Direct Debit Mandate

Pay by Direct Debit

If you pay for your own premium and you wish to pay by direct debit, please complete and submit the relevant form below. Please note that quotes remain unchanged if you choose to pay by Direct Debit.

For payment in Euro, please complete the SEPA Direct Debit Mandate.

For payment in Sterling, please complete the GBP Direct Debit Mandate.

For payment in Swiss Franc, please complete the CHF Direct Debit Mandate.

Allianz Care - resources-member-direct-debit-mandate-form-sepa-direct-debit