This document is a PAD (Pre Authorized Debit) cancellation notice sent from an individual to a payee organization. It cancels the individual's authorization to debit funds from their bank account in the amount of $________, effective immediately. The individual acknowledges that this cancellation does not terminate any other obligations they have with the payee. The individual's signature is required to validate the cancellation notice.

1. PAD (Pre Authorized Debit) CANCELLATION NOTICE
TO: _____________________________________
DATE: ___________________________________
Per the terms set forth by the Canadian Payments Association and Rule H1, I/We,
____________________________________________, cancel my/our authorization to
negotiate (Personal, Business, Funds Transfer or Cash Management) post-dated cheques
in the amount of $_________________ against my/our account number
_____________________________ effective immediately. Please return all un-used post
dated cheques immediately to the address indicated on the face of the cheques. I/We
acknowledge that this cancellation does not terminate any other obligation that I/we may
have with the Payee.
Signed: _________________________ _________________________
Payor/Valid Signing Authority(ies)
Note: Subject to the terms of any agreement between a Payor and Payee including their Payor’s
PAD Agreement, a Cancellation Notice may be provided to a Payee by way of registered mail,
telephone, Internet, e-mail, fax or prepaid courier and must be provided in compliance with the
notice requirements for cancellations, if any, set out in the applicable Payor’s PAD Agreement.