Third Party Permission Form

Use this form if you want to give permission for us to discuss your account with somebody other than you.

PROCESSING INSTRUCTIONS FOR STAFF

1. ensure that the details match those on the account.
2. send a text to the mobile number on the member account notifying them that a request has been received
3. If a password is provided, enter this into the password field of the member inquiry screen.
4. Place a telegram on the account noting that 12 months authority has been granted to the named person and that data protection questions should include letters from the password.
4. If an account has a third party authority telegram more than 12 months old, a new authority will be required before we can speak to a third party.

If a member wishes to give someone permanent authority to operate an account, Lasting Power of Attorney will be required and this form will not be appropriate.
Your name Your name First Last
Date of Birth Date of Birth / DD / MM YYYY
Member Number
Mobile Phone Number
Email

Confirm Email Address
Authorisation

Give us details of the person or company that you are authorising us to speak with about your account details
The authorised third party is

Let us know if it is an individual such as a friend or relative, or a company such as an advice agency
Person's Name Person's Name First Last
This person is

This person is A family member A friend An advisor Other Other

let us know who this person is.
The password they will tell us

choose a password and give it to the person who will need to use it when they speak to us on your behalf. Do not give it to anyone else.
The company is

The company is Citizens Advice Step Change Payplan IVA provider Other Other
Case reference number
I understand this this authority will last for a maximum of 12 months unless renewed and that it can be cancelled by me or the third party at any time.

I understand this this authority will last for a maximum of 12 months unless renewed and that it can be cancelled by me or the third party at any time.

This is how long you want your permission to last, after which you will need to renew if you still want them to have access to your account. You can contact us to withdraw permission at any time.
I understand that they will be able to discuss any and all details of my account but will not be able to change my details, make money transfers or apply for loans on my behalf.

I understand that they will be able to discuss any and all details of my account but will not be able to change my details, make money transfers or apply for loans on my behalf. I agree
Draw or type your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Third Party Permission Form

Third Party Permission Form

PROCESSING INSTRUCTIONS FOR STAFF

Authorisation