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Pre-Authorized Payment (PAP) Enrolment Form
I authorize the College of Physicians & Surgeons of Alberta (payee) to debit my account (as identified by the uploaded void cheque) for:
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Annual CPSA Practice Permit fee
Annual Professional Corporation fee
Both of the above fees
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I authorize debit to take place in December each year, for the fee(s) applicable for the following calendar year. I further authorize increases to these amounts, as established by CPSA Council.
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I understand I can cancel this authorization at any time by notifying CPSA in writing. I also understand I am responsible for providing CPSA with a new void cheque if I change my banking information. (see note #1 below)
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1. If this account is closed, it is your responsibility to notify CPSA immediately of alternative arrangements for payment of the annual fee(s).
2. Only Canadian bank accounts are eligible for CPSA’s PAP plan.
3. PAP plan members must still complete and submit the Renewal Information Form (RIF) and, if applicable, any Professional Corporation Information Forms (PCIF).
4. See the complete Pre-Authorized Payment (PAP) Terms and Conditions.
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