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Riting, to debit my/our account described in the schedule below, any amounts which Department of State Growth (User ID No 454274) may debit or charge me/us through the Direct Debit System. Registration Number Period of Registration * Scheduled Payment Due Date 6 or 12 months for light vehicles, 3, 6 or 12 months heavy vehicles ( 4.5 tonnes) * This date must be at least 14 days prior to the expiry date of the registration. Direct Debit authority from my bank account Name of Account hold.

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