Contact Info | Feedback | Sitemap
Skip Navigation Links
Skip Navigation Links
Forms
Central Provident Fund Board's Form
Direct Debit Authorisation Form
Direct Credit Authorisation Form
Documents for preparing the DOI with Central Provident Fund Board
A letter to Central Provident Fund Board
Central Provident Fund Board's Form
Direct Debit Authorisation Form
1.  Form is required for Central Provident Fund (CPF) Board to deduct funds from medical institution’s account arising from Medisave refunds due to amendment or cancellation of Medisave and/or MediShield Life claims, interest payable and administrative fees for service request or for wrongful deduction.
2. Please DO NOT use correction fluid or correction tape on the form. If you need to make an amendment on the form, please cancel and sign against the change.
3. Please state the name of the debiting bank account under “My/Our Name” on the form and sign as per your bank records.
4. Please complete Part 1 of the form and send it to CPF Board. The Board will send the form to the bank for approval after the hospital code has been assigned by MOH.
 
Signing of Direct Debit Authorisation (DDA) and Direct Credit Authorisation (DCA) forms

When completing the DDA and DCA, please ensure the applicable bank account holders as follows:

Business Type Bank account holder
Sole Proprietor Sole proprietor’s name
Partnership All partners’ names
Limited Liability Partnership Limited Liability Partnership’s name
Limited Liability Partnership Limited Liability Partnership’s name
Company Company's name

For accounts opened in the name of clinics, please provide your bank’s confirmation on the names of the authorised persons who have access to the bank account.

The Board will not accept DDA and DCA forms if the name(s) of Bank Account Holder(s) is not based on the above.

Please complete 2 DDA forms –
i. For the payment of amount payable due to Amendment/Cancellation of claims, monthly interest amount (if any), or any administrative fees; and
ii. For the payment of Administrative Financial Penalty (if any). Deductions will only be made after the medical institution receives a Notice of Penalty and does not submit an appeal or if appeal is rejected. The DDA is applicable for all future penalties unless the medical institution informs the Board of its intention to make payment of the penalty via other payment modes.