Creditor's ID. Signature. Signature. IBAN. Account number - IBAN. BIC. SWIFT BIC. Type of Payment. Recurrent Payment. Th
SEPA Direct Debit Mandate By signing this mandate form, you authorise (A) Three to send instructions to your bank to debit your account and (B) your bank to debit your account in accordance with the instructions from Three. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Your rights are explained in a statement that you can obtain from your bank. Unique Mandate reference Your Three account number
Three Account Number Name of the debtor(s)
Name Street name and number
Address Postal code
City
Country
Account number - IBAN
IBAN
SWIFT BIC
BIC Name of the creditor
Creditor’s Name
Three Street name and number
Creditor’s Address
3rd Floor, One Clarendon Row Postal code
City
Dublin 2
Dublin
Country
Ireland Creditor’s ID
Creditor’s ID
Type of Payment
IE33ZZZ304503
Recurrent Payment
X
(DDMMYY)
Date
Signature
Signature Note: Your rights regarding the above mandate are explained in a statement that you can obtain from your bank.
