Pre-Authorized Payment Cancellation

PRE-AUTHORIZED PAYMENT (PAP) AGREEMENT – CANCELLATION NOTICE

You may at any time cancel your Pre-authorized Payment Agreement to prepay your CRNNL registration fee by
completing this form and submitting it to CRNNL up to 30 days prior to when you want your final debit withdrawal.

To:

College of Registered Nurses of Newfoundland and Labrador

Date of final debit withdrawal:

I,

, cancel my authorization to issue pre-authorized debits against my account
(Your Name)

number

. I acknowledge that this cancellation does not terminate any other obligation

that I/we may have with the College of Registered Nurses of Newfoundland and Labrador.

Signature of Account Holder

Date

CRNNL Registration Number

Please print and sign the completed form and mail or fax it to:
CRNNL Accounting, 55 Military Road, St. John’s, NL A1C 2C5, Fax: 1-709-753-4940