[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Recipient's Name] [Recipient's Address] [City, State, ZIP] Subject: Cancellation of Direct Debit Authorization Dear [Recipient's Name], I am writing this letter to officially cancel the Direct Debit Authorization that I have previously granted to [Company Name] for debiting funds from my bank account. [If applicable, mention any specific details related to the authorization, such as the reference number, account number, or any specific payment arrangement] Due to [explain your reason for cancellation concisely], it is necessary for me to revoke this authorization effectively immediately. I kindly request you to acknowledge and process my cancellation request without any delay. Please ensure that no further debits or charges occur from my bank account after the cancellation date mentioned below. Cancellation Details: — Authorization Reference/Account Number: [insert details] — Name on Bank Account: [insert name— - Bank Name: [insert bank name] — Bank Account Number: [insert bank account number] — Cancellation Effective Date: [insert date] I request you to confirm this cancellation in writing and provide me with an updated written confirmation stating that my direct debit authorization has been canceled. Kindly send this confirmation to my address mentioned above or email it to [insert email address]. I also want to remind you of your obligation to cease all future attempts to debit my bank account. Any failure to comply with this request may result in legal action being taken against [Company Name] to retrieve the wrongfully debited funds. Please confirm the cancellation of the Direct Debit Authorization within [insert a reasonable timeframe, e.g., 14 days] from the receipt of this letter. If I do not receive confirmation within the specified timeframe, I reserve the right to escalate this matter to the appropriate regulatory authorities. I hope for your prompt attention to this matter. Should you require any additional information, please do not hesitate to contact me at the phone number or email address provided above. Thank you for your cooperation. Sincerely, [Your Name]
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.