codarts Sil Authorization form SEPA recurrent collection SEPA rotterdam Direct debit instalments SEPA-authorization Name ‘Codarts, Hogeschool voor de Kunsten Address Kruisplein 26 Postal code/City/Country 3012 CC Rotterdam / Netherlands Creditor ID NL88ZZZ411268010000 Reason payment statutory college fee Reference authorization (to be filled in by the administration) By signing this form, you authorize Codarts, Hogeschool voor de Kunsten to send recurrent collection instructions to your bank to debit your account and your bank to debit your account on a recurrent basis in accordance with the instructions from Codarts, Hogeschool voor de Kunsten for the whole duration of your enrolment. 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. Ask your bank for the conditions. Payment college fee (please tick the applicable payment option below) On 1 instalment BB In Ginstaiments (with the firstnstalment the amount will erased by € 24. administration costs) Student number: Student name (full name) Address: =k. w Ck Postal code: 4690 = Sig City: ‘ Country: etugad Dateofbirh:_)8 [05] 200.21. Signature student’ IBAN (no saving account): BIC: Name account holder: Place: Signature account holder*: “By signing this form agree that the caflege fee will be ald by the above mentioned person. also agree with the possible changes of the college fee during the study year. ‘This authorization can only be used for IBAN accounts from countries within SEPA domain.