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The Pre Authorized Debit Form is a critical financial document used in the Indonesian banking system to establish automated payment arrangements. It is primarily used when a customer needs to set up recurring payments for services, subscriptions, or regular financial obligations. The document must comply with Bank Indonesia Regulation No. 22/23/PBI/2020 on Payment Systems and related financial regulations. This form captures essential information including account holder details, payment specifications, and authorization parameters, while incorporating necessary consumer protections under Indonesian law. It serves as a legally binding agreement between the account holder, their bank, and the payment beneficiary, enabling automated regular payments while protecting all parties' interests under Indonesian banking regulations.

1. Account Holder Information: Details of the account holder including full legal name, ID number, address, and contact information as required by KYC regulations

2. Bank Account Details: Specific details of the account to be debited, including bank name, branch, account number, and account type

3. Debit Authorization: Clear authorization statement giving permission for automatic debits, including purpose and scope of the authorization

4. Payment Details: Specifics of the payment arrangement including maximum amount, frequency, and start date of the automatic debits

5. Merchant/Payee Information: Details of the receiving party, including company name, registration number, and account information

6. Terms and Conditions: Essential terms governing the pre-authorized debit arrangement, including processing timeframes and customer's rights

7. Cancellation Rights: Clear explanation of how and when the customer can cancel the pre-authorized debit arrangement

8. Declaration: Customer's confirmation of understanding and agreement to the terms

9. Signature Section: Space for customer signature, date, and witness signature if required