Paperless direct debit form | Southern Cross Pet Insurance

Set up a direct debit

You can pay your pet insurance premium by direct debit. Complete the form below to set up a new, or update an existing direct debit.

Policy details

Policy number

Your full name

Your phone number

Your email address

Bank account details

Name of Bank Account Holder

Bank Account Number

Name of Bank

Name of Branch

Bank Address

City

About Your Payment

When will we apply the changes?
We will apply the changes to your direct debit from the next available due date, if this is less than 5 working days it may defer to the next due date. If your premium is currently overdue, we will provide you with written notice with the amount and date prior to deducting any payments.

How often would you like us to collect your payments? Monthly Monthly Quarterly 6 monthly Annually

Required

If you have other pets insured with us, do you want this change to apply to all of the other pets?

Yes No

I have the authority to set up a direct debit from this bank account

I agree that this authority is subject to the bank's terms and conditions that relate to my account, and the direct debit terms and conditions

Submit

Pay your Southern Cross Pet Insurance premium by direct debit

Set up a direct debit

Policy details

Bank account details

About Your Payment

Need a hand?