Pre-Authorized Debit Extra Withdrawal "*" indicates required fields Reference # -2024-08-22-Unit #-SM-PAD-Extra WithdrawalDisclosure This form is intended to be used to authorize additional/extra pre-authorized debit withdrawals (e.g. special levy payments). The form can only be used if you are currently taking advantage of the monthly pre-authorized debit (PAD) program. If you wish to register for the Pre-Authorized Debit program, you must complete the “Pre-Authorized Debit Agreement”. The form must be received by Korecki Real Estate Services Inc., by no later than the 20th of the month prior to the month it is to commence. (e.g. to be on the PAD plan for the month of July the form must be received by June 20th).Building/Unit InformationStrata Plan #*Strata Lot #Unit #*Building NameBuilding Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Registered Owner(s) InformationOwners Name(s)*Home Phone*Cell PhoneWork PhoneEmail* Payment DetailsThis option is only available to owners currently taking advantage of the monthly pre-authorized debit (PAD) program. Please submit your PAD forms first if you have not yet done so.What type of a payment are you looking to make?*Monthly Reoccurring PaymentOne Time PaymentAcknowledgements A) I/We area currently taking part in Haven Properties Inc. PAD program for the payment of our monthly strata fees on behalf of our Strata Corporation. I/We hereby authorize Haven Properties Inc. on behalf of our Strata Corporation to debit my/our account on a one time and/or monthly basis effective from the payment/start date to the end date noted below, for the total one time and/or monthly payments as listed above due by the undersigned to the Strata Corporation. B) I/We guarantee that all persons whose signatures are required to sign on this account have signed the agreement. C) I/We waive any and all requirements for pre-notification of debiting, including, without limitation, pre-notification of any change in the amount of the PAD due to a change in any applicable rate, topup, or adjustment. I/We acknowledge that any maintenance fee increase will be retroactive to the start of the Strata Corporation’s fiscal year. D) I/We acknowledge that provisions and delivery of this authorization to Haven Properties Inc. constitutes delivery by me/us to the aforementioned financial institution. E) I/We undertake to inform Haven Properties Inc. in writing, of any changes in the account information provided in this authorization ten (10) days prior to the next due date of the debit. F) I/We acknowledge that Haven Properties Inc., has the right to charge me/us a fee in the event that the debit is not cleared from my/our financial institution. G) I/We acknowledge that that this authorization may be cancelled at any time upon delivery of written notice to Haven Properties Inc. H) I/We acknowledge that charges will be reimbursed subject to notification by me/us to the branch of account with 90 days under and of the following conditions: a. the PAD was not drawn in accordance with this Authorization b. this authorization was revoked c. the debit was posted to the wrong account due to invalid/incorrect information supplied by Haven Properties Inc. I) I/We acknowledge that revocation of this Authorization does not terminate any contract for goods or services that exists between me/us and Haven Properties. This Authorization applies only to the method of payment and does not otherwise have any bearing on the contract for goods or services exchanged. J) I/We acknowledge that I/we understand that I/we are participating in a PAD plan established by Haven Properties Inc., and I/we accept participation in the PAD plan upon the terms and conditions set out herein. K) I/we understand and acknowledge that the contact information provided as part of this form will be used for convenience of communication only, and that the strata corporations’ records will not be updated with the said contact information. Should I/we wish to update my/our contact information with the strata corporation, I/we acknowledge and understand that such information must be provided via a change of address and contact details form.Date* MM slash DD slash YYYY Date* MM slash DD slash YYYY Signature