Fillable Fee Account - Customer Application Form (Cabinet Office)

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Fee Account - Customer Application Form (Cabinet Office)

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Fee Account - Customer Application Form
Section 1 - Details of the applying organisation
1.1 Full legal name of applicant organisation:
1.2 Type of organisation:
Number of years trading
1.4 Key shareholders and/or
Parent Company
1.5 Full registered office address:
Address
PostcodeTown
1.6 Contact details:
Name
Position/Title
Email
1.7 Are you an existing HM Courts & Tribunals Service direct debit customer?
If Yes, enter your customer reference(s).
Reference(s)
If your organisation type is 'other' please
provide details of the sector in which you
operate and membership of any Trade or
Regulatory Organisation:
No Yes
As part of this Customer Agreement, a consumer credit search will be carried out by an appointed credit reference agency
against their consumer information database, either on the directors of the company or the owners of the business. A note of this
search will appear on your consumer credit file, but will not affect your ability to obtain credit in the future. Please note, we will
only carry out a consumer credit search on any director who is an officer of a registered company that is either a 'Small company'
as defined under s247(2) of the Companies Act 1985, or that is a newly formed company which has yet to file its first set of
accounts.
Please note that you may consent for such a search to be conducted of up to 2 other owners or directors, provided that (i)
your business has no more than 3 owner/director; and (ii) you are empowered by both director/owner 2 and 3 to give
consent for such a search to be conducted on them.
Government departments and local authorities will be subject to separate arrangements and will not be required to undergo a
credit check.
Registration No.
Limited Company/LLP/PLC
Registration No.
Registered with Law Society
FSA member
Registered with Tenant
Services Authority
%
Telephone
1.8 Does your parent company or any subsidiary companies have an existing Fee Account facility with HM
Courts & Tribunals Service?
If Yes, enter their Fee Account number.
Fee Account Number
No Yes
1.3 Credit limit required
£
Section 3 - Secondary contact
Telephone
Email
Position/Title
Name
3.1 Contact details:
Section 2 - Trading details (if different from Section 1)
2.1 Trading name:
Telephone
Email
Position/Title
Name
2.3 Contact details:
PostcodeTown
Address
2.2 Trading address:
Section 4 - Billing details
4.1 Billing address:
PostcodeTown
Address
Telephone
Email
Position/Title
Name
4.2 Billing contact:
4.3 Billing email:
As in Section 1 As in Section 2 As below
As in Section 1 As in Section 2 As below
The billing email address must be a generic email account that is monitored constantly and to which correspondence can
be sent (eg ask@abc.co.uk). It cannot be a personal email address (eg jo@abc.co.uk).
NOTE: All account information correspondence will be to this Billing email address.
4.4 Do you want to receive weekly or monthly invoices
Do you want to receive your invoices electronically
If, yes do you require .xml format in addition to the pdf?
Yes No
Yes No
Weekly Monthly
Section 6 - Declaration
By ticking the declaration boxes and submitting this application form you confirm that you are authorised to complete
this form on your organisation's behalf and that :
The details supplied in this application are correct
You have read and understand the Terms & Conditions and agree to be bound by them
Authorised by:
Name
Position/Title Telephone
Email Date
We will process, manage, control release and record personal information to:
Search credit reference and fraud agencies' records (including information from the electoral register and from
overseas) so we can manage your account with us and make decisions about credit, including whether to make
credit available, or to continue to extend your existing credit (these searches will not be seen or used by other -
lenders to assess your ability to get credit);
access any application for credit or other financial services you, or a member of your household or a business to
which you are a party makes (we will sometimes use a credit scoring or other automatic decision-making system
to do this);
if you are providing information about others, such as a spouse, or a member of this business to which you are a
party, you must have their permission to do so;
manage your accounts and policies, and make decisions on questions about any application, agreements or
correspondence which you may have with us;
carry out, monitor and analyse our business;
contact you (unless you tell us that you prefer not to receive direct marketing) about other products and services
which we consider may interest you;
fight fraud, money-laundering, terrorism and other crimes; and
keep to any laws or regulations in any country.
Please send completed and signed application forms to the following address:
Liberata PbA Support Team
PO Box 3166
Cardiff
CF30 0FH
or
DX 134282
CARDIFF 46
Signed
If you need this application in an alternative format, for example in large print, please contact Liberata PbA
Support Team.
Instruction to your
bank to pay by Direct Debit
Liberata PbA Support Team
PO Box 3166
Cardiff
CF30 0FH
Service user number
6 9 8 15 2
Please fill in the whole form including official use box using a ball
point pen and send it to:
Name(s) of account holder(s)
Bank/building society account number
Branch sort code
Name and full postal address of your bank
To: The Manager Bank
Address
Postcode
Reference - For HM Courts & Tribunals Service Official Use Only
Banks and building societies may not accept Direct Debit Instructions for some types of account
DDI1
FOR HM Courts & Tribunals Service OFFICIAL USE ONLY
This is not part of the instruction to your bank or building society.
Instruction to your bank or building society
Please pay HM Courts & Tribunals Service Direct Debits from the account
detailed in this Instruction subject to the safeguards assured by the Direct
Debit Guarantee. I understand that this Instruction may remain with HM
Courts & Tribunals Service and, if so, details will be passed electronically
to my bank/building society.
Signature(s)
Date
The
Direct Debit
Guarantee
This guarantee should be detached and retained by the payer.
• This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits
• If there are any changes to the amount, date or frequency of your Direct Debit HM Courts & Tribunals Service will notify you
ten working days in advance of your account being debited or as otherwise agreed. If you request HM Courts & Tribunals
Service to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
• If an error is made in the payment of your Direct Debit, by HM Courts & Tribunals Service or your bank or building society,
you are entitled to a full and immediate refund of the amount paid from your bank or building society
- If you receive a refund you are not entitled to, you must pay it back when HM Courts & Tribunals Service asks you to
• You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be
required. Please also notify us.
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Completed 16 August 2020

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