuous Payment Authority

My loan with is being paid using a continuous payment authority.

I’m withdrawing my authorisation for any more payments to be taken from my account for this debt.

The last 4 digits of the card these payments are being taken from are <1234>.

In line with the Payment Services Regulations 2009 any more payments taken from the card will be treated as an unauthorised transaction.

Please send me confirmation you have done this.

Yours faithfully