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The Pre-Authorized Payment Form is a standardized document used in Indonesia to establish and maintain recurring payment arrangements between parties. It is primarily utilized when regular, automated payments need to be set up for services, subscriptions, or financial obligations. The document complies with Bank Indonesia Regulation No. 22/23/PBI/2020 on Payment Systems and related financial regulations. It contains essential elements including customer identification, bank account details, payment specifications, and authorization provisions. This form is crucial for businesses offering subscription-based services, utility companies, financial institutions, and other organizations requiring regular payment collection. The document serves as both a legal authorization and a record of the payment arrangement, protecting the interests of all parties involved while ensuring compliance with Indonesian banking and consumer protection laws.

1. Bank/Payment Processor Information: Details of the financial institution or payment processor managing the pre-authorized payments

2. Customer Information: Complete details of the customer authorizing the payments, including full name, address, and contact information

3. Bank Account Details: Customer's bank account information from which payments will be deducted

4. Payment Details: Specific information about the payment amount, frequency, and purpose

5. Authorization Statement: Clear statement of authorization from the customer permitting regular debits from their account

6. Terms and Conditions: Essential terms including cancellation rights, processing timeframes, and customer obligations

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

8. Signature and Date: Space for customer signature, date, and witness signature if required